Iatrogenic affectation of ocular motility by immune checkpoint inhibitors

Area of Science:

• Ophthalmology
• Oncology
• Immunology

Background:

• Immune checkpoint inhibitors (ICIs) are vital cancer therapies, improving survival but causing autoimmune-related toxicities.
• The ocular side effects of ICIs, particularly those affecting ocular motility, are not fully characterized.
• Accurate data collection is needed to define the safety profile of ICIs.

Purpose of the Study:

• To identify and characterize pharmacological ocular iatrogenic events related to ocular motility induced by ICIs.
• To review the existing literature on ICI-induced ocular motility disorders.
• To inform ophthalmologists about potential ICI-related ocular adverse events.

Main Methods:

• Systematic literature search of clinical search engines.
• Inclusion of four systematic reviews and numerous case reports.
• Focus on ocular iatrogenesis related to ocular motility.

Main Results:

• Adverse effects identified include oculomotor paresis, optic neuropathy/atrophy, myastheniform syndromes, thyroid pseudo-orbitopathy, orbital apex syndrome, and hypophysitis.
• Most cases were managed with minimal or partial interruption of cancer therapy.
• Aggressive systemic treatments were often necessary for effective management of ocular events.

Conclusions:

• Ophthalmologists must be aware of ICI treatments and their potential for severe ocular motility iatrogenesis.
• Effective management requires communication of adverse effects and reported treatments.
• Future research should focus on differential diagnosis and optimizing cancer treatment decisions alongside managing ocular side effects.