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Ocular side effects of systemically administered chemotherapy

Catherine Y Liu, MD, PhD
Jasmine H Francis, MD
Jose S Pulido, MD, MS, MPH
David H Abramson, MD, FACS
Section Editors
Paul J Hesketh, MD
Jonathan Trobe, MD
Deputy Editor
Diane MF Savarese, MD


Molecularly targeted agents have emerged as an important component of systemic therapy for a wide range of cancer types. Most of these agents work through mechanisms that are markedly different from conventional cytotoxic chemotherapy, interfering with cellular signaling and angiogenesis pathways that are needed for tumor growth. Many of these agents are associated with distinct adverse effect profiles, several of which affect the eye. Although relatively uncommon, ocular side effects from systemically administered chemotherapy (particularly targeted agents) can be severe, disabling, and irreversible. While some ocular side effects can be managed symptomatically while chemotherapy is continued, others can be vision threatening and warrant immediate discontinuation of the drug.

The ocular side effects of intraarterial chemotherapy administration (including chemotherapy administered into the ophthalmic artery for retinoblastoma) are beyond the scope of this topic review. (See "Retinoblastoma: Treatment and outcome", section on 'Local chemotherapy'.)


When a patient receiving chemotherapy presents with a specific ocular sign or symptom, it is important to delineate whether the complaint is due to the malignancy itself, an associated effect (eg, a paraneoplastic syndrome), or the anticancer treatment.

In general, paraneoplastic visual syndromes are rare; they include cancer-associated retinopathy, melanoma-associated retinopathy, and paraneoplastic optic neuropathy (optic neuritis). (See "Paraneoplastic visual syndromes".)

Differentiating metastasis from drug toxicity — The most common intraocular malignancy is metastatic disease, which most commonly involves the uveal tract. The uvea consists of the iris and ciliary body anteriorly, and the choroid posteriorly (figure 1).

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Literature review current through: Dec 2017. | This topic last updated: Aug 17, 2017.
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