Chemotherapy's effect on the eyes

In some cases, eye problems can result from treatment by chemotherapy. Such problems include dry eyes, conjunctivitis, cataracts, photophobia and watery eyes. While some problems are minor and will clear up quickly, others are more serious and could lead to progressive loss of vision. Notify your doctor immediately if you notice cloudy or blurred vision, eye pain, sensitivity to light, increased tearing or sudden loss of vision.

Some common eye problems include:

Cataracts

Cataracts are painless, but lead to a progressive loss of vision over time. A cataract is a cloudy area in lens of an eye preventing light from passing through. As it grows, vision becomes cloudier. Cataracts usually occur in one eye, and won’t spread to the second eye.

Some chemotherapy drugs that have been linked with cataracts:

  • Targretin (bexarotene) – a retinoid, used to control cell growth. Problems occur in 10 to 29 percent of patients
  • Dexamethasone – a corticosteroid, used to decrease inflammation. Problems occur in less than 10 percent of patients.
  • Hydrocortisone – a corticosteroid, used to decrease inflammation. Problems occur in 10 percent to 29 percent of patients.
  • Methylprednisolone – a corticosteroid, used to decrease inflammation. Problems occur in 10 percent to 29 percent of patients.
  • Prednisone – a corticosteroid, used to decrease inflammation. Problems occur in 10 percent to 29 percent of patients.
  • Tamoxifen – an antiestrogen, used to bind to the estrogen receptor on a cancer cell, which blocks estrogen from going into the cell and interferes with cell growth. Problems occur in less than 10 percent of patients.

Symptoms of cataracts include:

  • Cloudy or blurry vision
  • Difficulty seeing at night or in the dark
  • Colors appear dull or faded
  • Lights seems to be too bright, or there appears to be a halo around lights
  • Double vision


Cataract surgery to correct the problem is very common. Doctors may suggest you wear glasses and use bright lights before you decide to go through with surgery.

Conjunctivitis

Conjunctivitis, commonly known as “pink eye,” refers to the redness and inflammation that occurs around the conjunctiva — a clear, thin membrane that covers the white of the eye. Allergies, viruses or bacteria can cause conjunctivitis. Most viral conjunctivitis clears up on its own within 5 to 7 days. Bacterial conjunctivitis may require antibiotic eye drops.

Some chemotherapy drugs that have been linked to conjunctivitis:

  • Xeloda (capecitabine) – an antimetabolite, used to stop cancer cells from dividing. Problems occur in 10 percent to 29 percent of patients.
  • BiCNU (carmustine) - an alkylating agent, used to damage the DNA of cancer cells. Problems occur in 10 percent to 29 percent of patients.
  • Ellence (epirubicin) - an antitumor antibiotic, used to block cell growth by interfering with DNA. Problems occur in 10 percent to 29 percent of patients.
  • Methotrexate – an antimetabolite, used to stop cancer cells from dividing. Problems occur in 10 percent to 29 percent of patients.
  • Neumega (oprelvekin) -a cytokine that stimulates the production, maturation and activation of platelets, and can help return platelet levels to normal. Problems occur in 10 percent to 29 percent of patients.
  • Fluorouracil, an antimetabolite, used to stop cancer cells from dividing. Problems occur in less than 10 percent of patients.

Symptoms of Conjunctivitis:

Redness or swelling of the eyelids

  • Itchy or watery eyes
  • Light sensitivity
  • Pus or discharge from the eye

With conjunctivitis, it is very important to wash your hands often and avoid contact with others. Avoid touching or rubbing your eyes, as this can make the problem worse. Never share eye makeup with anyone, and discard it in the case of bacterial conjunctivitis. Avoid wearing contact lenses. Depending on the type of conjunctivitis, your doctor may treat it with eye drops, ointments or antihistamines.

Photophobia

Photophobia is the avoidance of light due to pain. This may be caused by injury to the cornea — the clear covering over the eye — or inflammation of the uveal tract, which contains many structures important for your eye to function properly. When exposed to light, your pupils constrict, or become smaller. When there is swelling of any eye structure, it may cause pain when your pupils are constricting.
Some chemotherapy drugs that have been linked to photophobia:

  • Ara-C (cytarabine) – an antimetabolite, used to stop cancer cells from dividing. Problems occur in 10 percent to 29 percent of patients.
  • Fluorouracil – an antimetabolite, used to stop cancer cells from dividing. Problems occur in more than 30 percent of patients.
  • Isotretinoin – a retinoid, used to control cell growth. Problems occur in more than 30 percent of patients.
  • Tretinoin – a retinoid, used to control cell growth. Problems occur in more than 30 percent of patients.


Symptoms of photophobia include pain when you move from a dark to a light area. Treatment involves removing the underlying cause of the eye problem, though your doctor may prescribe steroids, either in the form of eye drops or pills.

Watery eyes

Watery eyes or excessive tearing occurs when tears fall from the eyes, even when you are not crying. This can be caused by a blockage in the eye’s drainage system or the production of too many tears. Allergies, infections, pollution or foreign objects in the eyes can also cause it.

Some chemotherapy drugs that have been linked to watery eyes:

  • Xeloda (capecitabine) -an antimetabolite, used to stop cancer cells from dividing. Problems occur in 10 percent to 29 percent of patients.
  • Cytarabine -an antimetabolite, used to stop cancer cells from dividing. Problems occur in 10 percent to 29 percent of patients.
  • Adriamycin (doxorubicin) – an antitumor antibiotic, used to block cell growth by interfering with DNA. Problems occur in 10 percent to 29 percent of patients.
  • Fluorouracil – an antimetabolite, used to stop cancer cells from dividing. Problems occur in more than 30 percent of patients.
  • Taxotere (docetaxel) - a plant alkaloid, used to attack cells during cell division. Problems occur in less than 10 percent of patients.


This can be treated, in some cases with antibiotics, or surgery in serious cases.

Dry eyes

Dry eyes, also known as keratoconjunctivitis sicca, occur when your eyes do not produce enough tears. Even if your eyes are producing excessive tearing, dry eye syndrome can cause a lack of an important chemical to lubricate your eyes, which may result in a dry feeling.

Some chemotherapy drugs that have been linked to dry eyes:

  • Vesanoid (isotretinoin) - a retinoid, used to control cell growth. Problems occur in more than 30 percent of patients.
  • Accutane (tretinoin) - a retinoid, used to control cell growth. Problems occur in more than 30 percent of patients.


Dry eyes may be treated with artificial tears or ointments, or in some cases, surgery.

Tests your doctor may perform to determine if there are eye problems:

  • Fluorescein or Rose Bengal staining: Special drops are placed in your eye. Using a special light, your doctor can see if there are any problems with the surface of your eyes.
  • Ophthalmoscopy: this involves the use of an ophthalmoscope, to look at the back of your eye. With the instrument, your doctors can see the structures of the ye, including the lens, retina, blood veins and vessels.
  • Pupil dilation: special eye drops are used to widen your pupil, allowing your doctor the opportunity to look at the back of your eye
  • Tonometry: a “puff” of air is blown into your eye to test the fluid pressures
  • Visual acuity test: your doctor will use a chart to determine how well you can see at different distances

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