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Updated: Sep 29, 2025
Induction of Ocular Surface Inflammation and Collection of Involved Tissues
Published on: August 4, 2022
Atezolizumab induced immune-related adverse event mimicking conjunctival metastatic disease
Julia Aschauer1, Ruth Donner1, Jan Lammer1
1Department of Ophthalmology and Optometry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Purpose:
To describe a case of an immune-related adverse event associated with Atezolizumab therapy which was aggravated by ocular surgery.
Observations:
A 59-year-old man treated with Atezolizumab for metastatic non-small-cell lung cancer developed a conjunctival hypertrophic lesion mistaken for metastatic tissue. Biopsy surgery induced fulminant and multifocal granulomatous conjunctival tissue growth and sterile corneal ulceration. The immune-related adverse event was refractory to topical therapy, with curative success only after introduction of systemic prednisone.
Conclusions:
Atezolizumab use may be associated with severe and recalcitrant ocular surface inflammation with potential exacerbation after surgical interventions.
Insights
Atezolizumab immunotherapy can cause severe eye inflammation, particularly after surgery. Systemic steroids were required to treat this immune-related adverse event in a non-small-cell lung cancer patient.
Area of Science:
- Oncology
- Immunology
- Ophthalmology
Background:
- Atezolizumab is an immune checkpoint inhibitor used for metastatic non-small-cell lung cancer.
- Immune-related adverse events (irAEs) are known complications of immunotherapy.
- Ocular irAEs can significantly impact patient quality of life.
Observation:
- A patient receiving Atezolizumab developed a conjunctival lesion mimicking metastatic disease.
- Surgical biopsy of the lesion triggered severe, widespread granulomatous inflammation and sterile corneal ulcers.
- The ocular inflammation was resistant to topical treatments.
Findings:
- The case highlights a severe immune-related adverse event involving the ocular surface.
- Surgical intervention exacerbated the inflammatory response.
- Systemic corticosteroid therapy was curative for the severe ocular inflammation.
Implications:
- Clinicians should be aware of potential severe ocular irAEs with Atezolizumab.
- Surgical procedures on patients undergoing Atezolizumab therapy may risk exacerbating ocular irAEs.
- Prompt recognition and systemic treatment are crucial for managing severe ocular surface inflammation.
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