Ethambutol Optic Neuropathy

Paul D. Chamberlain; Ama Sadaka; Shauna Berry; Andrew G. Lee


Curr Opin Ophthalmol. 2017;28(6):545-551. 

In This Article

Screening for Clinical Ethambutol-induced Optic Neuropathy

Primary prevention of EON is the best treatment. This includes regular screening for visual changes. Patients started on ethambutol should be appropriately educated about the possibility of visual loss and the need for screening and follow-up with an ophthalmologist, as well as the need to seek care immediately if they notice any visual disturbances. Baseline examination immediately prior to or at the time of ethambutol treatment initiation should include visual acuity, formal visual field testing, color vision testing, and dilated fundus examination. Follow-up screening should be done on a monthly basis in high-risk patients (preferably by an eye care specialist) and testing should include at least visual acuity check and Amsler grid testing. Patients could be given an Amsler grid or pocket Snellen chart for use at home to test their own vision in between visits to the eye care provider. Whenever vision changes are detected by the patient or eye care provider, however, the primary prescribing physician should be contacted regarding the decision to continue or discontinue ethambutol. A temporary suspension of treatment can be considered based upon the risk–benefit ratio and consultation with the prescribing physician until the diagnostic evaluation of the visual loss can be completed.