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VOL. 11, ISSUE 1 (2026)
Ethambutol-induced optic neuropathy in a patient with pulmonary tuberculosis: The need for early ophthalmic surveillance
Authors
Dr. Anjana Venugopal, Dr. Vignesh T M, Dr. Sudhakar N A, Dr. Preethiraj Ballal, Dr. Anirudha K
Abstract
Ethambutol is a first-line antitubercular drug
widely used under the National Tuberculosis Elimination Programme (NTEP).
Although considered relatively safe at recommended doses, ethambutol-induced
optic neuropathy (EON) remains a potentially reversible but vision-threatening
adverse effect. We report a 50-year-old female with drug-sensitive pulmonary
tuberculosis who developed sudden, painless diminution of vision in the right
eye after two months of intensive phase therapy (HRZE regimen). Ophthalmic evaluation
revealed reduced visual acuity, color vision defect, central scotoma on visual
field analysis, and retinal nerve fibre layer changes suggestive of toxic optic
neuropathy. Ethambutol was discontinued immediately and modified antitubercular
therapy was initiated in consultation with pulmonology. The patient received
systemic corticosteroids with partial visual recovery noted on follow-up.
Subsequently, after loss to follow-up, she developed similar involvement in the
fellow eye, confirming bilateral ethambutol-induced toxic optic neuropathy.
This case underscores the importance of baseline and periodic ophthalmic
screening in patients receiving ethambutol, especially in high-burden
tuberculosis settings such as India.
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Pages:41-43
How to cite this article:
Dr. Anjana Venugopal, Dr. Vignesh T M, Dr. Sudhakar N A, Dr. Preethiraj Ballal, Dr. Anirudha K "Ethambutol-induced optic neuropathy in a patient with pulmonary tuberculosis: The need for early ophthalmic surveillance". International Journal of Medicine Research, Vol 11, Issue 1, 2026, Pages 41-43
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