Cyclosporine for Dry Eye Associated With Nivolumab: A Case Progressing to Corneal Perforation

Cornea. 2016 Mar;35(3):399-401. doi: 10.1097/ICO.0000000000000724.


Purpose: To present the clinical outcome of 2 cases of severe dry eye associated with Nivolumab, with 1 case progressing to corneal perforation.

Design: Case report.

Case 1: : 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.

Case 2: : 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.

Trial registration: NCT01024231.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antibodies, Monoclonal / adverse effects*
  • Antineoplastic Agents / adverse effects*
  • Corneal Perforation / drug therapy*
  • Cyclosporine / therapeutic use*
  • Dry Eye Syndromes / chemically induced
  • Dry Eye Syndromes / drug therapy*
  • Female
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Male
  • Middle Aged
  • Nivolumab
  • Treatment Outcome


  • Antibodies, Monoclonal
  • Antineoplastic Agents
  • Immunosuppressive Agents
  • Nivolumab
  • Cyclosporine

Associated data