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Ophthalmic adverse effects of immune checkpoint inhibitors: the Mayo Clinic experience
  1. Blake Hugo Fortes1,
  2. Harris Liou2,
  3. Lauren A Dalvin1
  1. 1 Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 Mayo Clinic School of Medicine – Scottsdale Campus, Scottsdale, Arizona, USA
  1. Correspondence to Lauren A Dalvin, Department of Ophthalmology, Mayo Clinic, 200 1st St SW, Rochester, MN, USA; dalvin.lauren{at}


Background/Aims To investigate immune-related ophthalmic side effects of systemic checkpoint inhibitors and compare side effect frequency and requirement for cessation of immunotherapy by checkpoint target.

Methods Patients taking immune checkpoint inhibitors at a single centre from January 1, 2010 to February 29, 2020 were retrospectively reviewed for clinical characteristics, treatments and concurrent systemic adverse effects.

Results Of 996 patients, 28 (2.8%) experienced an ophthalmic side effect that came to the attention of an eye care provider. Mean age at presentation of the side effect was 63 years (median 64, range 25–88). The checkpoint inhibitor most often preceding side effects was pembrolizumab in 12 (43%). The most common side effect was dry eye in 16 (57%), followed by uveitis in 4 (14%) patients, and singular cases of ptosis and binocular diplopia, among others. Ocular surface adverse effects occurred more frequently with programmed death ligand-1 (PD-L1) targeting therapy. There were no significant differences in the frequency of orbit/ocular adnexa and uveitis or retinal side effects based on checkpoint targets. Follow-up was available in 13 (46%) patients, with mean duration of 20 months (median 16, range 2–52 months). Of these patients, the ophthalmic side effects were controlled without discontinuing therapy in 12 (92%). Checkpoint inhibitor cessation was required in one patient with panuveitis.

Conclusion Ophthalmic immune-related adverse events are rare but could be more common than previously estimated. PD-L1-directed checkpoint inhibitors may have a slight predilection for ocular surface adverse effects. Most ophthalmic events can be treated with targeted therapy without discontinuation of life-prolonging immunotherapy.

  • Immunology
  • Drugs
  • Pharmacology

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  • Twitter Lauren A Dalvin @LADalvinMD.

  • Contributors BHF: investigation, formal analysis, writing of original draft and visualisation. HL: investigation, data curation and writing of original draft. LAD: conceptualisation, methodology, writing—review and editing, and supervision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availbility statement Data are available upon reasonable request.

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