A 29-year-old man was brought to the hospital for treatment after an alleged workplace accident. Initial assessment revealed only mild chest injury and mild confusion, with no other injury. His vision was unaffected with no relative afferent pupillary defect. A computed tomography scan of the brain, performed to rule out brain injury, revealed an incidental finding of a foreign body in the left intravitreal cavity with no other significant findings. Further examination of his medical history revealed that he had experienced a trauma one year earlier, in which his left eye was pierced by a projectile. Immediately post-trauma, his vision had been reduced significantly, but improved over the next few weeks without medical treatment. The current examination of his left eye revealed a small hyperpigmented area on the sclera, representing the point of entry of his previous wound. An encapsulated foreign body was observed in the inferior intravitreal cavity, surrounded by retinal atrophy, and a normal posterior pole. He was managed conservatively without complications. The decision to remove a missed retained intraocular foreign body is complex and depends on multiple factors, including surgical difficulty and the composition, size, and location of the retained foreign body. Removal should be weighed against the possible serious complications of intraocular surgery. If removal is surgically difficult, or the retained material is inert, patients can be managed conservatively with regular monitoring.

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.