The risk of optic neuropathy from the important antibacterial drug, ethambutol: What role should the nurse play ?

Abstract

Ethambutol is an important drug currently used in the treatment of tuberculosis (TB) and non-tuberculosis mycobacterial (NTM). However, use of ethambutol occasionally results in central vision loss and compromised color vision, known as ethambutol-induced optic neuropathy. This effect may occur during treatment or even after drug discontinuation. Screening for early detection of the disease and immediate discontinuation of medication is a crucial strategy. However, due to its low incidence, screening with special ophthalmic devices and examination by an ophthalmologist in every patient taking ethambutol is neither practical nor cost-effective. Generally, patients are referred to an ophthalmologist only after experiencing visual symptoms, while some patients remain unaware until severe visual loss occurs. The mainstay treatment is immediate drug cessation. After withdrawal, a small number of patients may gradually regain vision, while most suffer from permanent visual loss, significantly affecting their quality of life. Therefore, continuous monitoring and appropriate counseling of patients taking ethambutol are important in reducing the risk of developing this disease.

This article emphasizes the role of frontline nurses in preventing vision-threatening complications that can lead to disability, including early detection and appropriate management of ethambutol-induced optic neuropathy. The discussion is based on experiential lessons of the author in real-world practice, the phenomenon described by the owner of the experience. Furthermore, it encourages future research to establish preventive strategies to reduce the risk of irreversible blindness.