Ocular surface changes noted after immune checkpoint inhibitor therapy

A notable proportion of patients undergoing immune checkpoint inhibitor (ICI) therapy experience changes in markers of ocular surface health, indicating a potential side effect of this treatment, according to a study, which showed that with appropriate medical intervention, such as the use of preservative-free artificial tears, cyclosporine, topical corticosteroids, warm compresses, and punctal plugs, it is possible to stabilize ocular surface disease.

The study, which involved 16 patients on ICI therapy, utilized multiple markers to assess ocular surface dryness. The Wilcoxon rank-sum test was employed to determine significant changes in initial and final ocular surface indices.

Various treatment modalities were employed to address these ocular surface changes. The most common interventions included the use of preservative-free artificial tears (88%), followed by cyclosporine (25%), topical corticosteroids (31%), warm compresses (25%), and punctal plugs (13%).

The median follow-up period was 3.4 months, ranging from 0 to 79 months, while the median duration of ICI treatment was 7 months, spanning from 1 to 40 months. Four patients succumbed to their conditions during the observation period.

Overall, half of the eyes showed worsening Schirmer I scores, and 29% exhibited an increase in lissamine green staining, both indicators of ocular surface dryness. Over the course of follow-up, 43% of patients experienced a decline in Ocular Surface Disease Index (OSDI) scores.

Reference
Chen K, Ibañez Bruron MC, Mondaca S, et al. Quantitative Ocular Surface Changes in Patients Undergoing Immune Checkpoint Inhibitor Therapy. Ocul Immunol Inflamm. 2023;1-4. doi: 10.1080/09273948.2023.2252892. Epub ahead of print. PMID: 37722802.