Can cancer treatment impact my eyes and vision?

Nagham Al-Zubidi, ophthalmologist at the University of Texas MD Anderson Cancer Center in Houston

Many cancer treatments can affect your eyes and vision in a variety of ways. Some mild eye-related side effects, such as dryness or blurred vision, can resolve on their own, but serious side effects can impact your vision in the long term.

Traditional chemotherapy can damage the macula, a part of the retina at the back of the eye that’s important for central vision, which you rely on to do things like read, drive and see faces. People undergoing radiation for head and neck cancer or brain cancer also can experience eye changes. When delivered close to the eyes, radiation intended to destroy the cancer may damage the retina and optic nerve, causing vision loss. Radiation can also cause cataracts, a clouding of the lens of the eye that may require surgery.

Newer treatments also can trigger eye-related side effects. Immunotherapy can cause the immune system to attack the eyes, causing inflammation in the eye. Common side effects of immune checkpoint inhibitors, a type of immunotherapy, include dry eyes and uveitis, which is inflammation in the middle layer of your eye that can result in pain, redness and blurred vision. Targeted therapies, such as MEK or EGFR inhibitors, also can cause side effects, including blurred vision and conjunctivitis, which leads to redness and irritation in the white part of your eye.

It’s a good idea to have a baseline eye exam prior to starting a treatment that comes with a risk for eye-related side effects. This exam will alert your health care team of any existing eye conditions, such as macular degeneration or optic nerve damage, that may get worse with treatment. If you have a history of glaucoma or autoimmune disease, doctors may be more cautious about selecting cancer treatments that could worsen your underlying conditions and affect your vision. Talk to your oncologist about these risks.

Your oncologist or ophthalmologist may recommend regularly scheduled eye exams during treatment. If you notice any new eye-related symptoms, including light sensitivity, pain, redness, irritation or vision changes, report them to your health care team right away. If you feel mild eye discomfort or dryness, you likely won’t need to stop treatment and can use artificial tears while doctors monitor you. If the eye symptoms interfere with your daily activities or your doctors are concerned about lasting damage to your vision, you may need to pause or even discontinue treatment until these side effects are under control.

CANCER AND YOUR EYES // CancerCare describes treatment-related eye and vision changes and what to ask your doctor. // Cleveland Clinic explores which specific cancer drugs can cause eye-related side effects.

The expert’s response was edited for clarity and based on an interview with Kendall K. Morgan.