Erlotinib-induced dry eye.

Abstract

Erlotinib is a newer, second-line oral antineoplastic drug mainly used in the treatment of non-small cell lung carcinoma, in addition to carcinomas of the pancreas, esophagus, and ovaries.[1] It targets protein tyrosine kinase and inhibits phosphorylation of epidermal growth factor receptor (EGFR), thereby blocking tumor cell proliferation. Other previously reported ocular side effects of erlotinib include trichomegaly, periorbital inflammation, ectropion, and epiphora.[2–4] Case Report A 58-year-old female presented with complaints of persistent irritation and redness in both eyes since a month. She was diagnosed with adenocarcinoma of the lung and had been under treatment with oral EGFR antagonist erlotinib for 6 months. Ocular examination revealed sparse eyelashes, blepharitis, and diffuse conjunctival congestion in both eyes [Fig. 1a]. Fluorescein staining showed punctate epithelial erosions and a tear film breakup time of 9 s [Fig. 1b]. She was diagnosed with erlotinib-induced blepharitis and dry eye; she was started on treatment with topical azithromycin ointment and preservative-free lubricants and was advised lid hygiene and hot fomentation as supportive therapy. Discontinuation of erlotinib was not advised as the tumor was responsive to the therapy and the side effects were tolerable and improved with treatment.Figure 1: (a) Diffuse slit-lamp image showing sparse eyelashes and blepharitis with decreased tear film height. (b) Diffuse slit-lamp image with cobalt blue filter showing punctate epithelial erosions on corneaEGFR receptors are found in the sebaceous glands, hair follicles, capillary system, and basal epidermal cells, and the abundance of these in the periorbital region has been hypothesized to be the reason for the ocular side effects of erlotinib.[2,4] A murine study with topical erlotinib showed it to cause a reduction in goblet cell numbers, ultrastructural changes to the corneal epithelium, and a significant reduction in the tear film breakup time.[5] With foreseeable increase in the use of erlotinib in cancer therapy, it is essential to understand its ocular side effects for appropriate patient education and treatment, which may warrant a concerted management from the ophthalmologist and the oncologist. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.