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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.
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.
Why: Corneal changes are found on examination before the person notices them, and they decide whether the next dose is given in full, reduced or held.
“Perform baseline exam within 4 weeks prior to the first dose. Perform each follow-up exam within 10 days prior to the next planned dose.”
GlaxoSmithKline, via DailyMed (US National Library of Medicine) 2026 · US prescribing information (boxed warning)
Why: In the US the drug can only be prescribed, dispensed and given by certified prescribers and settings, so that every person is counselled and monitored.
“Prescribers must counsel patients receiving BLENREP on the risk of ocular toxicity, the need for monitoring via ophthalmic exams before each dose, and provide patients with the BLENREP REMS Patient Guide.”
GlaxoSmithKline, via DailyMed (US National Library of Medicine) 2026 · US prescribing information (REMS)
Why: Lubricating the eye eases dryness and grittiness; contact lenses can worsen damage to the corneal surface.
“Counsel patients to use preservative‑free artificial tears at least 4 times a day starting with the first infusion and continuing until the end of treatment, and to avoid wearing contact lenses for the duration of therapy.”
GlaxoSmithKline, via DailyMed (US National Library of Medicine) 2026 · US prescribing information
Why: Holding the drug lets the cornea recover; most changes resolve, and a lower dose lowers the chance they return.
“Withhold BLENREP until improvement in both corneal exam findings and change in BCVA to Grade 1 or less. Resume treatment at Reduced Dosage Level 1 as per Table 1 . If recurrent Grade 2 or 3 ocular toxicity is experienced, resume treatment at Reduced Dosage Level 2.”
GlaxoSmithKline, via DailyMed (US National Library of Medicine) 2026 · US prescribing information (Table 2)
Why: Blurred vision can make driving and reading unsafe.
“Changes in visual acuity may be associated with difficulty for driving and reading. Counsel patients to use caution when driving or operating machinery.”
GlaxoSmithKline, via DailyMed (US National Library of Medicine) 2026 · US prescribing information
Why: Eye problems usually start in the first weeks; regular checks find them early.
“Refer patients to an eye care professional for an ophthalmic exam including visual acuity and slit lamp exam prior to treatment initiation, every other cycle for the first 8 cycles, and as clinically indicated.”
ImmunoGen, via DailyMed (US National Library of Medicine) 2026 · US prescribing information (boxed warning)
Why: Steroid drops given around each infusion are meant to reduce inflammation of the cornea; the label asks for a slit lamp check first because steroid drops can mask infection or raise eye pressure.
“Administer one drop of ophthalmic topical steroids in each eye 6 times daily starting the day prior to each infusion until day 4; then administer one drop in each eye 4 times daily for days 5-8 of each cycle of ELAHERE”
ImmunoGen, via DailyMed (US National Library of Medicine) 2026 · US prescribing information
Why: Lubricant drops ease dryness; leaving a gap stops them washing the steroid drop out.
“Instruct patients to use lubricating eye drops and advise to wait at least 10 minutes after ophthalmic topical steroid administration before instilling lubricating eye drops”
ImmunoGen, via DailyMed (US National Library of Medicine) 2026 · US prescribing information
Why: Conjunctivitis and corneal damage are common with this drug, and can lead to ulcers if missed.
“Conduct an ophthalmic exam prior to initiation of TIVDAK, prior to every cycle for the first nine cycles, and as clinically indicated. The ophthalmic exam should include visual acuity, slit lamp exam of the anterior segment of the eye, and an assessment of normal eye movement.”
Seagen, via DailyMed (US National Library of Medicine) 2026 · US prescribing information (boxed warning)
Why: The steroid calms inflammation; the vasoconstrictor narrows the small vessels of the eye surface so that less drug reaches it during the drip.
“Instruct patients to administer one drop in each eye prior to each infusion and to continue to administer eye drops in each eye three times daily for 72 hours after each infusion.”
Seagen, via DailyMed (US National Library of Medicine) 2026 · US prescribing information
Why: Cooling also narrows the vessels, again reducing how much drug reaches the eye surface.
“Apply cold packs fully over the eyes following administration of the vasoconstrictor eye drops. Change cold packs as needed throughout infusion to ensure eye area remains cold during the entire infusion”
Seagen, via DailyMed (US National Library of Medicine) 2026 · US prescribing information
Why: Eye problems can appear after treatment stops; in the main trial some began more than 30 days after the last dose.
“Topical lubricating eye drops: Instruct patients to administer for the duration of therapy and for 30 days after the last dose of TIVDAK.”
Seagen, via DailyMed (US National Library of Medicine) 2026 · US prescribing information
Why: These are signs of damage that could threaten sight if treatment continued.
“Ulcerative keratitis or perforation”
Seagen, via DailyMed (US National Library of Medicine) 2026 · US prescribing information (Table 2)
Why: Dry eye affects about a third of people on enfortumab; it is usually milder than with the other three drugs.
“Consider artificial tears for prophylaxis of dry eyes and ophthalmologic evaluation if ocular symptoms occur or do not resolve.”
Seagen, via DailyMed (US National Library of Medicine) 2026 · US prescribing information (warning, not boxed)
How care is usually carried out, read from the guidelines and standards cited. Your own team's protocol and their judgement come first; this page is for understanding it, not for doing it yourself.
For each drug, the current US prescribing information is the governing protocol: no international guideline on ADC eye care was found. All four share regular examination by an eye care professional, lubricating drops and avoiding contact lenses; they differ in the frequency of examination (every dose for belantamab; every other cycle for 8 cycles for mirvetuximab; every cycle for 9 cycles for tisotumab; on symptoms for enfortumab) and in prophylaxis (steroid drops for mirvetuximab and tisotumab, plus a vasoconstrictor and cold packs for tisotumab; lubricants alone for belantamab). On belantamab, the US label and the 2025 Latin American expert panel disagree on stopping: the label stops the drug after a recurrent grade 4 finding; the panel says no ocular event requires permanent discontinuation, and that dose decisions should give priority to myeloma control and be shared between haematologist and ophthalmologist.
GlaxoSmithKline, via DailyMed (US National Library of Medicine) 2026 · ImmunoGen, via DailyMed (US National Library of Medicine) 2026 · Seagen, via DailyMed (US National Library of Medicine) 2026 · Seagen, via DailyMed (US National Library of Medicine) 2026 · Oncology and Therapy 2025
Where it differs: Examination before each dose, or monthly, for the first 3 months and then as the ophthalmologist decides, rather than before every dose throughout; a simpler mild, moderate and severe grading by ophthalmologists in place of the trial grading scale; topical antibiotics and steroids at the ophthalmologist's discretion; and no ocular event that by itself mandates stopping treatment.
Evidence: Consensus of 13 haematologists, oncologists and ophthalmologists from Argentina, Brazil, Colombia and Mexico, built on discussion, the DREAMM trials and experience; recommendations are not graded. It is written for settings where the drug may be approved and specialist access is uneven.
| Recommendation | Grade, as printed | Source |
|---|---|---|
| Belantamab: ocular toxicity in 92 per cent in DREAMM-7, grade 3 or 4 in 77 per cent “In DREAMM-7, ocular toxicity occurred in 92% of patients, including Grade 3 or 4 in 77% of patients.” | US prescribing information, trial data | GlaxoSmithKline, via DailyMed (US National Library of Medicine) 2026 |
| Mirvetuximab: ocular adverse reactions in 59 per cent of people with ovarian cancer “Ocular adverse reactions occurred in 59% of patients with ovarian cancer treated with ELAHERE.” | US prescribing information, pooled trial data | ImmunoGen, via DailyMed (US National Library of Medicine) 2026 |
| Tisotumab: ocular adverse reactions in 55 per cent of people with cervical cancer “Ocular adverse reactions occurred in 55% of patients with cervical cancer treated with TIVDAK across clinical trials.” | US prescribing information, pooled trial data | Seagen, via DailyMed (US National Library of Medicine) 2026 |
| Belantamab: no ocular event indicates permanent discontinuation (panel view, differs from the US label) “No ocular events indicate permanent discontinuation of belantamab mafodotin treatment.” | expert panel consensus, ungraded | Oncology and Therapy 2025 |
Shares Belantamab mafodotin, Relapsed or refractory multiple myeloma, Multiple myeloma, Antibody-drug conjugate (ADC).
Shares Belantamab mafodotin, Relapsed or refractory multiple myeloma, Multiple myeloma, Antibody-drug conjugate (ADC).
Shares Multiple myeloma and the tags protocol, supportive-care.
Shares Belantamab mafodotin, Relapsed or refractory multiple myeloma, Multiple myeloma, Antibody-drug conjugate (ADC).
Shares Ocular toxicity (keratopathy, blurred vision), Tisotumab vedotin, Belantamab mafodotin, Mirvetuximab soravtansine.
Shares Belantamab mafodotin, Relapsed or refractory multiple myeloma, Multiple myeloma, Antibody-drug conjugate (ADC).
Shares Belantamab mafodotin, Relapsed or refractory multiple myeloma, Multiple myeloma, Antibody-drug conjugate (ADC).
Shares the tags protocol, supportive-care.