Methanol Induced Optic Neuropathy: An Unusual Case With the Absence of Classic Symptoms

Methanol toxicity is an emergency that doctors come across all around the globe, requiring immediate treatment or it can cause life-threatening conditions affecting the central nervous system, causing toxic optic neuropathy and metabolic acidosis. We present a case of an 18-year-old boy, who presented in the medicine emergency with sudden bilateral visual loss and vomiting. He did not have any significant past medical history and all of his examinations were normal except bilaterally dilated pupils and the fundus examination showing bilateral optic disc pallor and cup to disc (C/D) ratio 0.5 and his visual acuity was no perception of light (NPL). He was admitted and treated conservatively with high-dose steroids and ethanol. Later on, a diagnosis of methanol toxicity was made based on toxicology report and imaging studies. His ABGs remained normal throughout and his vision improved to hand movement (HM) over the course of 2 weeks. Methanol toxicity can vary in presentation and could lead to toxic optic neuropathy causing sudden total visual loss. It usually occurs as an outbreak so cases like these should be reported to have a general awareness about it; aiding in early detection, timely management and better public health strategies.