This study was done 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.

996 patients taking immune checkpoint inhibitors at a single centre were retrospectively reviewed. 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. The checkpoint inhibitor most often preceding side effects was pembrolizumab in 43%. The most common side effect was dry eye in 57%, followed by uveitis in 14%patients, and singular cases of ptosis and binocular diplopia, among others. Ocular surface adverse effects occurred more frequently with 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 46% patients, with mean duration of 20 months. Of these patients, the ophthalmic side effects were controlled without discontinuing therapy in 92%. Checkpoint inhibitor cessation was required in one patient with panuveitis.

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.