Walsh & Hoyt: Toxic and Deficiency Optic Neuropathies: Evaluation

In most cases, analysis of the symptoms and signs obtained from a detailed history and physical examination will establish the diagnosis of a toxic or nutritional optic neuropathy. As stated above, it is prudent to obtain neuroimaging unless one is absolutely confident of the diagnosis. MR imaging before and after intravenous injection of gadolinium-diethylenetriamine-pentaacetic acid (gadolinium-DTPA) with special attention to the optic nerves and optic chiasm, is the optimum investigation in most cases. A vitamin B12 level should be determined to identify pernicious anemia, and red blood cell folate levels provide one marker of general nutritional status.