Walsh & Hoyt: Toxic Optic Neuropathies

The primary issue in patients suspected of having a toxic optic neuropathy is whether or not they were exposed to a substance that has been proved to damage the optic nerve by the same route of exposure. Visual loss may occur from either acute or chronic intoxication depending upon the agent, but there should not be a long interval between the cessation of the exposure and the onset of symptoms. The patient must have symptoms and signs that are compatible with a toxic optic neuropathy and typical of those in other patients proved to have suffered loss of vision from the same agent. Of course, the symptoms cannot have preceded the exposure.