Acute methanol poisoning is still complicated by a poor vital or visual prognosis. The pathophysiology of methanol poisoning is not yet fully understood. It appears that the major toxic effects are related to the main metabolite of methanol, formic acid. The central nervous system and the visual pathway are the main targets of methanol poisoning. When irreversible brain lesions occur, the diagnosis of brain death can be made. Other organs, like the pancreas or the kidney, may also be damaged according to the severity of metabolic acidosis; however, the toxic manifestations are in this case mostly reversible. The historical treatment of methanol poisoning relies on ethanol administration. However, ethanol therapy has numerous side effects and a new antidote, fomepizole, that was previously approved for the treatment of ethylene glycol poisoning, appears effective, safe and easy to use. Hemodialysis remains effective for the removal of both methanol and formic acid.