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Ethambutol-related Impaired Visual Function in Childrens Less than 5 Years of Age Treated for a Mycobacterial Infection: Diagnosis and Evolution

Levy, Michael MD*; Rigaudière, Florence MD, PhD; de Lauzanne, Agathe MD*; Koehl, Bérengère MD*; Melki, Isabelle MD*; Lorrot, Mathie MD, PhD*‡; Faye, Albert MD, PhD*‡

The Pediatric Infectious Disease Journal: April 2015 - Volume 34 - Issue 4 - p 346–350
doi: 10.1097/INF.0000000000000589
Original Studies

Background: The effects of ethambutol (EMB) on vision are particularly difficult to detect in children less than 5 years of age because of a lack of complaints and objective clinical signs. The aim of this study was to assess the frequency of visual abnormalities and the utility of visual-evoked potentials (VEPs) recordings in monitoring the visual function of children less than 5 years of age who were exposed to EMB during anti-mycobacterial treatment.

Methods: We performed a retrospective study in Robert-Debré University Hospital, Paris, France, including all children less than 5 years of age, who were treated with EMB for a mycobacterial infection from January 2002 to December 2012.

Results: Fourteen patients were enrolled, including 12 treated for Mycobacterium tuberculosis infection. The sex ratio was 1:1. The median age was 1.65 years (0.3 to 4.7). Five patients had subarachnoid involvement. The median EMB dose was 22 mg/kg/day (15 to 27). Only 11 patients were monitored using VEPs. Three children (27.3%) developed a visual impairment secondary to EMB, with delays of 4, 7 and 36 weeks. One of the 3 patients developed an impairment of the retrochiasmatic visual pathways, and 2 other patients developed classical retrobulbar optic neuritis. In all cases, the discontinuation of EMB resulted in a normalization of these findings.

Conclusion: Alterations in visual function related to the use of EMB are not uncommon in young children and are most likely underestimated. Systematic close monitoring using VEPs recordings is needed in young children treated with EMB.

Supplemental Digital Content is available in the text.

From the *Assistance publique, Hôpitaux de Paris, Hôpital Robert Debré, Service de Pédiatrie Générale, F-75019 Paris, France; Assistance publique, Hôpitaux de Paris, Hôpital Lariboisière, Service de Physiologie clinique et d’Explorations Fonctionnelles Visuelles, F-75010 Paris, France; and Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, F-75010, Paris, France.

Accepted for publication October 01, 2014.

The authors have no conflicts of interest or funding to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Address for correspondence: Michael Levy, MD, Pediatric Department, CHU Robert Debré, APHP, 48 Boulevard Sérurier 75019 Paris, France.

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