Ocular Surface Ulceration Associated With an Epidermal Growth Factor Receptor Inhibitor

To present the case of ocular surface ulceration in a patient receiving erlotinib for lung adenocarcinoma.

An 80-year-old woman presented with a corneal ulcer of the right eye in the setting of poor contact lens hygiene and overwear. During the initial treatment of her corneal ulcer, erlotinib therapy was held by her oncologist. After 1.5 months of treatment, the corneal infection resolved with full epithelialization. Erlotinib was then restarted, and she remained out of contact lenses.

One week after reinitiation of erlotinib treatment, the patient presented with new onset right eye pain and conjunctival injection. She was found to have a new conjunctival ulcer and new peripheral corneal epithelial defects. Three weeks after the discontinuation of erlotinib, the conjunctival ulceration and all peripheral epithelial defects had resolved.

There are a number of systemic and ocular side effects associated with erlotinib. Ocular adverse effects such as dry eye, epithelial keratopathy, nonhealing corneal epithelial defects, corneal ulceration, conjunctivitis, anterior uveitis, trichomegaly, and periorbital skin rash leading to ectropion and epiphora have been reported in the literature. To our knowledge, this is the first reported case of conjunctival ulceration associated with the use of erlotinib.