Herbert Open Access Journals


Ocular adverse effects of Anti-cancer Chemotherapy

Parul Singh1*, Abhishek Singh 2#

*Correspondence: Parul Singh parulophtha@gmail.com

1. Department of Ophthalmology, V.C.S.G.G.M.S & R.I., Srinagar Garhwal, Uttarakhand, India.

Author Affiliations

2. Department of Radiotherapy and Clinical oncology, V.C.S.G.G.M.S & R.I., Srinagar Garhwal, Uttarakhand, India.

© 2012 Singh et al; licensee Herbert Publications Ltd.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Systemic anti-cancer therapies can produce acute and chronic organ damage. Ocular toxicity induced by anti-cancer chemotherapy is not uncommon, but underestimated and under-reported. The development of more aggressive regimens, use of newer agents and combination chemotherapy have resulted in a significant increase of reported cases of chemotherapies induced ocular side effects.
Visual changes have been attributed to a number of chemotherapeutic agents such as antimetabolites, alkylating agents, taxanes and platinum agents. In addition to the eye itself, structures of the skin including the eye lids may be affected. Ocular toxicities induced by chemotherapeutic agents are generally not preventable; therefore clinicians must be aware of potential vision threatening complications. Prompt consultation with an ophthalmologist can lead to early detection, proper diagnosis and appropriate therapeutic measures. Dose reduction or discontinuation of incriminated drugs may help in reducing severity and duration of side effects.

An ophthalmologist should be part of team caring for patients undergoing systemic chemotherapy for baseline examination and ongoing assessment. Baseline examination will help to diagnose adverse effects caused later due to chemotherapeutic agents and; diagnose any pre-existing conditions, especially in elderly patients. It is easy to miss association between chemotherapy and visual changes. This article documents ocular changes that are believed to be related to the administration of certain chemotherapeutic agents.


Systemic anti-cancer therapies can produce acute and chronic organ damage. Bone marrow suppression, hepatic, pulmonary, cardiac, renal and gastrointestinal toxicities of chemotherapeutic agents used in treating cancer patients are well known. The development of more aggressive regimens as well as newer agents and combination chemotherapies have resulted in significant increase of reported cases of chemotherapy induced ocular side effects.

Besides this, patients undergoing chemotherapy may develop ocular problems due to other conditions, as in metastases to the eye or central nervous system. Metastases to eye can come from primaries of breast, lung, gastro-intestinal, melanoma, prostate, and kidney. Radiotherapy, when used with chemotherapy, may also contribute to ocular problems in patients treated with concurrent chemo-radiotherapy.

The increased use of chemotherapeutic agents has resulted in longer cancer patient survival. Consequently, the ophthalmologist is seeing more patients with adverse ocular side effects secondary to these antineoplastic agents. Ocular toxicity induced by cancer chemotherapy includes a broad spectrum of disorders reflecting the unique anatomical, physiological and biochemical features of the eye.

Combination chemotherapy regimens may make it difficult to attribute ocular toxicity to a particular drug. Infrequent and under-reporting of ocular adverse effects exists and literature consists mainly of case reports. This article reviews and lists commonly used cancer chemotherapeutic agents along with their ocular side effects.

1. Alkylating agents:

Alkylating agents have the cytotoxic ability to substitute hydrogen atoms in certain organic compounds by alkyl groups. They include platinum complexes, nitrogen mustard derivatives, alkyl sulphonates and nitrosoureas.

A) Platinum complexes -

(i) Cisplatin: Cisplatin, a heavy metal compound, is an established drug for treatment of head and neck, lung, cervical, ovarian and testicular cancer, upper gastrointestinal malignancies, osteogenic sarcoma, neuroblastoma, recurrent brain tumors in children, and urinary bladder cancer. Cisplatin is known to produce non-specific blurred vision, papilledema [1].  Unilateral as well as bilateral retrobulbar neuritis and optic neuritis have been reported for high doses as well as cumulative dose regimens [2]. Transient cortical blindness [3-5], temporary homonymous hemianopia [6, 7] and macular pigmentary changes more likely to occur at high-dose intravenous regimens. Wilding et al reported 13 women who were treated with high cumulative doses of cisplatin for ovarian tumors. Blurred vision in eight patients, decreased color vision in three patients, irregular pigmentation in the macula in six patients and cone dysfunction on electro-retinogram (ERG) in nine patients were documented [8]. Another case reported a 55 year old man, who received cisplatin as salvage regimen for non-hodgkin’s lymphoma, developed bilateral irreversible visual loss with visual field showing central scotoma bilaterally [9]. Intra-carotid administration of cisplatin has led to severe ocular and orbital toxicity like ipsilateral retrobulbar neuritis [10, 11]. Few cases of central retinal artery occlusion, leading to ipsilateral visual loss from severe retinal or optic nerve ischemia were also reported [12]. After supra-ophthalmic infusion of cisplatin, a single case of uveal effusion with exudative retinal detachment, enlarged recti muscles and inflammation of surrounding soft tissue has been reported [13].

(ii) Carboplatin: Carboplatin is used as treatment primarily for lung cancer, head and neck cancer, ovarian cancer, breast cancer, gastro-intestinal cancers and osteogenic sarcoma. Carboplatin may cause maculopathy and optic neuropathy, weeks after intravenous administration [14, 15]. Intra-carotid therapy can cause severe ocular and orbital toxicity [16]. Sub-tenon injection of carboplatin has been associated with limitation of ocular motility[17].

(iii) Oxaliplatin: Oxaliplatin is third generation 1,2 diaminocyclohexane platinum derivative,  used mainly for colon, recurrent or metastatic esophageal cancer, locally advanced or metastatic pancreatic cancer, recurrent epithelial ovarian, relapsed or refractory non-hodgkin’s lymphoma and palliative treatment of testicular cancer. Leonard and co-workers conducted a survey to evaluate neurotoxicity secondary to oxaliplatin therapy[18]. Eighty-six patients with metastatic colorectal cancer reported blurred vision, eye pain, and visual field cuts. Besides this, low rate of visual disturbances, including tearing, conjunctivitis and abnormal lacrimation was also reported in trials [19].

B- Nitrogen mustard derivatives:

(i) Chlorambucil: Chlorambucil is indicated in adult hodgkin’s disease, adult follicular non-hodgkin’s disease and adult chronic lymphocytic leukemia. Keratitis was the most common side effect observed. A single case treated for nephrotic syndrome has been reported to develop diplopia, bilateral papilledema and retinal hemorrhages [20].

(ii) Cyclophosphamide: Cyclophosphamide is used in treatment of many malignancies including breast cancer, lymphomas and leukemias, retinoblastoma, small cell lung cancer, ovarian cancer, sarcomas and multiple myeloma. Blurred vision, kerato-conjunctivitis sicca, blepharo-conjunctivitis and pin point hemorrhages have been reported as its ocular adverse effects [21, 22]. A case of irreversible lacrimal duct stenosis in a women receiving adjuvant chemotherapy for early stage breast cancer was reported, while four other patients developed reversible epiphora [23].

(iii) Ifosphamide: This drug is used in the treatment of soft tissue sarcoma, osteosarcoma, non-hodgkin’s lymphoma, small cell lung cancer, ovarian, testicular and cervical cancer. Blurred vision and florid conjunctivitis has been reported [24].

C- Alkyl sulphonates:

(i) Busulphan: Busulphan is used for chronic myeloid leukemia and other myeloproliferative disorders. The most common ocular side effect is posterior sub-capsular cataract [25]. Non-specific blurred vision and kerato-conjunctivitis sicca may also occur after busulphan infusion [20].

D- Nitrosoureas:

(i) Carmustine: It is mainly used as treatment for brain neoplasms, palliative treatment of multiple myeloma, refractory or relapsed hodgkin’s and non-hodgkin’s lymphoma, cutaneous T-cell lymphoma and metastatic malignant melanoma. There have been several reports of ocular toxicities associated with their use. One patient with myeloma on carmustine therapy developed bilateral acute optic neuro-retinitis [26]. Loss of depth perception and blurring of vision was reported in two patients (out of 31 patients) with breast cancer treated with carmustine with adriamycin [27]. Several other cases of retinopathy, progressive blindness with diplopia, blurred vision, retrobulbar pain, optic neuritis and optic atrophy has also been reported [20, 28, 29]. A case of decreased visual acuity due to marked retinopathy with hemorrhages, exudates and retinal infarcts has been reported [30]. Shingleton et al evaluated 50 patients for ocular toxicity who received systemic high-dose intravenous BCNU alone.  One patient developed counting fingers vision with a fundus picture, consistent with central retinal artery occlusion [31].

2. Antimetabolites:

A-Pyrimidine analogs:

(i) Cytosine arabinoside: Cytosine arabinoside interferes with DNA synthesis by inhibiting DNA Polymerase enzyme. It is used for treatment of acute myeloid leukemia, acute lymphocytic leukemia, lymphomatous meningitis and during blast crisis of chronic myeloid leukemia. Numerous ocular side-effects such as ocular pain, tearing, foreign body sensation, photophobia, blurred vision with evidence of bilateral conjunctival hyperemia and fine corneal punctate opacities have been reported [32,33]. After intrathecal injection of cytosine arabinoside, severe visual loss due to optic neuropathy has been reported [34].

(ii) 5-Fluorouracil (5-FU): 5-FU is an established anti-cancer agent used in skin, head and neck, breast, gastro-intestinal and cervical cancer. The ocular adverse effects reported include blurred vision, ocular pain, photophobia, excessive lacrimation, eye irritation, conjunctivitis, circumferential edema, ectropion and keratitis [35]. The topical use also impairs corneal and conjunctival re-epitheliazation [36]. A case of irreversible lacrimal duct stenosis was reported by Stevens et al, in a women receiving adjuvant chemotherapy for early stage breast cancer [37]. Brink and Beex reported 18 patients, who received prolonged high doses of 5-FU and developed canalicular fibrosis leading to permanent intractable epiphora [38].

(iii) Capecitabine: Capecitabine is a prodrug of 5-fluorouracil and shares its toxicities with it. It is used for treatment of metastatic breast cancer, colon cancer, and advanced gastric carcinoma. Waikhom et al reported two cases with ocular irritation, decreased vision and corneal deposits [39].

B- Folic acid analogues:

(i) Methotrexate: Methotrexate is a folic acid antagonist used in breast cancer, choriocarcinoma, osteogenic sarcoma, acute leukemia, advanced mycosis fungoides (cutaneous lymphoma) and head and neck cancer. The ocular toxicities caused by methotrexate consists of peri-orbital edema, ocular pain, blurred vision, photophobia, conjunctivitis, blepharitis and decreased reflex tear secretions [20]. When methotrexate is administered by intra-thecal route as in acute leukemias, optic neuropathy and inter-nuclear ophthalmoplegia can develop and, this can be potentiated by concurrent cranial irradiation usually used in such cases [40, 41]. Intra-carotid administration of methotrexate in combination with intravenous cyclophosphamide, resulted in macular edema and retinal pigment epithelial changes in all patients, despite intra-carotid injection of mannitol [42]. A case was also reported by Penjavic et al, in which they described a reduced full field ERG in B-wave amplitude [43].

(ii) Pemetrexed: It is indicated for use in malignant pleural mesothelioma and locally advanced or metastatic non–small cell lung cancer. Increased lacrimation, ocular surface disease including conjunctivitis has been reported in 1% to 5% patients.

C- Purines analogues:

(i) Fludarabine: It is used for treatment of refractory B-cell chronic lymphocytic leukemia, advanced low grade non-hodgkin’s lymphoma, refractory or relapsed acute leukemias and mycosis fungoides. The ocular toxicities caused include diplopia, photophobia and, decreased visual acuity secondary to optic neuritis with or without disc edema or cortical blindness [44].

(ii) Pentostatin: Pentostatin is used for treatment of hairy cell leukemia, cutaneous T-cell lymphoma and chronic lymphocytic leukemia. It has been found to be associated with abnormal vision, amblyopia, conjunctivitis, dry eye, problems with lacrimation, photophobia, retinopathy and watery eyes [45, 46].

3. Mitotic inhibitors:

A. Taxanes:

(i) Paclitaxel: Paclitaxel is known to produce neurotoxocity when used for its indications in metastatic or relapsed breast cancer and advanced ovarian cancer [47]. Both transient scintillating scotoma and visual impairment have been reported after its use [48]. Other ocular side-effects induced by paclitaxel include photopsia and possible ischemic optic neuropathy.

(ii) Docetaxel: It is indicated in locally advanced, metastatic and refractory breast cancer, advanced gastric and gastro-esophageal adenocarcinoma, locally advanced head and neck cancer, metastatic prostate cancer and locally advanced or metastatic non-small cell lung carcinoma. S Kolnik and Doughman reported a case of erosive conjunctivitis and punctual stenosis secondary to docetaxel administration [49]. Esmaeli et al reported canalicular narrowing and naso-lacrimal duct obstruction in three patients [50, 51].

B- Plant alkaloids:

Vincristine, vinblastine, vindesine, vinorelbine: They are used for acute lymphoblastic leukemia, ewing’s sarcoma, hodgkin’s disease, non-hodgkin’s disease, lung cancer, breast cancer and soft tissue sarcomas. Cranial nerve palsies [52, 53], optic neuropathy [54, 55], optic atropy [56], cortical blindness [57] and night blindness [58] are the ocular side-effects of these plant alkaloids. The cranial nerve palsies include ptosis, internal ophthalmoplegia, corneal hyperesthesia and lagophthalmos [10].

C- Topoisomerase Inhibitors:

(i) Topoisomerase inhibitor II: Etoposide is a topoisomerase-II inhibitor. Intra-arterially administered etoposide results in arterial thrombosis [59] which can affect the eye by occluding central retinal artery. Etoposide is used of treatment of retinoblastoma in combination with cisplatin or carboplatin. Due to synergistic effects with cisplatin two cases of retinal toxicities have been reported[60].

(ii) Topoisomerase inhibitor I: Irinotecan and topotecan are topoisomerase-I inhibitors used for cytotoxic treatment of carcinoma. They do not have any significant ocular adverse effects reported yet.

4. Antibiotics:

A- Anthracyclines:

(i) Doxorubicin: It is used in combination regimens in the treatment of breast cancer, ovarian cancer, non-hodgkin’s lymphoma, sarcoma and acute leukemia. Excessive lacrimation and conjunctivitis have been reported as its ocular adverse effects [61].

(ii) Mitomycin-C: Mitomycin-C is used in combination chemotherapy regimens in gastric, pancreatic, colon, lung, urinary bladder, breast and cervical cancer. It is also used as hypoxic cell selective cytotoxic agent in combination with radiation therapy in anal and head and neck cancers. The only known ocular toxicity after systemic use of mitomycin-c is blurred vision [61]. All other severe ocular toxicities were reported after topical use in ophthalmologic surgeries.

(iii) Mithramycin (Plicamycin): Mithramycin is used in treatment of hypercalcemia of malignancies and for testicular cancer. There was a single case reported of peri-orbital pallor in absence of anemia as ocular adverse effect [20].

5- Hormonal agents:

A- Tamoxifen: It is used as adjuvant therapy of estrogen dependent breast carcinoma. In 1978, Kaiser-Kupfer and Lippman described four patients who developed keratopathy and retinopathy after tamoxifen use [62, 63]. Decreased visual acuity, bilateral macular edema, retinal yellow-white dots and corneal opacities, bilateral optic neuritis and retinal hemorrhages has also been reported [64, 65]. Gorin et al described intra-retinal crystals and posterior sub-capsular opacities with tamoxifen usage [66]. On the whole, the most common tamoxifen induced ocular toxicities remain to be the retinopathy and cataract, lesions of cornea and optic nerve.

B- Anastrazole: The incidence of cataract with anastrazole usage was found to be lesser than with tamoxifen. The ATAC (Armidex, Tamoxifen, alone or in combination) trial randomized patients with hormone receptor positive localized breast cancer to five years of anastrazole or tamoxifen use. Cataracts were described in 6% patients receiving anastrazole versus 7% receiving tamoxifen [67].

6.  Monoclonal antibodies:

(i) Rituximab: Rituximab was approved by US-FDA (Food and Drug Administration, U.S.A.) in 1997 and is used to treat B-cell non-Hodgkin lymphoma. It is a monoclonal antibody against the CD20 antigen, found on B cells. It works, in part, by labeling cells so that the immune system can attack them. Ocular side-effects described with rituximab usage are conjunctivitis, transient ocular edema, burning sensation, transient visual changes or permanent and severe loss of visual acuity [68].

(ii) Alemtuzumab: Alemtuzumab is an antibody against the CD52 antigen, which is found on both B cells and T cells. It was FDA approved in 2001 to treat some patients with B-cell chronic lymphocytic leukemia. Adverse reactions identified during post-approval use of alemtuzumab are optic neuropathy and endophthalmitis. [69].

(iii) Cetuximab: Cetuximab is an antibody against the EGFR (epidermal growth factor receptor) protein, which is present in large amounts on some tumor cells and helps them grow and divide. Cetuximab blocks the activation of EGFR. It was FDA approved in 2004 to treat some advanced colorectal cancers as well as some head and neck cancers. One case report described a patient with squamous blepharitis. A case treated with combined chemotherapy including cetuximab for colorectal carcinoma showed accelerated growth of eyelashes with persistent bilateral corneal erosions. [70].

(iv) Panitumumab: It targets epidermal growth factor receptor (EGFR) antigen. It is used to treat EGFR-expressing, metastatic colo-rectal carcinoma with disease progression on or following fluoropyrimidine, oxaliplatin and irinotecan containing chemotherapy regimens.  Ocular toxicities included but are not limited to growth of eyelashes; conjunctivitis; ocular hyperemia; increased lacrimation; eye/eyelid irritation [71].

(v) Bevacizumab: Bevacizumab targets the VEGF (vascular endothelial growth factor) protein, which is normally made by tumor cells to attract new blood vessels to feed their growth. Bevacizumab attaches to VEGF and blocks it from signaling for new blood vessels formation. It was approved by FDA in 2004 and is used to treat metastatic colorectal cancer, with intravenous 5-florouracil–based chemotherapy for first- or second-line treatment, non-squamous non-small cell lung cancer, with carboplatin and paclitaxel for first line treatment of unresectable, locally advanced, recurrent or metastatic disease, metastatic breast cancer, with paclitaxel for treatment of patients who have not received chemotherapy for metastatic HER2-negative breast cancer, glioblastoma, as a single agent for adult patients with progressive disease following prior therapy and, metastatic renal cell carcinoma with interferon alfa.

Ocular adverse reactions that have been reported from unapproved use for treatment of various ocular disorders during post-approval use of bevacizumab are endophthalmitis; intraocular inflammation such as iritis and vitritis; retinal detachment; other retinal disorders; increased intraocular pressure; hemorrhage following intraocular injection including conjunctival, vitreous hemorrhage or retinal hemorrhage; vitreous floaters; visual disturbances; ocular hyperemia; ocular pain and/or discomfort. [72].

FDA recently revoked on 18-11-2011, the agency’s accelerated approval of the breast cancer indication for bevacizumab. [73].

7. Drugs targeting signal transduction:

(i) Imatinib: It is indicated in treatment of adults with newly diagnosed Philadelphia chromosome positive (Ph+) CML in chronic phase; treatment of adults with Ph+ ALL with resistance or intolerance to prior therapy. Peri-orbital edema due to fluid retention is reported in 47.2% of patients. Dry eyes, visual disorders including blurred vision, reduced visual acuity, and visual disturbance (1% to less than 10%) were reported [74].

(ii)  Nilotinib: Clinical trials data show that ocular adverse effects caused by nilotinib are uncommon (less than 1%). Eye disorders reported are hemorrhage, reduced visual acuity, peri-orbital edema, conjunctivitis, eye irritation and dry eye [75].

(iii) Vemurafenib: It is a kinase inhibitor indicated for the treatment of patients with unresectable or metastatic melanoma with BRAF mutation. Serious ophthalmologic reactions including uveitis, iritis and retinal vein occlusion, have been reported. Routine monitoring of patients on vemurafenib for ophthalmologic reactions is recommended [76].

(iv) Erlotinib: Corneal ulcerations and perforations, excessive eyelash growth including in-growing eyelashes, and thickening of the eyelashes have been reported. Grade 3 conjunctivitis and keratitis have been reported infrequently in patients receiving erlotinib therapy in non-small cell cancer and pancreatic cancer clinical trials [77].

(v) Everolimus: Inhibitor of mammalian target of rapamycin (mTOR), which is a serine-threonine kinase. It is indicated in advanced pancreatic neuroendocrine tumors and advanced renal cell carcinoma. The ocular toxicities reported are eyelid edema, ocular hyperemia, conjunctivitis. [78].

(vi) Temsirolimus: Temsirolimus is also inhibitor of mTOR and is indicated in treatment of advanced renal cell carcinoma. No ocular adverse effect associated with temsirolimus use has been reported so far.


Ophthalmic complications induced by cytotoxic chemotherapy are often under-estimated and under-reported due to priority given to other life-threatening conditions. The possible reversal of some of these side effects, if diagnosed timely, emphasizes the need for oncologists to be aware these ocular reactions and suggest immediate consultation with an ophthalmologist so that they can be recognized early and some ophthalmic intervention can be done before irreversible changes occur to hamper patient’s quality of life. An ophthalmic baseline examination prior to anti-cancer treatment may help detect any pre-existing ocular condition and lead to reduction of ocular side effects when predisposed patients are screened and examined regularly during and after chemotherapeutic therapy. Reporting of ocular adverse effects of chemotherapy should be encouraged for definite analysis of the burden. Anticipation of various treatment related toxicities may also provide the opportunity for pharmacists to develop intervention strategies that could minimize expected adverse effects. On the whole, oncologist and ophthalmologist should work together in order to prevent irreversible ocular toxicities of chemotherapeutic agents and to determine true cause of visual disturbance.

Table 1: Common ocular adverse effects and anti-cancer drugs associated.

Publicarion history

Editor: Evan Yu, Fred Hutchinson Cancer Research Center, USA.
Editor-In-Chief: G.J. Peters, VU University Medical Center, Netherlands.
Received: 25 December 2011 Revised: 21 January 2012 Re-Revised: 31 January 2012
Accepted: 08 February 2012 Published: 14 February 2012


  1. Ostrow S, Hahn D, Wiernik PH and Richards RD. Ophthalmologic toxicity after cis-dichlorodiammineplatinum(II) therapy. Cancer Treat Rep. 1978; 62:1591-4. | Article | PubMed
  2. Caraceni A, Martini C, Spatti G, Thomas A and Onofrj M. Recovering optic neuritis during systemic cisplatin and carboplatin chemotherapy. Acta Neurol Scand. 1997; 96:260-1. | Article | PubMed
  3. Berman IJ and Mann MP. Seizures and transient cortical blindness associated with cis-platinum (II) diamminedichloride (PDD) therapy in a thirty-year-old man. Cancer. 1980; 45:764-6. | Article | PubMed
  4. Diamond SB, Rudolph SH, Lubicz SS, Deppe G and Cohen CJ. Cerebral blindness in association with cis-platinum chemotherapy for advanced carcinoma of the fallopian tube. Obstet Gynecol. 1982; 59:84S-6S. | Article | PubMed
  5. Pippitt CH, Jr., Muss HB, Homesley HD and Jobson VW. Cisplatin-associated cortical blindness. Gynecol Oncol. 1981; 12:253-5. | Article | PubMed
  6. Cohen RJ, Cuneo RA, Cruciger MP and Jackman AE. Transient left homonymous hemianopsia and encephalopathy following treatment of testicular carcinoma with cisplatinum, vinblastine, and bleomycin. J Clin Oncol. 1983; 1:392-3. | Article | PubMed
  7. Crispino S, Pizzocaro G, Solero CL, Rodari A and Monfardini S. Transient left homonymous hemianopsia during treatment of testicular carcinoma with cisplatinum, vinblastine, and bleomycin. Chemioterapia. 1984; 3:337-9. | Article | PubMed
  8. Wilding G, Caruso R, Lawrence TS, Ostchega Y, Ballintine EJ, Young RC and Ozols RF. Retinal toxicity after high-dose cisplatin therapy. J Clin Oncol. 1985; 3:1683-9. | Article | PubMed
  9. Katz BJ, Ward JH, Digre KB, Creel DJ and Mamalis N. Persistent severe visual and electroretinographic abnormalities after intravenous Cisplatin therapy. J Neuroophthalmol. 2003; 23:132-5. | Article | PubMed
  10. Imperia PS, Lazarus HM and Lass JH. Ocular complications of systemic cancer chemotherapy. Surv Ophthalmol. 1989; 34:209-30. | Article | PubMed
  11. Urba S and Forastiere AA. Retrobulbar neuritis in a patient treated with intraarterial cisplatin for head and neck cancer. Cancer. 1988; 62:2094-7. | Article | PubMed
  12. Stewart DJ, Wallace S, Feun L, Leavens M, Young SE, Handel S, Mavligit G and Benjamin RS. A phase I study of intracarotid artery infusion of cis-Diamminedichloroplatinum(II) in patients with recurrent malignant intracerebral tumors. Cancer Res. 1982; 42:2059-62. | Article | PubMed
  13. Margo CE and Murtagh FR. Ocular and orbital toxicity after intracarotid cisplatin therapy. Am J Ophthalmol. 1993; 116:508-9. | PubMed
  14. Rankin EM and Pitts JF. Ophthalmic toxicity during carboplatin therapy. Ann Oncol. 1993; 4:337-8. | Article | PubMed
  15. O'Brien ME, Tonge K, Blake P, Moskovic E and Wiltshaw E. Blindness associated with high-dose carboplatin. Lancet. 1992; 339:558. | Article | PubMed
  16. Lauer AK, Wobig JL, Shults WT, Neuwelt EA and Wilson MW. Severe ocular and orbital toxicity after intracarotid etoposide phosphate and carboplatin therapy. Am J Ophthalmol. 1999; 127:230-3. | Article | PubMed
  17. Mulvihill A, Budning A, Jay V, Vandenhoven C, Heon E, Gallie BL and Chan HS. Ocular motility changes after subtenon carboplatin chemotherapy for retinoblastoma. Arch Ophthalmol. 2003; 121:1120-4. | Article | PubMed
  18. Leonard GD, Wright MA, Quinn MG, Fioravanti S, Harold N, Schuler B, Thomas RR and Grem JL. Survey of oxaliplatin-associated neurotoxicity using an interview-based questionnaire in patients with metastatic colorectal cancer. BMC Cancer. 2005; 5:116. | Article | PubMed Abstract | PubMed Full Text
  19. Eloxatin (oxaliplatin for injection) prescribing information. | Website
  20. Al-Tweigeri T, Nabholtz JM and Mackey JR. Ocular toxicity and cancer chemotherapy. A review. Cancer. 1996; 78:1359-73. | Article | PubMed
  21. Jack MK and Hicks JD. Ocular complications in high-dose chemoradiotherapy and marrow transplantation. Ann Ophthalmol. 1981; 13:709-11. | Article | PubMed
  22. Kende G, Sirkin SR, Thomas PR and Freeman AI. Blurring of vision: a previously undescribed complication of cyclophosphamide therapy. Cancer. 1979; 44:69-71. | Article | PubMed
  23. Stevens A and Spooner D. Lacrimal duct stenosis and other ocular toxicity associated with adjuvant cyclophosphamide, methotrexate and 5-fluorouracil combination chemotherapy for early stage breast cancer. Clin Oncol (R Coll Radiol). 2001; 13:438-40. | Article | PubMed
  24. Choonara IA, Overend M and Bailey CC. Blurring of vision due to ifosfamide. Cancer Chemother Pharmacol. 1987; 20:349. | Article | PubMed
  25. Kaida T, Ogawa T and Amemiya T. Cataract induced by short-term administration of large doses of busulfan: a case report. Ophthalmologica. 1999; 213:397-9. | Article | PubMed
  26. Lokich JJ, Skarin AT and Frei E, 3rd. 1,-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (methyl CCNU) and adriamycin combination therapy. Cancer. 1974; 34:1593-7. | Article | PubMed
  27. Louie AC, Turrisi AT, Muggia FM and Bono VH, Jr. Visual abnormalities following nitrosourea treatment. Med Pediatr Oncol. 1978; 5:245-7. | PubMed
  28. Greenberg HS, Ensminger WD, Chandler WF, Layton PB, Junck L, Knake J and Vine AK. Intra-arterial BCNU chemotherapy for treatment of malignant gliomas of the central nervous system. J Neurosurg. 1984; 61:423-9. | Article | PubMed
  29. Grimson BS, Mahaley MS, Jr., Dubey HD and Dudka L. Ophthalmic and central nervous system complications following intracarotid BCNU (Carmustine). J Clin Neuroophthalmol. 1981; 1:261-4. | Article | PubMed
  30. Johnson DW, Cagnoni PJ, Schossau TM, Stemmer SM, Grayeb DE, Baron AE, Shpall EJ, Bearman SI, McDermitt J and Jones RB. Optic disc and retinal microvasculopathy after high-dose chemotherapy and autologous hematopoietic progenitor cell support. Bone Marrow Transplant. 1999; 24:785-92. | Article | PubMed
  31. Shingleton BJ, Bienfang DC, Albert DM, Ensminger WD, Chandler WF and Greenberg HS. Ocular toxicity associated with high-dose carmustine. Arch Ophthalmol. 1982; 100:1766-72. | Article | PubMed
  32. Hopen G, Mondino BJ, Johnson BL and Chervenick PA. Corneal toxicity with systemic cytarabine. Am J Ophthalmol. 1981; 91:500-4. | PubMed
  33. Percy DH and Danylchuk KD. Experimental retinal dysplasia due to cytosine arabinoside. Invest Ophthalmol Vis Sci. 1977; 16:353-64. | Article | PubMed
  34. Margileth DA, Poplack DG, Pizzo PA and Leventhal BG. Blindness during remission in two patients with acute lymphoblastic leukemia: a possible complication of multimodality therapy. Cancer. 1977; 39:58-61. | Article | PubMed
  35. Khaw PT, Sherwood MB, MacKay SL, Rossi MJ and Schultz G. Five-minute treatments with fluorouracil, floxuridine, and mitomycin have long-term effects on human Tenon's capsule fibroblasts. Arch Ophthalmol. 1992; 110:1150-4. | Article | PubMed
  36. Shapiro MS, Thoft RA, Friend J, Parrish RK and Gressel MG. 5-Fluorouracil toxicity to the ocular surface epithelium. Invest Ophthalmol Vis Sci. 1985; 26:580-3. | Article | PubMed
  37. Stevens A and Spooner D. Lacrimal duct stenosis and other ocular toxicity associated with adjuvant cyclophosphamide, methotrexate and 5-fluorouracil combination chemotherapy for early stage breast cancer. Clin Oncol (R Coll Radiol). 2001; 13:438-40. | Article | PubMed
  38. Brink HM and Beex LV. Punctal and canalicular stenosis associated with systemic fluorouracil therapy. Report of five cases and review of the literature. Doc Ophthalmol. 1995; 90:1-6. | Article | PubMed
  39. Waikhom B, Fraunfelder FT and Henner WD. Severe ocular irritation and corneal deposits associated with capecitabine use. N Engl J Med. 2000; 343:740-1. | Article | PubMed
  40. Fishman ML, Bean SC and Cogan DG. Optic atrophy following prophylactic chemotherapy and cranial radiation for acute lymphocytic leukemia. Am J Ophthalmol. 1976; 82:571-6. | PubMed
  41. Margileth DA, Poplack DG, Pizzo PA and Leventhal BG. Blindness during remission in two patients with acute lymphoblastic leukemia: a possible complication of multimodality therapy. Cancer. 1977; 39:58-61. | Article | PubMed
  42. Millay RH, Klein ML, Shults WT, Dahlborg SA and Neuwelt EA. Maculopathy associated with combination chemotherapy and osmotic opening of the blood-brain barrier. Am J Ophthalmol. 1986; 102:626-32. | PubMed
  43. Ponjavic V, Granse L, Stigmar EB and Andreasson S. Reduced full-field electroretinogram (ERG) in a patient treated with methotrexate. Acta Ophthalmol Scand. 2004; 82:96-9. | Article | PubMed
  44. Chun HG, Leyland-Jones BR, Caryk SM and Hoth DF. Central nervous system toxicity of fludarabine phosphate. Cancer Treat Rep. 1986; 70:1225-8. | Article | PubMed
  45. Kraut EH, Bouroncle BA and Grever MR. Pentostatin in the treatment of advanced hairy cell leukemia. J Clin Oncol. 1989; 7:168-72. | Article | PubMed
  46. Major PP, Agarwal RP and Kufe DW. Clinical pharmacology of arabinofuranosyladenine in combination with deoxycoformycin. Cancer Chemother Pharmacol. 1983; 10:125-8. | Article | PubMed
  47. Damascelli B, Cantu G, Mattavelli F, Tamplenizza P, Bidoli P, Leo E, Dosio F, Cerrotta AM, Di Tolla G, Frigerio LF, Garbagnati F, Lanocita R, Marchiano A, Patelli G, Spreafico C, Ticha V, Vespro V and Zunino F. Intraarterial chemotherapy with polyoxyethylated castor oil free paclitaxel, incorporated in albumin nanoparticles (ABI-007): Phase I study of patients with squamous cell carcinoma of the head and neck and anal canal: preliminary evidence of clinical activity. Cancer. 2001; 92:2592-602. | Article | PubMed
  48. Capri G, Munzone E, Tarenzi E, Fulfaro F, Gianni L, Caraceni A, Martini C and Scaioli V. Optic nerve disturbances: a new form of paclitaxel neurotoxicity. J Natl Cancer Inst. 1994; 86:1099-101. | Article | PubMed
  49. Skolnick CA and Doughman DJ. Erosive conjunctivitis and punctal stenosis secondary to docetaxel (taxotere). Eye Contact Lens. 2003; 29:134-5. | Article | PubMed
  50. Esmaeli B, Burnstine MA, Ahmadi MA and Prieto VG. Docetaxel-induced histologic changes in the lacrimal sac and the nasal mucosa. Ophthal Plast Reconstr Surg. 2003; 19:305-8. | Article | PubMed
  51. Esmaeli B, Hidaji L, Adinin RB, Faustina M, Coats C, Arbuckle R, Rivera E, Valero V, Tu SM and Ahmadi MA. Blockage of the lacrimal drainage apparatus as a side effect of docetaxel therapy. Cancer. 2003; 98:504-7. | Article | PubMed
  52. Albert DM, Wong VG and Henderson ES. Ocular complications of vincristine therapy. Arch Ophthalmol. 1967; 78:709-13. | Article | PubMed
  53. Alexander P. Radiation-imitating chemicals. Sci Am. 1960; 202:99-108. | Article | PubMed
  54. Sanderson PA, Kuwabara T and Cogan DG. Optic neuropathy presumably caused by vincristine therapy. Am J Ophthalmol. 1976; 81:146-50. | Article | PubMed
  55. Sandler SG, Tobin W and Henderson ES. Vincristine-induced neuropathy. A clinical study of fifty leukemic patients. Neurology. 1969; 19:367-74. | Article | PubMed
  56. Shurin SB, Rekate HL and Annable W. Optic atrophy induced by vincristine. Pediatrics. 1982; 70:288-91. | Article | PubMed
  57. Byrd RL, Rohrbaugh TM, Raney RB, Jr. and Norris DG. Transient cortical blindness secondary to vincristine therapy in childhood malignancies. Cancer. 1981; 47:37-40. | Article | PubMed
  58. Ripps H, Carr RE, Siegel IM and Greenstein VC. Functional abnormalities in vincristine-induced night blindness. Invest Ophthalmol Vis Sci. 1984; 25:787-94. | Article | PubMed
  59. Schacter L. Etoposide phosphate: what, why, where, and how? Semin Oncol. 1996; 23:1-7. | Article | PubMed
  60. Hilliard LM, Berkow RL, Watterson J, Ballard EA, Balzer GK and Moertel CL. Retinal toxicity associated with cisplatin and etoposide in pediatric patients. Med Pediatr Oncol. 1997; 28:310-3. | Article | PubMed
  61. Vizel M and Oster MW. Ocular side effects of cancer chemotherapy. Cancer. 1982; 49:1999-2002. | Article | PubMed
  62. Kaiser-Kupfer MI, Kupfer C and Rodrigues MM. Tamoxifen retinopathy. A clinicopathologic report. Ophthalmology. 1981; 88:89-93. | PubMed
  63. Kaiser-Kupfer MI and Lippman ME. Tamoxifen retinopathy. Cancer Treat Rep. 1978; 62:315-20. | Article | PubMed
  64. Pavlidis NA, Petris C, Briassoulis E, Klouvas G, Psilas C, Rempapis J and Petroutsos G. Clear evidence that long-term, low-dose tamoxifen treatment can induce ocular toxicity. A prospective study of 63 patients. Cancer. 1992; 69:2961-4. | Article | PubMed
  65.  Ashford AR, Donev I, Tiwari RP and Garrett TJ. Reversible ocular toxicity related to tamoxifen therapy. Cancer. 1988; 61:33-5. | Article | PubMed
  66. Gorin MB, Day R, Costantino JP, Fisher B, Redmond CK, Wickerham L, Gomolin JE, Margolese RG, Mathen MK, Bowman DM, Kaufman DI, Dimitrov NV, Singerman LJ, Bornstein R and Wolmark N. Long-term tamoxifen citrate use and potential ocular toxicity. Am J Ophthalmol. 1998; 125:493-501. | Article | PubMed
  67. Howell A, Cuzick J, Baum M, Buzdar A, Dowsett M, Forbes JF, Hoctin-Boes G, Houghton J, Locker GY and Tobias JS. Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial after completion of 5 years' adjuvant treatment for breast cancer. Lancet. 2005; 365:60-2. | Article | PubMed
  68. Rituximab prescribing information. Retreived on 18-12-2011. | Website
  69. Alemtuzumab prescribing information. Retreived on 18-12-2011.
  70. Foerster CG, Cursiefen C and Kruse FE. Persisting corneal erosion under cetuximab (Erbitux) treatment (epidermal growth factor receptor antibody). Cornea. 2008; 27:612-4. | Article | PubMed
  71. Panitumumab prescribing information. Retreived on 18-12-2011. | Pdf
  72. Bevacizumab  prescribing  information. Retreived on 18-12-2011. | Pdf
  73. US-FDA newsroom report. Retrieved on 18-12-2011. | Website
  74. Imatinib prescribing information. Retreived on 18-12-2011. | Website
  75. Nilotinib prescribing information. Retreived on 18-12-2011. | Pdf
  76. ZELBORAF  full prescribing information. Retrieved on 18-12-2011. | Pdf
  77. Tarceva full  prescribing information. Retrieved on 18-12-2011. | Pdf
  78. Afinitor full prescribing information. Retrieved on 18-12-2011. | Pdf
ISSN 2049-7962
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Singh P and Singh A: Ocular adverse effects of Anti-cancer Chemotherapy. journal of Cancer Therapeutics and Research 2012, 1:5 http://dx.doi.org/10.7243/2049-7962-1-5

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