J Korean Ophthalmol Soc.  2015 Dec;56(12):1997-2003. 10.3341/jkos.2015.56.12.1997.

Bitemporal Hemianopsia in Ethambutol-Induced Optic Neuropathy

• Lee HJ
• Rhiu S
• Lee SH
• Jeong JH

• KMID: 2148768
• DOI: http://doi.org/10.3341/jkos.2015.56.12.1997

Abstract

PURPOSE
To report three cases with bitemporal hemianopsia after using ethambutol to treat tuberculosis.
CASE SUMMARY
A 50-year-old male with chronic renal failure and tuberculous pleurisy, a 57-year-old male with diabetic retinopathy and pulmonary tuberculosis, and a 59-year-old male with diabetes and pulmonary tuberculosis were referred for evaluation due to decreased visual acuity for several months after taking ethambutol to treat tuberculosis. All 3 patients had abnormal color vision and visual evoked potential in both eyes. Visual field showed bitemporal hemianopsia with or without central scotoma. Brain imaging tests were normal. Although ethambutol was discontinued in all three patients, one patient with renal disease showed further decrease in visual acuity and visual field worsened to total field defect.
CONCLUSIONS
Ethambutol-induced optic neuropathy is a wide spectrum disorder and based on our cases, can present as bitemporal hemianopsia mimicking compressive chiasmal lesions. A thorough history should be taken and immediate discontinuation of ethambutol is recommended in cases when bitemporal hemianopia occurs.

Keyword

Bitemporal hemianopsia; Ethambutol; Optic chiasm; Optic neuropathy; Tuberculosis

MeSH Terms

Color Vision
Diabetic Retinopathy
Ethambutol
Evoked Potentials, Visual
Hemianopsia*
Humans
Kidney Failure, Chronic
Male
Middle Aged
Neuroimaging
Optic Chiasm
Optic Nerve Diseases*
Scotoma
Tuberculosis
Tuberculosis, Pleural
Tuberculosis, Pulmonary
Visual Acuity
Visual Fields
Ethambutol