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Pathogenesis and treatment of ocular surface diseases associated with antibody-drug conjugates: a scoping review
Journal article   Open access   Peer reviewed

Pathogenesis and treatment of ocular surface diseases associated with antibody-drug conjugates: a scoping review

Annie Zhang, Courtney Oliver and Meghan K. Berkenstock
ANNALS OF EYE SCIENCE, v 11, 18
30 Jun 2026
DOI: https://doi.org/10.21037/aes-25-45
url
https://doi.org/10.21037/aes-25-45View
Published, Version of Record (VoR) Open

Abstract

Life Sciences & Biomedicine Science & Technology Ophthalmology
Background: Antibody-drug conjugates (ADCs) represent a growing class of targeted cancer therapies. While ADCs offer a promising therapeutic approach with high efficacy, they are also associated with the development of ocular surface diseases (OSDs). The objective of this review is to review the current knowledge of the incidence, mechanisms, and management of OSDs associated with ADCs approved by the United States Food and Drug Administration (FDA). Methods: A comprehensive literature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews (PRISMA-ScR) guidelines was conducted to identify all FDA-approved ADCs and their associated OSDs, focusing on studies published from January 1, 2000 through May 31, 2025. Databases searched included PubMed, Cochrane Library, and ScienceDirect. Eligible studies included clinical trials, cohort studies, case series, and case reports describing OSD or ocular toxicity associated with FDA-approved ADCs. Non-peer-reviewed literature, editorials, reviews, and studies without ocular outcome data were excluded. Results: Forty-five studies were included, comprising phase I-III clinical trials, case reports, meta-analyses, and pharmacovigilance studies, with varied sample sizes between articles ranging from one patient to over 1,000 patients. The incidence of OSD varies widely among ADCs. Belantamab mafodotin demonstrated the highest reported incidence (>80%), followed by mirvetuximab soravtansine (up to 61%) and tisotumab vedotin (up to 55%), with common manifestations including keratopathy, dry eye symptoms, conjunctivitis, and photophobia. Other ADCs demonstrated lower or variable rates of OSDs. Reports involving brentuximab vedotin and inotuzumab ozogamicin were limited by small sample sizes. Conclusions: OSDs occur due to direct and indirect epithelial toxicity and immune-mediated pathways, with clinical severity ranging from mild ocular surface irritation to ulcerative keratitis requiring treatment interruption or dose modification. Prophylactic and therapeutic strategies, such as preservative-free artificial tears, topical corticosteroids, and close ophthalmologic monitoring are highly recommended. Given the high incidence of OSDs with ADC therapies, early identification and multidisciplinary management involving oncologists and ophthalmologists are critical. These findings highlight the need for increased awareness to ensure early detection and timely management. Continued research is critical to clarify the underlying mechanisms of these toxicities, identify the highest risk patients, and implement mitigation strategies to minimize the development of OSDs.

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