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The Rodent Model of Nonarteritic Anterior Ischemic Optic Neuropathy (rNAION)

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Linezolid-induced optic neuropathy.

Divya Karuppannasamy¹, Andavar Raghuram, Devisundaram Sundar

¹Department of Ophthalmology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.

Indian Journal of Ophthalmology

|October 4, 2013

Summary

Systemic linezolid therapy can cause progressive vision loss, particularly in multidrug regimens for extensively drug-resistant tuberculosis (XDR-TB). Promptly discontinuing linezolid may lead to significant visual recovery.

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Area of Science:

Ophthalmology
Infectious Diseases
Pharmacology

Background:

Systemic antimicrobials are known to cause ocular adverse effects.
Multidrug therapy increases the risk of concurrent or overlapping drug-induced ocular toxicities.
Extensively drug-resistant tuberculosis (XDR-TB) often requires complex, long-term multidrug regimens.

Observation:

A 45-year-old male patient with XDR-TB experienced painless, progressive vision loss in both eyes.
The patient was receiving second-line anti-tuberculous drugs, including linezolid and ethambutol.
Initial suspicion of ethambutol-induced toxic optic neuropathy led to its withdrawal, but vision continued to deteriorate.

Findings:

Discontinuation of ethambutol did not resolve the vision loss.
Withdrawal of linezolid resulted in a marked improvement in the patient's visual function.
This case suggests linezolid as a potential cause of toxic optic neuropathy.

Implications:

Ocular toxicity, specifically optic neuropathy, should be considered in patients on linezolid therapy.
Close monitoring of visual function is crucial for patients undergoing long-term linezolid treatment, especially those with XDR-TB.
This highlights the importance of careful drug selection and monitoring in complex treatment regimens to prevent irreversible visual impairment.