Linezolid-Induced Toxic Optic Neuropathy – A Case Series with Review of Literature

This is the authors' abstract. We don't add key points for this paper.

Linezolid is widely used for drug-resistant and complicated gram-positive infections, but prolonged therapy can cause mitochondrial toxicity, including toxic optic neuropathy. We retrospectively reviewed patients presenting to a tertiary neuro-ophthalmology clinic (June 2023–July 2024) with visual symptoms temporally related to linezolid exposure after exclusion of alternative causes. Six men (12 eyes; mean age 47.6 ± 8.8 years) were identified; indications were multidrug-resistant tuberculosis (n = 3) and infected foot ulcer (n = 3). Mean duration of therapy was 12.4 ± 3.2 months (600 mg/day in five; 1200 mg/day in one), with a mean cumulative dose of 216 ± 54.6 g. Patients presented after a mean of 17.8 ± 9.9 days (median 15 days) with painless, progressive bilateral vision loss and dyschromatopsia; one had concurrent peripheral neuropathy. Median best-corrected visual acuity improved from logMAR 1.03 at presentation to 0.00 at 6 months after drug discontinuation and regimen modification, with improvement in visual field sensitivity and color vision in most. Peripheral neuropathy persisted in the affected patient. This case series, to our knowledge, is the largest to date and is accompanied by a focused review of literature, highlighting dose/duration, clinical features, investigations, management, and monitoring.