EC Ophthalmology

Importance: Systemic and targeted anticancer therapies prolong survival but may be associated with ocular adverse events (OAEs) that can impair vision and quality of life.

Objective: To systematically review ocular toxicities associated with systemic and targeted anticancer therapies, focusing on clinical manifestations, mechanisms, and management.

Methods: This systematic review was conducted in accordance with PRISMA 2020 guidelines. PubMed, Embase, and the Cochrane Library were searched from inception through June 2025 for studies reporting ocular adverse events related to systemically administered anticancer therapies. Eligible publications included clinical trials, observational studies, case series, and case reports. Two reviewers independently screened studies and extracted data. Due to substantial clinical and methodological heterogeneity, findings were synthesized qualitatively.

Findings: After screening and eligibility assessment, studies describing a wide spectrum of ocular toxicities were included. Reported adverse events ranged from mild ocular surface disease to sight-threatening complications such as uveitis, retinal vascular occlusion, and optic neuropathy. The pattern of toxicity varied by drug class, with antimetabolites frequently associated with lacrimal drainage obstruction, hormonal therapies with maculopathy, mitotic inhibitors with neuro-ophthalmic complications, and targeted or immune-based therapies with inflammatory and vascular events. Most ocular adverse events improved with early recognition, ophthalmic management, and modification of systemic therapy.

Conclusions and Relevance: Ocular toxicities of anticancer therapies are uncommon but clinically meaningful. Risk-based ophthalmic screening, patient education, prompt referral, and multidisciplinary collaboration are essential to preserve vision and maintain oncologic treatment adherence.

Keywords: Ocular Toxicity; Chemotherapy; Targeted Therapy; Immunotherapy; Anticancer Drugs; Ophthalmic Adverse Events

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