# Eye care with antibody-drug conjugates that harm the cornea: belantamab, mirvetuximab, tisotumab and enfortumab

Source: https://onco.cc/protocols/eye-care-with-ocular-toxic-antibody-drug-conjugates/  
OnCo record `eye-care-with-ocular-toxic-antibody-drug-conjugates` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Some antibody-drug conjugates damage the front surface of the eye (the cornea), causing dry, gritty or painful eyes and blurred vision. With belantamab, mirvetuximab and tisotumab, an eye specialist examines you before and during treatment, you use eye drops on a schedule, and no contact lenses. Report any change in your sight at once: the dose can be paused or lowered, and most problems improve.

## Summary

Four antibody-drug conjugates have ocular warnings in their US labels. Belantamab mafodotin (BLENREP) has a boxed warning and is available only through a REMS: an eye care professional performs a slit lamp examination and best-corrected visual acuity (BCVA) at baseline (within 4 weeks before the first dose) and before every dose (within 10 days), patients use preservative-free artificial tears at least four times a day, and avoid contact lenses; doses are held and reduced by a grade built from corneal findings and loss of Snellen lines. In DREAMM-7, ocular toxicity occurred in 92 per cent and 83 per cent needed a dose modification for it. Mirvetuximab soravtansine (ELAHERE) has a boxed warning: examination with visual acuity and slit lamp before starting, every other cycle for the first 8 cycles and as indicated; corticosteroid eye drops six times daily from the day before each infusion to day 4, then four times daily on days 5 to 8; lubricating drops at least four times daily. Tisotumab vedotin (TIVDAK) has a boxed warning: examination before every cycle for the first nine cycles; a steroid drop before each infusion and three times daily for 72 hours after; a vasoconstrictor drop immediately before each infusion; cold packs over the eyes throughout the infusion; lubricating drops for the whole of treatment and 30 days after. Enfortumab vedotin (PADCEV) has no box: monitor, consider artificial tears for prophylaxis, and an eye examination if symptoms occur.

Where sources differ: the US BLENREP label permanently stops the drug after a recurrent grade 4 finding, while a 2025 Latin American expert panel (haematologists and ophthalmologists) held that no ocular event mandates permanent discontinuation and that dose decisions should give priority to myeloma control. The labels for mirvetuximab and tisotumab require steroid drops; the BLENREP label does not instruct them, and the panel leaves them to the ophthalmologist.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: ADC eye care; ADC ocular toxicity; Blenrep eye exams; Blenrep REMS; Elahere eye drops; Tivdak eye drops and cold packs; keratopathy with antibody-drug conjugates; corneal toxicity with ADCs
- Tags: protocol; ocular-toxicity; antibody-drug-conjugate; supportive-care

## Connected records

- cancers: [Bladder & urothelial cancer](https://onco.cc/cancers/urothelial/), [Multiple myeloma](https://onco.cc/cancers/multiple-myeloma/), [Platinum-resistant ovarian cancer](https://onco.cc/cancers/platinum-resistant-ovarian-cancer/), [Recurrent or metastatic cervical cancer](https://onco.cc/cancers/recurrent-metastatic-cervical-cancer/), [Relapsed or refractory multiple myeloma](https://onco.cc/cancers/myeloma-relapsed-refractory/)
- fronts: [Antibody-Drug Conjugates](https://onco.cc/fronts/adcs/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Antibody-drug conjugate (ADC)](https://onco.cc/technologies/adc/)
- drugs: [Belantamab mafodotin](https://onco.cc/drugs/belantamab-mafodotin/), [Enfortumab vedotin](https://onco.cc/drugs/enfortumab-vedotin/), [Mirvetuximab soravtansine](https://onco.cc/drugs/mirvetuximab-soravtansine/), [Tisotumab vedotin](https://onco.cc/drugs/tisotumab-vedotin/)
- terms: [Living with an antibody-drug conjugate: diarrhoea, blood counts, eyes and lungs](https://onco.cc/terms/adc-side-effects-breast/), [Ocular toxicity (keratopathy, blurred vision)](https://onco.cc/terms/ocular-toxicity/)

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