Methanol Intoxication Presenting With Bilateral Optic Neuritis and Paracentral Acute Middle Maculopathy

A 52-year-old male presented nine days following accidental methanol ingestion with a drop of vision in both eyes. A complete ophthalmic assessment was performed, with a referral to a neurologist for multidisciplinary management. On ophthalmological evaluation, visual acuity was hand motion (HM) bilaterally with swollen optic discs. Macular optical coherence tomography (OCT) showed a picture consistent with paracentral acute middle maculopathy (PAMM) in both eyes, and brain magnetic resonance imaging showed ischemic insults. Slight visual improvement was detected following steroid and antiplatelet therapy. At two months of follow-up, bilateral optic atrophy ensued. Special attention must be given to the macular assessment and not just the optic nerve when considering a case of methanol toxicity, as methanol intoxication can lead to ischemic manifestations.