67
Table 10. Ocular Toxicities
G3: Anterior uveitis with 3+
or greater cells; intermediate
posterior or pan-uveitis.
• Permanently discontinue ICPi.
• Urgent ophthalmolog y referral.
• Systemic corticosteroids and intravitreal/
periocular/topical corticosteroids.
• Methotrexate may be used in patients who
respond poorly to systemic corticosteroids
or those with severe sight-threatening
inflammation.
G4: Best corrected visual acuity
of 20/200 or worse in the affected
eye.
• Permanently discontinue ICPi.
• Emergent ophthalmolog y referral.
• Systemic corticosteroids-prednisone 1–2 mg/
kg/day or methylprednisolone 0.8–1.6 mg/
kg/day and intravitreal/periocular/topical
corticosteroids per ophthalmologist opinion.
Additional considerations:
• Consider use of infliximab, other TNFα blockers or IVIG in cases that are severe and
refractory to standard treatment.
10.2 Episcleritis
Workup/Evaluation: As per 10.0
Grading Management
G1: Asymptomatic • Continue ICPi.
• Prompt ophthalmolog y referral (usually within
1 week).
• Artificial Tears.
G2: Vision 20/40 or better • Hold ICPi therapy 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
G3: Symptomatic and vision
worse than 2/40
• Permanently discontinue ICPi.
• Urgent ophthalmolog y referral.
• Systemic corticosteroids and topical
corticosteroids with cycloplegic agents
G4: 20/200 or worse • Permanently discontinue ICPi.
• Emergent ophthalmolog y referral.
• Systemic corticosteroids and topical
corticosteroids with cycloplegic agents
Additional considerations:
• Consider use of infliximab or other TNF-α blockers in cases that are severe and
refractory to standard treatment.
(cont'd)
