8 cancer treatment-related eye changes and how to manage them

You probably know that cancer treatment can cause side effects like nausea, fatigue and hair loss. But some types of cancer treatment may also cause eye-related side effects that can affect your quality of life, including the quality of your vision, ease of reading or your ability to drive a car safely.

That’s why our Nagham Al-Zubidi, M.D., recommends scheduling an eye exam before beginning cancer treatment. “With good screening and monitoring, eye-related side effects can be prevented or slowed down,” Al-Zubidi says.

Yearly eye exams are critical for identifying vision and eye changes since they give your care team a base line of your current vision and eye function, Al-Zubidi says.

Eye changes from radiation therapy can be long-term

Eye changes are most common in cancer patients who undergo radiation therapy. This is especially true for patients with head and neck cancers, since radiation is delivered close to the eyes. Your care team will deliver the most precise dose to destroy cancer cells. But sometimes radiation can damage the retina and optic nerve, leading to vision loss.

These side effects can first appear up to 18 months after treatment and are often permanent, Al-Zubidi says. Patients who receive radiation in the head and neck area will likely have frequent appointments with an ophthalmologist up to 18 months after treatment, before moving to annual eye exams to monitor any side effects.

It’s important to talk to your care team if you experience any of the following symptoms – even if they’re only minor.

• Sensitivity to light: Avoiding bright lights or wearing glasses with tinted lenses can help you cope with this side effect.
• Loss of eyelashes: Unfortunately, says Al-Zubidi, the loss of eye lashes after radiation therapy is usually permanent. If your eyes water more due to loss of lashes, ask your doctor about different treatment options.
• Vision changes: Changes in your vision can range from simple blurred vision to more serious damage to the optic nerve or retina. You may also notice changes in the way you see colors. “Red is often the first color patients have trouble with when they have optic neuropathy,” Al-Zubidi says.

If you’re experiencing changes in your vision, talk to your doctor for a referral to ophthalmology. You may be referred to a low-vision service like visual rehab or occupational therapy if you have severe vision loss. You may also want to use magnifying glasses for reading and keep a tidy home to avoid tripping.

Certain cancer drugs can cause eye-related side effects

Chemotherapy, immunotherapy and hormone therapy are known to cause different eye problems. Most eye changes related to medications are temporary and go away by adjusting the dose or stopping the drugs.

Common eye-related side effects from these cancer treatments include:

Red, swollen eyelids: Also known as conjunctivitis, this is a condition where eyelids can become red, inflamed, crusty or even filled with pus. To cope, Al-Zubidi suggests keeping your eyes clean and free of crust. “It’s an old method, but a warm compress can really help relieve symptoms,” she says. Just be sure to use a separate towel for each eye to prevent spreading germs from one eye to the other. If you wear contacts, Al-Zubidi recommends wearing glasses until your symptoms get better.

Watery eyes: If your eyes swell, they may start to water. Al-Zubidi suggests applying a warm, wet compresses to help ease swelling and reduce tear production. Also, in some cases, chemotherapy or targeted therapy may block the tear drainage passages and cause excess tear production, so you’ll want to avoid rubbing your eyes. In extreme cases, your eye doctor may recommend a procedure to help the eyes drain more efficiently.

Flashes of light or floaters: Some people experience small dark shapes or bright streaks in their field of vision. These so-called floaters and flashes come and go, and they often don’t require treatment. But sometimes floaters can be a sign of a more serious eye condition. “If you suddenly start seeing repeated flashes or many floaters, this could be a serious problem, and you should seek medical care immediately,” Al-Zubidi says.

Dry eyes: Your eyes may feel very dry, or even gritty, as a result of some types of chemotherapy or targeted therapy drugs. Al-Zubidi recommends using over-the-counter, preservative-free artificial tears. If that doesn’t offer relief, talk with your doctor. You may be a good candidate for a procedure that places small plugs in your tear ducts to help lock in moisture. “The procedure takes only a few minutes in the clinic, and most patients don’t feel a thing,” Al-Zubidi says. Your doctor may suggest temporary plugs, which dissolve after a few months, or semi-permanent ones that last much longer and need to be removed in a separate procedure once your dry eye is resolved.

Eyelash changes: Depending on your treatment, your eyelashes may change color. Sometimes infections like blepharitis can cause eyelashes to grow toward your eye, which can be painful. Your doctor may suggest using artificial tears to help relieve discomfort. The good news, Al-Zubidi says, is eyelashes usually return to normal after you’ve finished treatment, unless you’re receiving radiation therapy.

Cataracts: If you notice cloudy areas in your field of vision, you may have cataracts. Al-Zubidi says these usually need to be removed surgically to prevent damage to your eyesight.

Glaucoma: Severe pressure in the eyes can cause damage to the optic nerve. To relieve the pressure, you may need to have surgery. If left untreated, glaucoma can cause vision loss or even blindness.

If you’re experiencing any of these side effects, talk to your doctor. “The sooner we can treat side effects related to your eyes, we’re more likely to be able to prevent serious damage,” Al-Zubidi says. “If you don’t already see an ophthalmologist, ask your oncologist for a recommendation to help you address vision changes.”

Request an appointment at MD Anderson online or by calling 1-877-632-6789.