Toxic/Nutritional Optic Neuropathy Follow-up

  • Author: Aftab Zafar, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Dec 5, 2011
 

Further Outpatient Care

  • Patients with toxic/nutritional optic neuropathy should be observed initially every 4-6 weeks and then, depending on their recovery, every 6-12 months. At each visit, the patient's visual acuity, color vision, visual fields, pupils, and optic nerves should be assessed.
Next

Inpatient & Outpatient Medications

  • See Medication.
Previous
Next

Deterrence/Prevention

  • Patients in whom ethambutol or isoniazid is indicated need to have a baseline ophthalmologic examination before treatment is instituted and should be monitored by their ophthalmologist periodically as long as they are on the drug to detect any optic nerve toxicity as soon as possible. Patients should also be made aware of the potential ocular adverse effects of these drugs and should be encouraged to seek medical attention as soon as visual symptoms become apparent.
  • Any patient for which amiodarone is being considered for treatment requires a baseline ophthalmic examination before the drug is initiated. Furthermore, once on the drug, patients should be evaluated at least every 6 months. Even if a patient presents with corneal changes associated with the drug, their decreased vision should never be attributed to this until any pathology of the optic nerve has been excluded.
  • Patients should seek assistance from their primary physician on methods to stop or reduce their smoking and/or alcohol intake.
Previous
Next

Complications

  • No complications are associated with the aforementioned therapy. The only complication of not seeking or complying with therapy is profound bilateral visual loss but never total blindness.
Previous
Next

Prognosis

  • If patients with nutritional optic neuropathy are compliant with the treatment regimen, and unless the loss of vision is already far advanced, the prospect for recovery or at least improvement is excellent, except for the most chronic cases. However, the rate of recovery varies from a few weeks to several months. The prognosis is also better if treatment is initiated in the first few months after the onset of symptoms. Visual acuity tends to recover before color vision. When recovery has been complete, recurrences are unusual. Although extremely rare, cases of spontaneous improvement of vision have been reported without patient cooperation.
  • For toxic optic neuropathies, when the responsible toxin is discontinued, vision usually recovers to normal over several days to weeks. However, this does depend in large part on the nature of the offending agent and on its total exposure before it was removed.
Previous
Next

Patient Education

  • Patients must be alerted to report any visual problems to their ophthalmologist immediately if they are taking ethambutol, isoniazid, or amiodarone.
Previous
 
Contributor Information and Disclosures
Author

Aftab Zafar, MD  Consulting Staff, Department of Ophthalmology, St Mary's General Hospital

Aftab Zafar, MD is a member of the following medical societies: Canadian Medical Association, Canadian Ophthalmological Society, College of Physicians and Surgeons of Ontario, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

Andrew W Lawton, MD  Medical Director of Neuro-Ophthalmology Service, Section of Ophthalmology, Baptist Eye Center, Baptist Health Medical Center

Andrew W Lawton, MD is a member of the following medical societies: American Academy of Ophthalmology, Arkansas Medical Society, and Southern Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Brian R Younge, MD  Professor of Ophthalmology, Mayo Clinic School of Medicine

Brian R Younge, MD is a member of the following medical societies: American Medical Association, American Ophthalmological Society, and North American Neuro-Ophthalmology Society

Disclosure: Nothing to disclose.

Ralph Garzia, OD  Assistant Dean for Clinical and Academic Programs, Associate Professor, College of Optometry, University of Missouri at St Louis

Ralph Garzia, OD is a member of the following medical societies: American Academy of Optometry and American Optometric Association

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Robert C Sergott, MD, to the development and writing of this article.

References

  1. Lim SA. Ethambutol-associated optic neuropathy. Ann Acad Med Singapore. Apr 2006;35(4):274-8. [Medline].

  2. Orssaud C, Roche O, Dufier JL. Nutritional optic neuropathies. J Neurol Sci. Nov 15 2007;262(1-2):158-64. [Medline].

  3. Murphy MA, Murphy JF. Amiodarone and optic neuropathy: the heart of the matter. J Neuroophthalmol. Sep 2005;25(3):232-6. [Medline].

  4. Macaluso DC, Shults WT, Fraunfelder FT. Features of amiodarone-induced optic neuropathy. Am J Ophthalmol. May 1999;127(5):610-2. [Medline].

  5. Nagra PK, Foroozan R, Savino PJ, et al. Amiodarone induced optic neuropathy. Br J Ophthalmol. Apr 2003;87(4):420-2. [Medline].

  6. Nazarian SM, Jay WM. Bilateral optic neuropathy associated with amiodarone therapy. J Clin Neuroophthalmol. Mar 1988;8(1):25-8. [Medline].

  7. Grzybowski A, Holder GE. Tobacco optic neuropathy (TON) - the historical and present concept of the disease. Acta Ophthalmol. Aug 2011;89(5):495-9. [Medline].

  8. Becker M, Masterson K, Delavelle J, Viallon M, Vargas MI, Becker CD. Imaging of the optic nerve. Eur J Radiol. May 2010;74(2):299-313. [Medline].

  9. Santaella RM, Fraunfelder FW. Ocular adverse effects associated with systemic medications : recognition and management. Drugs. 2007;67(1):75-93. [Medline].

  10. Zoumalan CI, Agarwal M, Sadun AA. Optical coherence tomography can measure axonal loss in patients with ethambutol-induced optic neuropathy. Graefes Arch Clin Exp Ophthalmol. May 2005;243(5):410-6. [Medline].

  11. Chai SJ, Foroozan R. Decreased retinal nerve fibre layer thickness detected by optical coherence tomography in patients with ethambutol-induced optic neuropathy. Br J Ophthalmol. Jul 2007;91(7):895-7. [Medline].

  12. Johnson LN, Krohel GB, Thomas ER. The clinical spectrum of amiodarone-associated optic neuropathy. J Natl Med Assoc. Nov 2004;96(11):1477-91. [Medline].

  13. Danesh-Meyer H, Kubis KC, Wolf MA. Chiasmopathy?. Surv Ophthalmol. Jan-Feb 2000;44(4):329-35. [Medline].

  14. Glaser JS. Nutritional and toxic optic neuropathies. In: Glaser JS, ed. Neuro-ophthalmology. 3rd ed. Philadelphia: Lippincott; 1999.

  15. Grant WM, Schuman JS. Toxicology of the Eye. 4th ed. Springfield, Ill: Charles C Thomas Publisher; 1993.

  16. Kerrison JB. Optic neuropathies caused by toxins and adverse drug reactions. Ophthalmol Clin North Am. Sep 2004;17(3):481-8; viii. [Medline].

  17. Lessell S. Nutritional deficiency and toxic optic neuropathies. In: Albert DM, Jakobiec FA, eds. Principles and Practice of Ophthalmology. 2nd ed. Philadelphia: WB Saunders Co; 2000.

  18. Mantyjarvi M, Tuppurainen K, Ikaheimo K. Ocular side effects of amiodarone. Surv Ophthalmol. Jan-Feb 1998;42(4):360-6. [Medline].

  19. Melamud A, Kosmorsky GS, Lee MS. Ocular ethambutol toxicity. Mayo Clin Proc. Nov 2003;78(11):1409-11. [Medline].

  20. Miller NR. Anterior toxic optic neuropathies. In: Walsh and Hoyt's Clinical Neuro-Ophthalmology. 4th ed. Baltimore: Lippincott Williams & Wilkins; 1982:254-260.

  21. Miller NR. Retrobulbar toxic and deficiency optic neuropathies. In: Walsh and Hoyt's Clinical Neuro-ophthalmology. 4th ed. Baltimore: Lippincott Williams & Wilkins; 1982:289-307.

  22. Phillips PH. Toxic and deficiency optic neuropathies. In: Miller NR, Newman NJ, eds. Walsh and Hoyt's Clinical Neuro-ophthalmology. 6th ed. Baltimore: Lippincott Williams & Wilkins; 2005:447-463.

  23. Rizzo JF 3rd, Lessell S. Tobacco amblyopia. Am J Ophthalmol. Jul 15 1993;116(1):84-7. [Medline].

  24. Sadun AA. Metabolic optic neuropathies. Semin Ophthalmol. Mar 2002;17(1):29-32. [Medline].

  25. Woon C, Tang RA, Pardo G. Nutrition and optic nerve disease. Semin Ophthalmol. Sep 1995;10(3):195-202. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.