Abstract: The eye injury caused by anti-tuberculosis drugs increases year by year as the prevalence of tuberculosis. The main adverse reactions of ethambutol are ethambutol toxic optic neuropathy and occasional retinal toxicity.  The mechanism might be chelation of mitochondria with metals, the impaired function of mitochondria, and the inhibited synthesis of ATP, so as to affect the transport of mitochondria from the cell body to the distal side of nerve axons while the energy is exhausted. It could be accompanied by axon edema, and the apoptosis of nerve cells.  Daily dose and renal dysfunction have a great impact on the occurrence of ethambutol toxic optic neuropathy. Less than 1/3 patients had improved visual acuity after withdrawal. The usage of ethambutol should be lower than conventional dose for the elder and the renal dysfunction people. The main adverse reactions of isoniazid are toxic optic neuropathy, abducens nerve paralysis and retrobulbar optic neuritis in children. The loss of vitamin B6 by using isoniazid or the blocking of pyridoxal phosphate synthesis so as to consume the neurotransmitters caused by the competitive inhibition between isoniazid and vitamin B6 could be the pathogenesis of isoniazid toxic optic neuropathy. The accumulated dose of isoniazid could have great effect on toxic optic neuropathy, and conventional dose could cause abducens nerve paralysis.  The adverse reaction of rifampicin and pyrazinamide is scarce. (Int Rev Ophthalmol, 2022, 46: 277-282)

Key words: anti-tuberculosis drugs, toxic optic neuropathy, adverse drug reaction