Ocular Adverse Effects of Gefitinib: A Case Report

Abstract

Gefitinib is a selective epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor. It is used for treating locally advanced or metastatic non-small cell lung carcinoma and is well tolerated systemically. However, sight-threatening ocular adverse effects, like corneal ulcer and perforation, can occur due to the expression of EGFR on limbal and conjunctival epithelia. In this report, we describe a case of a 36-year-old female who presented with loss of eyebrow hair and eyelashes of both eyes and blurring of vision in the right eye. On ocular examination, the patient had anterior blepharitis, madarosis, punctuate epithelial erosions and reduced corneal sensation in both eyes, and corneal thinning in the right eye. On specular microscopy, there was decreased central corneal thickness in both eyes. Treatment with topical antibiotics and lubricating drops led to the resolution of blepharitis and punctate epithelial erosions. This case report aims to create awareness among ophthalmologists and oncologists about the early detection of gefitinib-related ocular adverse effects and timely intervention in patients.

Uncommon Blepharitis

“…The identification of EGFR as an oncogene has led to the development of anticancer therapeutics directed against EGFR (called "EGFR inhibitors", EGFRi), including gefitinib [40], erlotinib [41], afatinib, brigatinib, and icotinib [42,43] for lung cancer, and cetuximab for colon cancer. However, sight-threatening ocular adverse effects, like corneal ulcers and perforation, can occur due to the expression of EGFR on limbal and conjunctival epithelia [44]. This therapy is often associated with severe trichiasis (misdirection of lashes), trichomegaly (thickening of lashes), and hypertrichosis (increased number of lashes and brow hairs) [45].…”