![]() ![]() ![]() Treatment with folate antagonists (such as methotrexate and trimethoprim sulfa).Ĭopper deficiency is usually caused by gastric surgery and its resultant malabsorption syndromes, GI disease, total parenteral nutrition, and enteral feeding, and rarely it may be secondary to acquired dietary deficiency. If an obvious visual field defect is not shown on routine 30-2 perimetry, central 10-2 perimetry will demonstrate central or cecocentral scotomas. This would eventually lead to the diffuse pallor of the optic disc. Continued exposure to a toxic substance or nutrient deficiency would cause the slow appearance of bilateral temporal optic disc pallor due to the injury of ganglion cell axons, specifically in the papillomacular nerve fiber bundle. Specifically, exposure to drugs, alcohol and tobacco use, dietary intake, and occupational background should be investigated in any patient presenting with bilateral symmetric slow visual loss.Įarly in the disease, optic nerves usually appear normal or, on occasion, slightly hyperemic. In most cases, vision loss progresses over months rather than days to weeks, and vision decreases slowly. A thorough history is crucial to making a diagnosis. Toxic and nutritional optic neuropathies both present clinically with symmetric progressive bilateral vision loss, decreased color vision, central or cecocentral scotomas on formal visual field testing, and no relative afferent pupillary defect because of the symmetric nature of optic nerve involvement. ![]()
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