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Effects of systemic targeted immunosuppressive therapy on ocular surface
Sabrina Mukhtar1, Vishal Jhanji
1Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Purpose Of Review:
The purpose of this review is to give an overview of the corneal manifestations of targeted systemic immunotherapies and provide guidelines for management when applicable.
Recent Findings:
The advent of newer systemic immunosuppressive therapy has resulted in the need for more awareness of potential ocular side effects. Side effects can range from vortex keratopathy as seen with the tyrosine kinase inhibitors, to epithelial microcysts as reported in the use of cytarabine and belantamab mafodotin, spontaneous corneal perforations have been reported with programmed death 1 inhibitors, while eyelid cicatrization has been reported epidermal growth factor inhibitors. Several immunomodulatory therapies result in conjunctivitis which tends to respond to topical lubrication and corticosteroid treatment. Most manifestations listed in the review are limited to the anterior segment; however, some may lead to retinal and optic nerve changes which can be permanently damaging.
Summary:
Ocular surface and corneal changes secondary to systemic immunosuppression can affect main components of the ocular surface. Although most adverse effects are reversible, few changes can be permanent and therefore close ophthalmologic monitoring is necessary.
Insights
New systemic immunotherapies can cause serious eye side effects, including corneal changes and vision loss. Ophthalmologists must monitor patients closely for these potential ocular surface complications.
Area of Science:
- Ophthalmology
- Immunology
- Pharmacology
Background:
- Systemic immunotherapies are increasingly used for various conditions.
- These therapies can lead to significant ocular side effects.
- Awareness of these adverse events is crucial for patient care.
Purpose of the Study:
- To review corneal manifestations associated with targeted systemic immunotherapies.
- To provide management guidelines for these ocular side effects.
Main Methods:
- Literature review of ocular side effects from systemic immunotherapies.
- Analysis of reported corneal changes and their association with specific drug classes.
Main Results:
- Tyrosine kinase inhibitors can cause vortex keratopathy.
- Cytarabine and belantamab mafodotin may lead to epithelial microcysts.
- Programmed death 1 inhibitors are linked to corneal perforations, and epidermal growth factor inhibitors to eyelid cicatrization.
- Conjunctivitis is common and usually responds to lubrication and corticosteroids.
- While most effects are anterior segment related, retinal and optic nerve damage can occur.
Conclusions:
- Systemic immunosuppression can cause diverse ocular surface and corneal changes.
- Close ophthalmologic monitoring is essential due to the potential for permanent vision impairment.
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