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This case report aims to discuss a case of tobacco-alcohol optic neuropathy secondary to alcohol abuse and chronic cigarette smoking in a 43-year-old man. Possible causes including vitamin B12 deficiency, methanol poisoning, and cyanide in tobacco were discussed. Clinical examination and blood investigation supported the diagnosis of vitamin B12 deficiency, possibly precipitated by methanol and cyanide. The patient was treated with vitamin B12 and folinic acid and asked to abstain from smoking and alcohol consumption. His left eye vision had improved to premorbid vision but there no improvement on the right eye. As a conclusion, tobacco-alcohol optic neuropathy is a diagnosis of exclusion and treatment shows variable response.