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[10] Diagnosis Toxic optic neuropathy is a diagnosis of exclusion, with patients typically presenting with [1] [2] : A history of drug, medications, or alcohol use Painless, bilateral, and symmetric vision loss Progressive loss of visual acuity that usually starts with a blur at the point of fixation Dyschromatopsia Central or cecocentral scotoma with preservation of the peripheral fields Papillomacular bundle loss History A detailed medical history is significant in elucidating toxic neuropathy and establishing the diagnosis