| Lacrimal glands: decreased tear production |
Chemotherapy: Fluorouracil (5-FU) |
Dry, irritated red eye, foreign-body sensation, positive fluorescein staining |
Penlight/slit lamp exam, fluorescein staining |
Tear replacement, occlude lacrimal puncta, education regarding avoiding rubbing lids when puncta plug is intact |
|
Radiation: >50 Gy |
| Lacrimal duct: fibrosis |
Chemotherapy: 5-FU |
Tearing |
Ophthalmic exam |
Dilation of duct |
|
Radiation: >50 Gy |
| Eyelids: |
| Ulceration |
Radiation: >50 Gy |
Blepharitis, bleeding/crusted lesion, previous infections |
Physical exam |
Topical/oral steroids, skin balm; teach: lid hygiene, radiosensitizing drugs, UV protection; avoid trauma, harsh soaps and lotions |
| Telangiectasia |
Radiation: >50 Gy |
Enlarged, tortuous blood vessels, pigmentary changes |
Slit lamp/penlight exam, open and closed eyelid exam |
Topical/oral steroids, skin balm; teach: lid hygiene, radiosensitizing drugs, UV protection; avoid trauma, harsh soaps and lotions |
| Conjunctiva: |
| Necrosis |
Radiation: Radioactive plaque therapy |
Dry, irritated eye, foreign-body sensation |
Slit lamp/penlight exam, fluorescein stain |
Steroids/antibiotic drops |
| Scarring |
Radiation: >50 Gy |
Irregular, rough conjunctival surface, telangiectasia |
— |
Tear replacement (resolves spontaneously) |
| Subconjunctival hemorrhage |
Radiation: >45 Gy |
Irritated eye, foreign-body sensation, dry, irregular conjunctival surface |
— |
Patching, tear replacement |
| Sclera: thinning |
Radiation: >50 Gy |
May be asymptomatic, dry eyes, foreign-body sensation; grey, charred, blue sclera |
Slit lamp/penlight exam |
Antibiotic drops, avoid trauma, protective glasses |
| Cornea: ulceration |
Radiation: >45 Gy |
Pain, foreign-body sensation, decreased visual acuity, photosensitivity |
Slit lamp/penlight exam, fluorescein staining |
Tear replacement, antibiotics, soft bandages, soft contact lens, surgery, ophthalmology |
| Neovascularization |
Radiation: >50 Gy |
Increased tearing, increased vessels surrounding edge of cornea |
Slit lamp exam |
Tear replacement, antibiotics, soft bandages, soft contact lens, surgery, ophthalmology |
| Keratinization |
Radiation: >50 Gy |
Decreased corneal sensation, photosensitivity, fluorescein staining |
Slit lamp exam, fluorescein staining |
— |
| Edema |
Radiation: >40 Gy |
Decreased visual acuity, hazy cornea |
Penlight/slit lamp exam: white, opaque cornea |
— |
| Lens: cataract |
Chemotherapy: Steroids (incidence varies with dose) |
Decreased visual acuity, opaque lens |
Direct ophthalmoscopic exam, decreased red reflex, slit lamp/penlight exam: opaque lens |
Prevention by shielding during treatment, surgical removal, educate regarding UV protection |
|
Radiation: >8 Gy (single dose), >10–15 Gy
(fractionated) |
| Iris: |
| Neovascularization |
Radiation: >50 Gy |
May be asymptomatic, new blood vessels in iris (rubeosis), blood in anterior chamber, different colored irises |
Slit lamp/penlight exam |
Steroid drops |
| Secondary glaucoma |
— |
Eye pain, headache, nausea/vomiting, decreased peripheral vision, increased intraocular pressure |
Measure ocular pressure |
Beta blocker drops, atropine, acetazolamide (Diamox) |
| Atrophy |
Radiation: >50 Gy |
Decreased iris stroma at pupillary margin |
Slit lamp/penlight exam |
Photocoagulation |
| Retina: |
| Infarction |
Radiation: >50 Gy |
Blanched white cotton specks, decreased visual acuity, decreased visual field, blurred vision (central or peripheral), blood vessels: yellow fluid, bleeding, thin, incompetent vessels, tortuous, enlarged vessels |
Visual acuity, visual field (confrontation computerized or Amsler grid), direct and indirect ophthalmoscope exam, fundus photography |
Steroids, photocoagulation, education regarding avoiding aspirin and bleeding precautions |
| Exudates |
Radiation: >50 Gy |
— |
Visual acuity, visual field (confrontation computerized or Amsler grid), direct and indirect ophthalmoscope exam, fundus photography |
Steroids, photocoagulation, education regarding avoiding aspirin and bleeding precautions |
| Hemorrhage |
Radiation: >50 Gy |
— |
Visual acuity, visual field (confrontation computerized or Amsler grid), direct and indirect ophthalmoscope exam, fundus photography |
Steroids, photocoagulation, education regarding avoiding aspirin and bleeding precautions |
| Telangiectasia |
Radiation: >50 Gy |
— |
Visual acuity, visual field (confrontation computerized or Amsler grid), direct and indirect ophthalmoscope exam, fundus photography |
Steroids, photocoagulation, education regarding avoiding aspirin and bleeding precautions |
| Neovascularization |
Radiation: >50 Gy |
— |
Visual acuity, visual field (confrontation computerized or Amsler grid), direct and indirect ophthalmoscope exam, fundus photography |
Steroids, photocoagulation, education regarding avoiding aspirin and bleeding precautions |
| Macular edema visual acuity and visual field |
— |
Blister of fluid in the macula |
Visual acuity, visual field (confrontation computerized or Amsler grid), direct and indirect ophthalmoscope exam, fundus photography |
Steroids, photocoagulation, education regarding avoiding aspirin and bleeding precautions |
| Optic neuropathy |
Radiation: >50 Gy |
Pale optic disc, abnormal pupillary responses |
Visual evaluation |
Visual aids |
|
Surgery: Tumor resection |
