Radiotherapy-Induced Ocular Surface Disease

Abstract

Today radiation is routinely used as a therapeutic modality for select tumors of the orbit, adnexa, paranasal sinus, and nasopharynx. Despite significant improvements in mechanisms of delivery and protective shielding, acute and chronic complications of radiation can affect different segments of the eye. In this report, we provide an overview of ocular damage secondary to radiotherapy. We identify the characteristic clinical changes and underlying pathophysiologic mechanisms involving the ocular surface and provide a rational approach to their prevention and treatment.

Ocular Risks From Orbital and Periorbital Radiation Therapy: A Critical Review

“…Corneal ulceration may occur as a consequence of corneal epithelial or stromal destruction, especially with fractionated radiation doses >60 Gy and has been reported with 20 Gy delivered in a single dose (30). Corneal ulcers typically cause pain, redness, discharge, tearing, photophobia, and decreased vision.…”

“…With moderate-dose orbital RT (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45), the time from radiotherapy to dry eye syndrome was reported to be 4 to 11 years, whereas with higher doses (>57 Gy), corneal vascularization and opacification secondary to ocular dryness were usually apparent within 9 to 10 months (18). Very rarely, dry eye syndrome complicated by secondary infection can cause ocular perforation.…”

“…Corneal edema has been reported after 40 to 50 Gy, resulting from loss of the intact corneal epithelial barrier or endothelial dysfunction (30).Corneal edema can be transient or may persist indefinitely. Depending on the time course, the amount of edema, and its location in relation to the visual axis, patients may be asymptomatic or may complain of photophobia, foreign body sensation, tearing, pain, haloes, or decreased vision.…”

Medical Issues in Cancer Survivors—A Review

“…Late complications of radiation are dose-dependent and also include the development of dry eyes because of lacrimal gland dysfunction, decreased corneal sensation, and changes in the surface of the cornea or ulceration. 76 Radiation induced damage to the retina and the optic nerve can result in significant loss of vision. Radiation retinopathy may present as a vascular disease of the retina similar to diabetic retinopathy with retinal hemorrhages, microaneurysms, retinal ischemia, and macular edema.…”

Influence of single-fraction Gamma-Knife radiosurgery on ocular surface and tear function in choroidal melanoma patients

“…This may result in the development of dry eye syndrome (DES), causing severe patient discomfort. Ocular morbidity varies for each technique used, depending on total dose, location and volume of the tumour and fractionation 3 4…”