# Eye side effects of checkpoint inhibitors: dry eye, uveitis and optic neuritis

Source: https://onco.cc/protocols/irae-ocular/  
OnCo record `irae-ocular` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Immunotherapy can occasionally cause dry, gritty eyes or inflammation inside the eye (uveitis), and rarely of the nerve to the eye. Red or painful eyes, sensitivity to light, floaters, blurred or double vision, or drooping eyelids should be reported so an eye specialist can see you. Most is treated with eye drops and immunotherapy usually continues; sudden loss of vision is an emergency.

## Summary

Dry eye (1 to 24% in prospective trials) and uveitis (under 1% to 6%) are the commonest ocular irAEs; optic neuritis, orbital inflammation, thyroid eye disease and eye-movement disorders from myasthenia or myositis also occur (SITC 2021). Most begin within 6 months of starting treatment. Infection and metastasis to the eye must be excluded, and steroids given before an eye examination can worsen an infection or mask the diagnosis.

SITC 2021: ophthalmology input for diagnosis, grading and management; consider referral for grade 1 to 2 symptoms and refer immediately for grade 3 or more; MRI brain with pituitary views if there are ocular or bulbar symptoms; start steroids for eye symptoms only under an ophthalmologist unless needed for another irAE; artificial tears for symptoms.

The 2025 Eye-irAE consensus definitions add disease-specific treatment: anterior uveitis is treated with topical steroid with review every 1 to 2 weeks and the checkpoint inhibitor is not stopped; posterior and panuveitis step up to local injections, with holding the checkpoint inhibitor or oral steroids only if disease progresses; immune-related optic neuritis is treated by withholding the checkpoint inhibitor and giving IV methylprednisolone 1000 mg daily for 3 to 5 days once infection is excluded; dry eye is managed locally and the checkpoint inhibitor usually continues.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: checkpoint inhibitor uveitis; ocular irAEs; Eye-irAEs; immune-related uveitis; immune-related optic neuritis; immune-related dry eye disease; ophthalmic immune-related adverse events
- Tags: protocol; irae; ophthalmology

## Connected records

- protocols: [Checkpoint inhibitor hypophysitis and adrenal insufficiency: emergency treatment, replacement and steroid emergency card](https://onco.cc/protocols/irae-hypophysitis-adrenal/), [Neurological side effects of checkpoint inhibitors: myasthenia gravis, Guillain-Barré syndrome, meningitis and encephalitis](https://onco.cc/protocols/irae-neurological/), [Thyroid inflammation and underactive thyroid from checkpoint inhibitors](https://onco.cc/protocols/irae-thyroid/)
- technologies: [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/)
- drugs: [Atezolizumab](https://onco.cc/drugs/atezolizumab/), [Avelumab](https://onco.cc/drugs/avelumab/), [Cemiplimab](https://onco.cc/drugs/cemiplimab/), [Dostarlimab](https://onco.cc/drugs/dostarlimab/), [Durvalumab](https://onco.cc/drugs/durvalumab/), [Ipilimumab](https://onco.cc/drugs/ipilimumab/), [Methylprednisolone](https://onco.cc/drugs/methylprednisolone/), [Nivolumab](https://onco.cc/drugs/nivolumab/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Tremelimumab](https://onco.cc/drugs/tremelimumab/)
- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/), [European Society for Medical Oncology (ESMO)](https://onco.cc/institutions/esmo/), [Society for Immunotherapy of Cancer](https://onco.cc/institutions/sitc/)
- terms: [Immune-related adverse events (irAEs)](https://onco.cc/terms/irae/)
- key papers: [ASCO 2021 guideline: how to recognise and manage the immune-related side effects of checkpoint inhibitors](https://onco.cc/key-papers/paper-asco-irae-guideline-jco-2021/)

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