Ethambutol-Induced Visual Disturbance: A Case Report Emphasizing Early Recognition and Management
Abstract
Ethambutol is a key component of first-line antitubercular therapy due to its bacteriostatic activity
against Mycobacterium tuberculosis. However, it
carries a well-recognized risk of optic neuropathy,
which, if not promptly identified, may result in
permanent visual impairment. Ethambutol-induced
optic neuropathy (EON) is typically dose- and
duration-dependent, but cases may also occur at
standard dosages in the absence of classical risk
factors.
We present the case of a 47-year-old male undergoing
standard anti-tubercular treatment who developed
progressive bilateral visual disturbances—central
scotomas, night blindness, and photophobia—
approximately six weeks after initiating therapy. He
was receiving ethambutol at a dose of 800 mg/day
(approximately 15 mg/kg/day). Clinical suspicion of
EON led to immediate discontinuation of ethambutol
and substitution with levofloxacin. Causality was
assessed as “probable” using both the WHO-UMC
system and Naranjo’s scale. Although formal
ophthalmologic evaluation and follow-up were
limited, the temporal relationship, clinical
presentation, and dose-response supported the
diagnosis.
This case underscores the need for heightened
clinical vigilance, routine visual monitoring, and
patient education—even in cases adhering to
standard treatment guidelines. Given the irreversible
nature of delayed-detected EON, baseline and
periodic ophthalmologic assessments should be
integrated into tuberculosis treatment protocols to
facilitate early…
How strong is the evidence?
Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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