Abstract
This article presents a case of ethambutol toxic optic neuropathy determined during the routine optometric examination of a 66-year-old man. Ethambutol is an established drug for the treatment of tuberculosis, but has significant side effects, notably optic neuropathy. The prognosis for vision restoration is unpredictable, with the possibility of permanent vision loss. Treatment cessation is the only option to limit ocular damage; therefore, the early recognition of ethambutol optic neuropathy by optometrists is essential.
Highlights
The global incidence of tuberculosis (TB) appears to be slowly decreasing,[1] the World Health Organization (WHO) regards the disease as a major global health problem.[2]
The improvement in treatment and the eradication of the disease have been hindered by the high prevalence of the human immunodeficiency virus (HIV), persisting global poverty and the emergence of highly drug-resistant forms of TB.[1]
There has been a reduction in the incidence of TB infections until the 1980s when the advent of HIV and acquired immunodeficiency disease syndrome (AIDS) saw a resurgence in TB infections, especially in the immunocompromised.[4]
Summary
The global incidence of tuberculosis (TB) appears to be slowly decreasing,[1] the World Health Organization (WHO) regards the disease as a major global health problem.[2]. Mr T, a Caucasian male, aged 66, presented to the private practice he routinely attends on 08 June 2017, complaining of decreased vision at distance and near over the preceding 6 weeks His current (progressive addition) spectacles, provided by this practice, were 11 months old and he reported no visual difficulties with them up until 6 weeks prior. He had been diagnosed with extrapulmonary TB (hip) in January 2017 and placed on Rifafour, a combination of four anti-TB medications (rifampicin, isoniazid, pyrazinamide and ethambutol). Frequent causes of optic neuropathies include viral and bacterial causes, ischaemic optic neuropathies, demyelinating diseases, compressive or Source: Photograph by K.C.P. using Canon CR-DGi non-mydriatic fundus camera FIGURE 1: Right eye fundus photograph of patient with ethambutol toxic optic neuropathy. Infiltrative optic neuropathies, Leber’s hereditary optic neuropathy and toxic and deficiency optic neuropathies.[12]
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