Ocular Toxicity of Cancer Immunotherapy
Summary
Cancer immunotherapy has transformed oncological care by harnessing the patient’s immune system to target malignant cells, yet it has introduced a spectrum of ocular toxicities that can compromise vision and quality of life. These adverse events span inflammatory disorders of the uveal tract, surface abnormalities of the cornea, and retinal perturbations. Immune checkpoint inhibitors, cytokine therapies and targeted biological agents alike may precipitate immune-related adverse events, reflecting off-target activation of T-lymphocytes against ocular antigens. Clinical presentations range from mild dry eye and conjunctivitis to sight-threatening uveitis, serous retinal detachment and corneal graft rejection. Underlying mechanisms include breakdown of immune tolerance at ocular immune-privileged sites, cytokine-mediated endothelial dysfunction in retinal vessels and direct toxicity to corneal epithelium. Early recognition through routine ophthalmic screening and multidisciplinary collaboration enables timely intervention with corticosteroids, immunosuppressive agents or therapy modification, thereby optimising visual outcomes while allowing continuation of life-prolonging cancer treatment. As the repertoire of immunomodulatory drugs expands globally, understanding the pathophysiology, epidemiology and management strategies for ocular toxicity remains essential to balancing oncological efficacy with preservation of sight.
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Ocular Toxicity of Cancer Immunotherapy publication trend
The graph below shows the total number of articles in ocular toxicity of cancer immunotherapy across all publications each year (not limited to Nature Index journals).
Technical terms
Immune checkpoint inhibitor: A monoclonal antibody that blocks regulatory pathways in T cells to enhance antitumour immunity but may disrupt self-tolerance.
Immune-related adverse event: An off-target inflammatory reaction resulting from immunotherapy, affecting organs such as the eye.
Uveitis: Inflammation of the uveal tract, comprising iris, ciliary body and choroid, which can threaten vision if untreated.
Dry eye syndrome: A disorder of the tear film leading to ocular surface irritation, commonly seen with biological cancer therapies.
Vogt–Koyanagi–Harada-like uveitis: An autoimmune-like posterior uveitis presenting with choroidal inflammation and exudative retinal detachment mimicking VKH disease.
References
- Association between immune checkpoint inhibitor medication and uveitis: a population-based cohort study utilizing TriNetX database. Frontiers in Immunology (2024).
- Ocular surface complications following biological therapy for cancer. Frontiers in Toxicology (2023).
- VKH-like uveitis during donafenib therapy for hepatocellular carcinoma: a case report and review of the literature. Frontiers in Pharmacology (2024).
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