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Case Report: Linezolid Optic Neuropathy and Proposed Evidenced-based Screening Recommendation

Dempsey, Sean P., OD1*; Sickman, Amy, OD2; Slagle, William Scott, OD, FAAO2,3

Optometry and Vision Science: May 2018 - Volume 95 - Issue 5 - p 468–474
doi: 10.1097/OPX.0000000000001216

SIGNIFICANCE This case illustrates a novel screening protocol for linezolid-induced toxic optic neuropathy.

PURPOSE To present a case report and analysis of linezolid-induced optic neuropathies in adult patients to develop screening recommendations.

CASE REPORT A case report of optic neuropathy from extended use of linezolid illustrates its potential effects on vision. We conduct a retrospective analysis of 39 reported cases to derive a recommended screening protocol for linezolid-induced toxic optic neuropathy in adult patients. Of 39 reported adult cases, 32 presented with optic neuropathy within 90 to 365 days of treatment. Within this subset, the duration of linezolid dosage to first symptoms is 235 ± 71 days. Seven outliers either experienced optic neuropathy within the first 28 days or between 600 and 1125 days. Of the 33 cases that quantified visual recovery, 30 reported final binocular visual acuity equivalent to 20/40 or better when the medication was discontinued from 0 to 268 days after symptom onset. Recovery potential was reported over a period of 2 weeks to approximately 6 months after cessation. To evaluate the effect of cumulative dose, the data were separated into patients taking 600 mg twice daily and those at 600 mg once daily. At the higher dosage, a mean of 180 ± 96 days with a mean cumulative dosage of 216 ± 115 g was noted at first symptom, whereas at lower dosage, a mean of 201 ± 102 days was noted with a mean cumulative dose of 138 ± 69 g.

CONCLUSIONS We recommend screening adult patients within 1 month after initiating linezolid, followed by a subsequent evaluation every 30 to 60 days beginning 3 months from initiation. Substantial visual recovery is reported when linezolid is discontinued. Toxicity appears to be correlated to duration of treatment, rather than cumulative dose.

1St. Cloud Veterans Affairs Health Care System, St. Cloud, Minnesota

2Salem Veterans Affairs Medical Center, Salem, Virginia

3Virginia Tech Carilion School of Medicine, Roanoke, Virginia *

Supplemental Digital Content: Appendix Table A1, available at, contains data from reported cases of linezolid-induced toxic optic neuropathy. Data include daily and cumulative dosages, time to first symptoms, time to cessation of the medication, visual acuities at diagnosis and recovery, and time to maximum recovery as reported.

Submitted: September 16, 2017

Accepted: March 7, 2018

Supplemental Digital Content: Direct URL links are provided within the text.

Funding/Support: None of the authors have reported funding/support.

Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest.

Author Contributions: Conceptualization: SPD, WSS; Data Curation: SPD, WSS; Formal Analysis: SPD, AS, WSS; Investigation: SPD, WSS; Methodology: SPD, WSS; Writing – Original Draft: SPD, AS, WSS; Writing – Review & Editing: SPD, AS, WSS.

© 2018 American Academy of Optometry