title: Spontaneous healing of corneal perforation after temporary discontinuation of erlotinib treatment.
abstract: OBJECTIVE
  To report a case of corneal perforation associated with oral administration of erlotinib and its spontaneous healing after temporary discontinuation of drug treatment.
  
  
  METHODS
  A 65-year-old man with metastatic lung cancer was treated with erlotinib (150 mg/day), a specific tyrosine kinase inhibitor of the epidermal growth factor receptor. He was referred to our corneal service for the treatment of bilateral corneal disorders, diagnosed with mild aqueous-deficient dry eye, and treated by insertion of punctal plugs. His corneal epithelial disorders initially improved, but subsequently worsened, as manifested by the development of bilateral corneal ulceration with corneal perforation in the right eye. The oral administration of erlotinib was interrupted in preparation for tectonic keratoplasty, but 2 days later the corneal perforation of the right eye and the bilateral epithelial defects had healed spontaneously. Treatment with erlotinib was resumed at half the initial dose, and the cornea of both eyes has remained apparently healthy.
  
  
  CONCLUSIONS
  Erlotinib may be secreted into tear fluid and thereby adversely affect the corneal epithelium. The development of corneal epithelial disorders in patients receiving this drug may be reversed by reducing its dose.
authors.affiliation: Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Ube, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Morishige
authors.affiliation: Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Ube, Japan.
authors.forename: Nanami
authors.initials: N
authors.lastname: Hatabe
authors.affiliation: Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Ube, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Morita
authors.affiliation: Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Ube, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Yamada
authors.affiliation: Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Ube, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kimura
authors.affiliation: Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Ube, Japan.
authors.forename: Koh-Hei
authors.initials: KH
authors.lastname: Sonoda
keywords: Corneal perforation; Erlotinib; Punctal plug