Analysis of clinical features of tacrolimus‐induced optic neuropathy

What is known and objective Tacrolimus is associated with optic neuropathy. The clinical features of tacrolimus‐induced optic neuropathy (TION) are unclear. The purpose of this article is to explore the clinical features of TION. Methods TION‐related case reports were collected and analysed by searching Chinese and English databases from 1989 to 31 December 2021. Results and discussion Twelve males and 7 females were included, with a median age of 54 years (range 23–66). TION onset time ranged from 2 months to 16 years after administration, and the main clinical features were blurred vision (4 cases), decreased visual acuity (7 cases), decreased visual acuity (5 cases), grey films (3 cases), visual field damage (3 cases) and headache (2 cases). Fifteen patients developed bilateral optic neuropathy. Ophthalmological examination showed visual acuity ranging from 20/25 to blindness, pupillary examination revealed relative afferent pupillary defect in 9 patients and marked decrease in colour vision in 15 eyes. The optic disc showed pallor (10 cases), oedema (8 cases), atrophy (4 cases) and haemorrhage (2 cases). After discontinuation or dose reduction of tacrolimus, symptoms improved in 10 patients, 1 patient recovered completely, and 4 patients did not recover. What is new and conclusion TION presents diverse clinical manifestations. TION should be promptly identified and treated to prevent severe and permanent vision loss. Tacrolimus‐induced optic neuropathy (TION) onset time ranged from 2 months to 16 years after administration. Tacrolimus primarily affects bilateral optic neuropathy. Visual acuity ranged from 20/25 to blindness, the optic disc is pale, oedematous and atrophic.