title: Cyclosporine for Dry Eye Associated With Nivolumab: A Case Progressing to Corneal Perforation.
abstract: OBJECTIVE
  To present the clinical outcome of 2 cases of severe dry eye associated with Nivolumab, with 1 case progressing to corneal perforation.
  
  
  METHODS
  Case report.
  
  
  METHODS
  : A 58-year-old man with metastatic melanoma was referred for the management of severe bilateral dry eyes after undergoing his sixth cycle of Nivolumab. The right eye progressed to corneal perforation 4 weeks after referral, after which Nivolumab was discontinued. When metastatic disease recurred, Nivolumab was continued with an ocular surface stabilized with an intensive regimen that included topical cyclosporine.
  
  
  METHODS
  : A 46-year-old woman with metastatic melanoma was referred for severe dry eye symptoms around the timing of her third cycle of Nivolumab. Improvement of symptoms and surface staining was achieved with a regimen that included aggressive lubrication and topical cyclosporine. On follow-up after completing Nivolumab therapy, metastatic melanoma has remained regressed.
  
  
  CONCLUSIONS
  Nivolumab can cause or worsen dry eye disease to the point of corneal perforation. Given that its antitumor effect is immune-mediated, therapies targeting ocular surface inflammation can be effective for stabilizing dry eye disease in patients who continue treatment with Nivolumab.
authors.affiliation: *Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT; and †Department of Internal Medicine, Yale School of Medicine, Smilow Cancer Hospital at Yale-New Haven Hospital, New Haven, CT.
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Nguyen
authors.forename: Maxwell
authors.initials: M
authors.lastname: Elia
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Materin
authors.forename: Mario
authors.initials: M
authors.lastname: Sznol
authors.forename: Jessica
authors.initials: J
authors.lastname: Chow
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D057112:Corneal Perforation / Q000188:drug therapy*; D016572:Cyclosporine / Q000627:therapeutic use*; D015352:Dry Eye Syndromes / Q000139:chemically induced / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D000077594:Nivolumab; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D000077594:Nivolumab; D016572:Cyclosporine