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Neuro-Ophthalmology
If the human eye works like a camera, we can imagine that the "processing of the film" into what we see as visual images is transmitted by the optic nerves from the globe of the eye, to their visual pathways in the brain and finally towards the visual processing centers at the back part of the brain.
Some common neuro-ophthalmic conditions affecting vision include optic neuritis and toxic optic neuropathy (from intake of anti-TB medications); while examples of those affecting eye movements are cranial nerve strokes and thyroid disease. Patients with eye problems secondary to brain tumors or strokes, as well as migraines are also commonly seen in this field.
Optic Neuritis
Optic neuritis occurs when swelling (inflammation) damages the covering (myelin) of the optic nerve. The optic nerve is a bundle of nerve fibers that transmits visual information from your eye to your brain. Common symptoms of optic neuritis include pain with eye movement and temporary vision loss in one eye.
The exact cause of optic neuritis is unknown. It's believed to develop when the immune system mistakenly targets the substance covering your optic nerve, resulting in inflammation and damage to the myelin.
The term "optic neuritis" is most commonly used when MS is the cause of inflammation and damage to the optic nerve. Besides MS, optic nerve inflammation can occur with other conditions, including infections or immune diseases, such as lupus. Rarely, another disease called neuromyelitis optica causes inflammation of the optic nerve and spinal cord.
Most people who have a single episode of optic neuritis eventually recover their vision without treatment. Sometimes steroid medications may speed the recovery of vision after optic neuritis.
Ethambutol Toxic Optic Neuropathy (ETON)
Ethambutol-induced optic neuropathy is a well-known and devastating complication of ethambutol therapy. It may occur in approximately 1% of patients taking ethambutol at the WHO recommended doses, though the risk increases substantially with increased dose. All patients on ethambutol should receive regular screening by an ophthalmologist including formal visual field testing. Visual evoked potentials and OCT may be helpful for EON screening, but more research is needed to clarify their clinical usefulness. Patients who develop signs or symptoms of ETON should be referred to the ethambutol-prescribing physician immediately for discontinuation or a reduction in ethambutol dosing.