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Treatment
Table 10. Ocular Toxicities
Evaluation, under the guidance of ophthalmology:
• Check vision in each eye separately
• Color vision
• Red reflex
• Pupil size, shape, and reactivity
• Fundoscopic examination
• Inspection of anterior part of eye with penlight
• Slight lamp exam
• Eye pressure
• Need to rule out Myasthenia Gravis
Prior Conditions:
• Exclude patients with history of active uveitis.
• History of recurrent uveitis requiring systemic immunosuppression or continuous
local therapy.
Additional considerations:
• Clinicians should be aware that ocular irAEs commonly accompany other organ
irAEs, and there should be a high level of clinical suspicion, as symptoms may not
always be associated with severity. Patients with all grades of ocular symptoms should
be referred to ophthalmolog y.
10.1 Uveitis/Iritis
Workup/Evaluation: As per 10.0
Ophthalmolog y consult should be universal for the symptoms described in 10.0.
Grading Management
G1: Anterior uveitis with trace
cells
• Continue ICPi
• Prompt referral to ophthalmology (usually within
1 week)
• Artificial tears
G2: Anterior uveitis with 1+ or
2+ cells
• Hold ICPi temporarily until after
ophthalmolog y consult.
• Urgent ophthalmolog y referral.
• Topical corticosteroids (e.g., 1% prednisolone
acetate suspension), cycloplegic agents (e.g.,
atropine), systemic corticosteroids.
• May resume ICPi treatment once off systemic
steroids if patient has only ocular irAE,
once corticosteroids are reduced to ≤10 mg
prednisone equivalent. Continued topical/
ocular steroids are permitted when resuming
therapy to manage and minimize local toxicity.
• Retreat after return to ≤G1.
