Drug Induced Optic Neurit...

• A 18-year-old male with complaints of neck pain , fever, generalized weakness and altered sensorium 
• MRI suggestive of calcific granuloma in right cerebral peduncle with enhancing exudates in basal cisterns.
• CSF analysis s/o Tubercular Meningitis.
• Started on DSTB ATT
• After 1 month he developed diminution of vision bilaterally. Fundoscopy revealed temporal pallor of optic disc and optic neuropathy
• Visual evoked potential study showed evidence of delayed conduction along bilateral optic pathways(right>left)
• Diagnosed as Optic Neuritis due to ethambutol toxicity
• ethambutol was discontinued. 

                                                                                            DISCUSSION

• As discussed with our 3 cases, it is evident that Imprecise and variable diagnostic criteria have confounded management of ocular TB and ocular complications of anti tubercular treatment.
• MDR ocular TB is rare and high index of suspicion of MDR TB should be there in India which has a burden of MDR TB cases including extra pulmonary cases.
• Therefore I would like to conclude the Routine Ocular examination and awareness of eye involvement in TB is important and management of ocular complications of tuberculosis and Anti tubercular treatment should be started at the earliest.