Complex Ocular Adverse Events Following Oxaliplatin Treatment: A Case Report

BACKGROUND Ocular adverse events related to systemic chemotherapy are relatively rare and often underrecognized in clinical practice. We describe a unique case of severe ocular toxicity associated with oxaliplatin-based chemotherapy, presenting as multiple iris cysts, anterior chamber inflammation, retinal detachment, and lens opacity, ultimately resulting in significant vision loss. CASE REPORT A 47-year-old woman with adenocarcinoma of the esophagogastric junction underwent laparoscopic radical gastrectomy on March 4, 2024. Postoperatively, she was started on adjuvant oxaliplatin-based chemotherapy on April 7, 2024. After completing 3 cycles by May 18, 2024, she developed acute bilateral vision loss. Ophthalmologic evaluation revealed multiple iris cysts, anterior chamber inflammation, exudative retinal detachment, and bilateral dense cataracts. Laboratory investigations demonstrated markedly elevated systemic and aqueous humor IL-6 levels, while orbital CT and MRI excluded ocular metastasis. The patient was initially prescribed oral prednisone, but treatment was unsuccessful due to poor adherence. Subsequently, her regimen was modified to oxaliplatin monotherapy. Surgical interventions were performed in both eyes, leading to partial restoration of vision. However, postoperative examinations continued to show persistent retinal detachment and iris cysts, indicating incomplete recovery. CONCLUSIONS This case underscores the potential for oxaliplatin to induce severe and complex ocular toxicities, mimicking metastatic or inflammatory ocular diseases. Early recognition, comprehensive ophthalmologic evaluation, and interdisciplinary collaboration are essential to distinguish drug-induced events from tumor-related manifestations. Moreover, prompt adjustment of chemotherapy and timely ophthalmic intervention can mitigate irreversible visual impairment. Increased awareness of such complications can aid clinicians in tailoring management strategies and improving quality of life in patients receiving oxaliplatin-based chemotherapy.