Review highlights variability in dry eye disease rates among immune checkpoint inhibitor users

Dry eye disease (DED) occurs in about 2% of patients treated with immune checkpoint inhibitors (ICIs), according to a study that found most cases are mild and manageable with topical treatment.

Across 13 studies, the pooled incidence of DED among patients receiving ICIs was 2%. However, reported rates varied widely from 0.2% to 65%, which the researchers suggested was likely due to differences in diagnostic criteria, monitoring, and case detection.

The pooled incidence of combined CTLA-4 and PD-1 treatment was 25% compared with 5% for CTLA-4 monotherapy, 13% for PD-1 inhibitors, and 15% for PD-L1 inhibitors, although these subgroup differences were not statistically significant (P = 0.18).

Rates also differed by cancer type. Lung cancer cohorts had higher observed DED rates (41%) compared with melanoma (4%) and renal cancer cohorts (32%) (P = 0.05), though these differences may reflect variations in surveillance and referral patterns.

Results were consistent with immune-related dysfunction of the lacrimal glands. Abnormal Schirmer test results were reported in 62% of symptomatic patients. Most DED events were mild and managed with topical therapy, while a smaller number required systemic immunomodulation.

Reference
Chen KY, Chan HC, Chan CM. What is the incidence and clinical significance of dry eye disease in patients treated with immune checkpoint inhibitors? A systematic review and meta-analysis of ocular immune-related adverse events. Acta Ophthalmol. 2026;doi: 10.1111/aos.70058. Epub ahead of print. PMID: 41800487.