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Eye Symptoms and Toxicities of Systemic Chemotherapy

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The MASCC Textbook of Cancer Supportive Care and Survivorship

Abstract

Cancer chemotherapy has the potential to produce acute and chronic toxicities in any organ system, especially when rapidly proliferating cells are involved. Epithelial cells on the surface of the eye rapidly proliferate and are susceptible to the effects of chemotherapy. Intravenous chemotherapy reaches the retina through the vascular supply and may thus have deleterious effects on this susceptible tissue. Also, many drugs may cause damage to the ocular surface through their secretion in tears and may even damage the lacrimal gland and tear drainage system itself (as with docetaxel). Many toxicities are dose-dependent or become evident at cumulative doses. Patients may note photophobia, a gritty sensation of the eye, diminished visual acuity, eyelid swelling, or watery or dry eyes. Physical examination may reveal conjunctivitis, which is very common, especially with drugs that are secreted in tears (e.g., cyclophosphamide, tamoxifen, interferons, busulfan, cytarabine), blepharitis (e.g., with epidermal growth factor receptor inhibitors), keratitis and corneal deposits (e.g., with cytarabine, capecitabine), cataract (e.g., with busulfan, steroids, tamoxifen), cranial nerve dysfunction affecting extraocular nerves (e.g., ptosis during treatment with vinca alkaloids or platins), excessive eyelash growth (e.g., with epidermal growth factor inhibitors), periorbital edema (e.g., with imatinib), intra-retinal crystals (e.g., with tamoxifen), or multifocal serous retinal or pigment epithelial detachments (e.g., with MEK inhibitors). The vast majority of ocular effects are mild to moderate in nature and reversible with discontinuation of the offending agent, especially when the complication is recognized early. Others have more serious consequences and may result in impaired vision despite discontinuation of the medication. Prophylactic measures (e.g., topical steroids with high-dose cytarabine, short-term oral steroids and diuretics for significant imatinib-related periorbital edema, ocular ice packs for long-term 5-fluorouracil administration) may mitigate toxicities and allow continuation of the drug or avoid a reduction in dose. Awareness of potential ocular effects may enable earlier recognition, and baseline and serial ophthalmologic examinations may be warranted, especially when long-term administration of a drug is likely.

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  1. Department of Ophthalmology, Weill Cornell Medical Center, New York, NY, USA

    Colin J. Prensky, Ashley R. Brissette & Kimberley C. Sippel

  2. AHT BioPharma Advisory Services, San Diego, CA, USA

    April Teitelbaum

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  1. Colin J. Prensky
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  2. Ashley R. Brissette
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  3. Kimberley C. Sippel
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  4. April Teitelbaum
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Correspondence to April Teitelbaum .

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  1. University of South Australia, Adelaide, SA, Australia

    Ian Olver

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Prensky, C.J., Brissette, A.R., Sippel, K.C., Teitelbaum, A. (2018). Eye Symptoms and Toxicities of Systemic Chemotherapy. In: Olver, I. (eds) The MASCC Textbook of Cancer Supportive Care and Survivorship. Springer, Cham. https://doi.org/10.1007/978-3-319-90990-5_35

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  • DOI: https://doi.org/10.1007/978-3-319-90990-5_35

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  • Online ISBN: 978-3-319-90990-5

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