Eye Symptoms and Toxicities of Systemic Chemotherapy

  • April Teitelbaum


Cancer chemotherapy has the potential to produce acute and chronic toxicities in any organ system, especially when rapidly proliferating cells are affected. Epithelial cells on the eye surface 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 the retina. Many drugs irritate the eye through their secretion in tears, affecting the tear ducts as well as the surface eye structures. Many toxicities are dose-dependent or become ­evident at cumulative doses. Patients may note photophobia, a gritty sensation of the eye, diminished visual acuity, 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), cataract (e.g., with busulfan, steroids, tamoxifen), cranial nerve dysfunction affecting extraoculomotor nerves (e.g., ptosis during treatment with vinca alkaloids or platins), excessive eyelash growth (e.g., with EGFR inhibitors), asymptomatic corneal deposits (e.g., during treatment with capecitabine), or intra-retinal crystals (e.g., during treatment with tamoxifen). 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. 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 exams may be warranted, especially when long-term administration of a drug is likely.


Optic Neuritis Visual Evoke Potential Vinca Alkaloid Conjunctival Hyperemia Periorbital Edema 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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© Society for Imaging Informatics in Medicine 2010

Authors and Affiliations

  1. 1.AHT BioPharma Advisory ServicesSan DiegoUSA

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