[Bilateral visual deterioration in excessive tobacco and alcohol consumption].

A 33-year-old patient with a history of excessive alcohol and tobacco abuse for years presented with bilateral painless deterioration of vision in the last 3 months. Examination revealed the initial phase of bilateral optic nerve atrophy. In cases like this a purely clinical discrimination between Leber's hereditary optic neuropathy (LHON) and tobacco-alcohol neuropathy can be very challenging. In this case LHON could be confirmed by genetic analysis. Visual and neurological outcomes differ for different mutations. Therapy with idebenone, a derivate of coenzyme Q, seems to be promising at least in selected patient groups.