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Optic neuropathy may be multi factorial in origin. It’s association with gutka use in South East Asia is most likely under diagnosed and often overlooked, considering it is a diagnosis of exclusion. The Optic nerve toxicity is well known occurring due to medications, metals, organic solvents, methanol, and carbon dioxide.1 Over recent years the effect of smokeless tobacco has been highlighted as one of the common causes of toxic optic neuropathy (TON), as visual impairment is already a colossal global health issue. Nonetheless,as high as 80 percent of the total burden of cases of blindness globally are due to causes that are actually preventable as per the World Health Organization (WHO). Various forms of tobacco have been used traditionally across cultures. A distinct form of chewable tobacco is gutka commonly used in South East Asia ,it is as an amalgam with additional areca or betel nuts, slaked lime, and spices.2 Out of 303 million smokeless tobacco users, 248 million (81%) live in south east Asia. In this region 24% men and 11% women use smokeless tobacco.3 However, in the age of global connectivity and escalating immigrant settlements gutka use is now a reason for public health concern in western countries as well.

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