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Updated: Jun 25, 2026

Primed Mycobacterial Uveitis (PMU) as a Model for Post-Infectious Uveitis
Published on: December 17, 2021
Risk factors for ethambutol optic toxicity
Katherine Anne Talbert Estlin1, Alfredo A Sadun
1Doheny Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA. kestlin@gmail.com
Context:
Optic neuropathy is a well-known complication of ethambutol therapy and usually manifests as a decrease in visual acuity, cecocentral scotomas, and deficits in color vision.
Objective:
To support or disprove the hypothesis that a significant majority of patients who develop ocular toxicity while undergoing treatment for a mycobacterium infection do so after experiencing either a prolonged course or unusually high serum levels of ethambutol.
Design:
Retrospective chart review (16 cases) and literature meta-analysis (54 cases).
Results:
Many cases lacked important data, but none countered the hypothesis. Age, duration of ethambutol, and dose of ethambutol were positively correlated with risk of toxicity.
Conclusions:
Given an understanding of the risk factors for ethambutol optic toxicity, there exists a rationale for an optimization of ethambutol dosing protocols that can maximize the therapeutic effect while minimizing the incidence of optic toxicity.
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