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Ophthalmology for the Oncologist



Dry Eye


Symptoms of dry eyes:

  • grittiness
  • soreness
  • foreign body sensation
  • reduced vision (if severe)

Signs of dry eyes

  • reduced tear film
  • punctuate epithelial erosions (best seen with fluorescein)
  • mucus strands (attached to erosions)

Causes of dry eyes

  • Chemotherapy
    • Methotrexate
    • Cyclophosphamide
    • Busulphan
  • Radiation therapy (to orbit)
    • 0%             after ≤ 30Gy
    • 100%         after ≥ 57Gy
  • Stem Cell / Bone Marrow transplantation (inc. GVHD)
    • 48% symptomatic
    • 62% show clinical signs

Probably caused mainly by adjunctive chemotherapy and radiation

  • Lacrimal gland infiltration eg. ALL

Treatment of dry eyes

  • Artificial tears (p.r.n. or regular)
  • Lubricant ointment (especially at night)
  • Cyclosporin drops useful (especially after GVHD)
  • Punctal plugs (usually temporary)
  • Punctal cautery (usually permanent)
  • Stop cause (eg. Chemotherapy agent)


Clinical Tip :

Dry eye is the commonest ocular symptom of any oncology patient, the easiest to overlook and often amenable to simple treatment.

Try simple off-the-counter lubricant drops as an empirical treatment.


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