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Ethambutol optic neuropathy

Chamberlain, Paul, D.a; Sadaka, Amab; Berry, Shaunab; Lee, Andrew, G.a,b,c,d,e

Current Opinion in Ophthalmology: November 2017 - Volume 28 - Issue 6 - p 545–551
doi: 10.1097/ICU.0000000000000416
NEURO-OPHTHALMOLOGY: Edited by Dean M. Cestari

Purpose of review We provide a summary of the epidemiology, clinical findings, management and outcomes of ethambutol-induced optic neuropathy (EON). Ethambutol-induced optic neuropathy is a well-known, potentially irreversible, blinding but largely preventable disease. Clinicians should be aware of the importance of patient and physician education as well as timely and appropriate screening.

Recent findings Two of the largest epidemiologic studies investigating EON to date showed the prevalence of EON in all patients taking ethambutol to be between 0.7 and 1.29%, a value consistent with previous reports of patients taking the doses recommended by the World Health Organization (WHO). Several studies evaluated the utility of optical coherence tomography (OCT) in screening for EON. These showed decreased retinal nerve fiber layer (RNFL) thickness in patients with clinically significant EON, but mixed results in their ability to detect such changes in patients taking ethambutol without visual symptoms.

Summary Ethambutol-induced optic neuropathy is a well-known and devastating complication of ethambutol therapy. It may occur in approximately 1% of patients taking ethambutol at the WHO recommended doses, though the risk increases substantially with increased dose. All patients on ethambutol should receive regular screening by an ophthalmologist including formal visual field testing. Visual evoked potentials and OCT may be helpful for EON screening, but more research is needed to clarify their clinical usefulness. Patients who develop signs or symptoms of EON should be referred to the ethambutol-prescribing physician immediately for discontinuation or a reduction in ethambutol dosing.

aBaylor College of Medicine

bDepartment of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital

cDepartments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine

dDepartment of Ophthalmology, UTMB, Galveston, University of Iowa Hospitals and Clinics, Texas A and M College of Medicine

eUniversity of Texas M.D. Anderson Cancer Center, Houston, Texas, USA

Correspondence to Andrew G. Lee, MD, Department of Ophthalmology, Houston Methodist Hospital, 6560 Fannin Street, Scurlock 450, Houston, TX 77030, USA. Tel: +1 713 441 8823; fax: +1 713 793 1636; e-mail:

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