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Toxic/Nutritional Optic Neuropathy Follow-up

  • Author: Andrew A Dahl, MD, FACS; Chief Editor: Hampton Roy, Sr, MD  more...
Updated: May 09, 2016

Further Outpatient Care

Patients with toxic/nutritional optic neuropathy should be observed initially every 4-6 weeks and then, depending on their recovery, every 6-12 months. At each visit, the patient's visual acuity, color vision, visual fields, pupils, and optic nerves should be assessed. Optical coherence tomography may be used to quantify nerve fiber layer or ganglion cell structure.


Inpatient & Outpatient Medications

See Medication.



Patients in whom ethambutol or isoniazid is indicated for tuberculosis need to have a baseline ophthalmologic examination before treatment is instituted and should be monitored by their ophthalmologist periodically as long as they are on the drug to detect any optic nerve toxicity as soon as possible. Patients should also be made aware of the potential ocular adverse effects of these drugs and should be encouraged to seek medical attention as soon as visual symptoms become apparent.

Any patient for which amiodarone is being considered for treatment requires a baseline ophthalmic examination before the drug is initiated. Furthermore, once on the drug, patients should be evaluated at least every 6 months. Even if a patient presents with corneal changes associated with the drug, their decreased vision should never be attributed to this until any pathology of the optic nerve has been excluded.

Patients should seek assistance from their primary physician on methods to stop or reduce their smoking and/or alcohol intake.



No complications are associated with the aforementioned therapy. The only complication of not seeking or complying with therapy is profound bilateral visual loss but never total blindness.



If patients with nutritional optic neuropathy are compliant with the treatment regimen, and unless the loss of vision is already far advanced, the prospect for recovery or at least improvement is excellent, except for the most chronic cases. However, the rate of recovery varies from a few weeks to several months. The prognosis is also better if treatment is initiated in the first few months after the onset of symptoms. Visual acuity tends to recover before color vision. When recovery has been complete, recurrences are unusual. Although extremely rare, cases of spontaneous improvement of vision have been reported without patient cooperation.

For toxic optic neuropathies, when the responsible toxin is discontinued, vision usually recovers to normal over several days to weeks. However, this does depend in large part on the nature of the offending agent and on its total exposure before it was removed.


Patient Education

Patients must be alerted to report any visual problems to their ophthalmologist immediately if they are taking ethambutol, isoniazid, or amiodarone.

Contributor Information and Disclosures

Andrew A Dahl, MD, FACS Assistant Professor of Surgery (Ophthalmology), New York College of Medicine (NYCOM); Director of Residency Ophthalmology Training, The Institute for Family Health and Mid-Hudson Family Practice Residency Program; Staff Ophthalmologist, Telluride Medical Center

Andrew A Dahl, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Intraocular Lens Society, American Medical Association, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Medical Society of the State of New York, New York State Ophthalmological Society, Outpatient Ophthalmic Surgery Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Andrew W Lawton, MD Neuro-Ophthalmology, Ochsner Health Services

Andrew W Lawton, MD is a member of the following medical societies: American Academy of Ophthalmology, Arkansas Medical Society, Southern Medical Association

Disclosure: Nothing to disclose.


Robert C Sergott, MD Professor of Ophthalmology, Department of Ophthalmology, Thomas Jefferson University; Consulting Surgeon, Wills Eye Hospital, Children's Hospital of Philadelphia

Disclosure: Nothing to disclose.

Brian R Younge, MD Professor of Ophthalmology, Mayo Clinic School of Medicine

Brian R Younge, MD is a member of the following medical societies: American Medical Association, American Ophthalmological Society, and North American Neuro-Ophthalmology Society

Disclosure: Nothing to disclose.

Aftab Zafar, MD Consulting Staff, Department of Ophthalmology, St Mary's General Hospital

Aftab Zafar, MD is a member of the following medical societies: Canadian Medical Association, Canadian Ophthalmological Society, College of Physicians and Surgeons of Ontario, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

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