Dr. JASPREET SUKHIJA

Abstract

A 26 year female who was on anti tubercular treatment presented with gradual decrease in vision in both eyes. At presentation her visual acuity(VA) was 3/60 with absent colour vision.Her visual field showed bilateral caecocentral scotoma (done earlier outside). Ethambutol was immediately stopped. However, vision did not improve on follow up which made us to discontinue Isoniazid also. There was a sudden decrease in vision on subsequent visit. At this moment she had mild disc oedema in both eyes which made us suspect superadded optic neuritis. Imaging was consistent with optic neuritis and she was found to have high MOG antibody titres. VA improved after 5 dose of IV methyprednisolone. At last follow up her VA was 6/6.Our case highlights that high suspicion of inflammatory optic neuropathy should be kept in mind in patients with toxic optic neuropathy where vision deteriorates rapidly as it can be improved with timely intervention.

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