Lorlatinib is a central nervous system (CNS) penetrant third generation tyrosine kinase inhibitor (TKI) approved for the first line management of metastatic non-small cell lung cancer (NSCLC) with anaplastic lymphoma kinase (ALK) rearrangement [1] which accounts for 3-5% of NSCLC cases [2]. The most commonly reported side effects include hyperlipidemia, edema, peripheral neuropathy and CNS effects [2]. While ocular side effects such as photopsia, blurred vision, vitreous floaters and diplopia have been documented with another ALK TKI, crizotinib, there are few reports of such effects with lorlatinib [3]. Herein we present a case of bilateral optic neuropathy, initially misdiagnosed as optic nerve metastases and treated with palliative radiotherapy.
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