Tobacco-alcohol amblyopia or toxic-nutritional optic neuropathy is a condition characterised by papillomacular bundle damage, central or caecocentral scotoma, and reduction of colour vision in a patient who abuses tobacco and alcohol.^1,2 There is consensus that nutritional deficiency has an important role as well.^3,4 The appearance of the optic nerve is usually normal, but peripapillary dilated vessels and haemorrhages have been described.^5,6 Testing with static perimetry often reveals central scotomas. Although this syndrome has been classified as optic neuropathy, the primary lesion has not actually been localised to the optic nerve and may possibly originate in the retina, chiasm, or even the optic tracts. We report two cases of tobacco-alcohol amblyopia and their electrophysiological findings after testing with multifocal electroretinography (MERG).

Case reports

Case 1

A 47 year old woman presented with gradual decrease in vision over 4 months. Her medical history showed that she has been in excellent health. She smoked one pack of cigarettes per week and had two to three beers daily. She denied any use of any medications in the past few months. She and her husband have been …