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Drug-induced optic neuropathy-TB or not TB
Monika Pradhan1, Dianne Sharp, Stephen Best
1Department of Ophthalmology, National Eye Centre, University of Auckland, Auckland, New Zealand.
Survey of Ophthalmology
|January 20, 2010
Summary
Autosomal dominant optic atrophy (ADOA) can be worsened by ethambutol, a tuberculosis drug. Early diagnosis of ADOA is crucial, especially when vision loss occurs despite drug cessation.
Area of Science:
- Ophthalmology
- Genetics
- Pharmacology
Background:
- Autosomal dominant optic atrophy (ADOA) is an inherited optic neuropathy with variable presentation.
- Ethambutol, used for tuberculosis, can cause optic neuropathy.
Observation:
- A patient presented with atypical, progressive vision loss after ethambutol therapy, even after cessation.
- The patient's sons showed milder visual disturbances and color vision defects.
Findings:
- The proband and his sons were diagnosed with Autosomal Dominant Optic Atrophy (ADOA).
- Genetic analysis confirmed an OPA1 gene mutation.
- Electrophysiology supported the diagnosis of optic neuropathy.
Implications:
- This case highlights the potential for ethambutol toxicity to unmask or exacerbate underlying genetic optic neuropathies like ADOA.
- Avoiding neurotoxic drugs in genetically predisposed individuals is critical.
- Environmental factors significantly influence the expression of inherited optic neuropathies.
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