Management of DR-TB ADR: Optic Neuritis

In optic neuritis, the patient may present with vision loss, peri-ocular pain and dyschromatopsia (a disorder of colour vision). This is a rare but serious Adverse Drug Reaction (ADR) caused by certain anti-TB medications.

Mild forms of this ADR present with episodes of disturbed or blackened rather than blurry vision, reduced night vision, photophobia and red eyes. Serious cases may present with loss of coloured vision and may also progress to demyelinating optic neuritis.

Patients will often report visual disturbances to field level health workers, who should immediately refer such cases to the nearest higher health centres - District/ Nodal DR-TB Centre (N/DDR-TBC)/ sub-district or district hospital, medical college hospitals, etc.

Suspected Agent(s)

• Ethambutol (E)
• Linezolid (Lzd)
• Ethionamide (Eto)
• Clofazimine (Cfz)
• Isoniazid (H)
• Streptomycin (S)

Suggested Management Strategies

• Stop E and Lzd. Do not restart.
• Refer the patient to an ophthalmologist.

Points to Note

• The most common drugs that cause optic neuritis are E and Lzd.
• The condition usually reverses with the cessation of the drugs.
• Improve diabetes control in diabetic patients.

Resources

• Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, March 2021.

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