angioneurotic edema, urticaria, and depigmentation of the eyelids [1, 2, 31]. Thiotepa may also be associated with poliosis if the eyelashes are directly exposed to the drug [2, 31].

27.2.22 Vincristine

Vincristine is a vinca alkaloid used to treat Hodgkin disease, lymphosarcoma, reticulum cell sarcoma, rhabdomyosarcoma, neuroblastoma, and Wilms tumor. Its use has been associated with ptosis, extraocular muscle paresis with diplopia, and loss of eyelashes and eyebrows [2, 4, 5].

27.3 Summary

Chemotherapeutic agents causing orbital and periorbital side effects have been presented in a format for easy reference in a clinical setting. In order to better determine which agents truly cause orbital and periorbital side effects, reporting of such side effects, whether proven or potential, will need to continue. An excellent central repository of such information for reference and reporting is the National Registry of Drug-Induced Ocular Side Effects at http://www.eyedrugregistry.com/ [1].

Unfortunately, many of the orbital and periorbital side effects of chemotherapy are unavoidable and are expected consequences of current necessary treatment for life-threatening diseases. Management in general consists of being aware of potential side effects and stopping medications that cause serious side effects if stopping will not jeopardize the overall treatment. Supportive treatment such as topical lubrication, eyelid hygiene, and delayed secondary repair of residual effects such as ectropion, symblepharon, strabismus, and ptosis may also be required.

References

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9.Bouche’ O, Brixi-Benmansour H, Bertin A, et al. Trichomegaly of the eyelashes following treatment with cetuximab. Ann Oncol 2005;16:1711–2.

10.Giuseppe T, Vicenzi B, Santini D, et al. Ocular toxicity related to cetuximab monotherapy in an advanced colorectal cancer patient. J Natl Cancer Inst 2005;97:606–7.

11.Margo CE, Murtagh FR. Ocular and orbital toxicity after intracarotid cisplatin therapy. Am J Ophthalmol 1993;116(4):508–9.

12.Kaya AO, Buyukberber S, Coskun U, et al. Acute erythema and edematous skin reaction and ectropion following docetaxel in a patient with non-small cell lung cancer. Cutan Ocul Toxicol 2008;27:327–31.

13.Marquez G, Herrera-Acosta E, Vidal I, et al. A case of trichomegaly of the eyelashes and facial hypertrichosis induced by erlotinib (Tarceva). Int J Dermatol 2009;48(1):97–8.

14.Lane K. Goldstein SM. Erlotinib-associated trichomegaly. Ophthal Plast Reconstr Surg 2007;23(1):65–66.

15.Lauer AK, Wobig JL, Shults WT, et al. Severe ocular and orbital toxicity after intracarotid etoposide phosphate and carboplatin therapy. Am J Ophthalmol 1999;127(2):230–3.

16.Forbes JE, Brazier DJ, Spittle M. 5-Fluorouracil and ocular toxicity. Br J Ophthalmol 1993;77(7):465–6.

17.Hurwitz BS. Cicatricial ectropion: a complication of systemic fluorouracil. Arch Ophthalmol 1993;111:1608–9.

18.Esmaeli B, Prieto VG, Butler CE, et al. Severe periorbital edema secondary to STI571 (Gleevec). Cancer 2002;95:881–7.

19.Grossman WJ, Wilson DB. Hypopigmentation from imatinib mesylate (Gleevec). J Pediatr Hematol Oncol 2004;26:214.

20.Fraunfelder FW, Solomon J, Druker BJ, et al. Ocular side effects associated with imatinib mesylate (Gleevec). J Ocul Pharmacol Ther 2003;19:371–5.

21.Schaich M, Schakel K, Illmer T, et al. Severe epidermal necrolysis after treatment with imatinib and consecutive allogeneic hematopoietic stem cell transplantation. Ann Hematol 2003;82:303–4.

22.Esmaeli R, Diba R, Ahmadi MA, et al. Periorbital oedema and epiphora as ocular side effects of imatinib mesylate (Gleevec). Eye 2004;18(7):760–2.

23.Fraunfelder FW, Solomon J, Druker BJ, et al. Ocular side-effects associated with imatinib mesylate (Gleevec). J Ocul Pharmacol Ther 2003;19:371–5.

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30.Leyden MJ, Sullivan JR, Cheng ZM, et al. Unusual side effect of mitoxantrone. Med J Aust 1983;2(10):514.

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Chapter 28

Ocular and Orbital Infections in the

Immunocompromised Cancer Patient

Viet H. Ho and Hao H. Ho

Abstract Significant progress has been made in the treatment of cancer patients, and the proportion of cancer patients achieving complete remission and longer survival has increased in recent years. However, a significant proportion of patients still do not achieve complete remission, and infection remains a frequent cause of treatment failure, particularly in patients with hematologic malignancies. Ocular and orbital infections are particularly important, not only because of their frequency but also because of the associated local and systemic morbidity. Opportunistic infections can be found in all areas in and around the eye: in extraocular locations (neuro-ophthalmic, orbital, ocular adnexa), in the anterior segment (cornea and conjunctiva), and in the posterior segment (retina and choroid). All opportunistic infections of the eye have their origin in suppression of the host’s immune system. Immune suppression can be acquired as a result of immunosuppressive therapy in solid organ transplant recipients or chemotherapy in patients with myeloproliferative disorders or solid tumors. Neutropenia remains the most important factor predisposing patients to infections.

28.1 Introduction

Cancer is one of the leading causes of death in developed countries. Cancer can be subdivided into two main categories: solid tumors and hematologic malignancies, which include leukemias, lymphomas, and multiple myeloma. Solid tumors account for more than 90% of all new cancer cases and hematologic malignancies for the remaining 5–10% [1]. Over the past decades, advances have resulted in substantial improvements in the prevention, early detection, and treatment of cancer, and the proportion of cancer patients achieving complete remission and longer survival has

V.H. Ho (B)

Danville San Ramon Eye Medical Corp., Danville, CA, USA e-mail: viethuyho@yahoo.com

Oncology Series 6, DOI 10.1007/978-1-4419-0374-7_28,

C Springer Science+Business Media, LLC 2011