Periocular Manifestations of Afatinib Therapy

Ophthalmic Plast Reconstr Surg. 2019 Jan/Feb;35(1):e12-e13. doi: 10.1097/IOP.0000000000001277.


Epidermal growth factor receptor tyrosine kinase inhibitor therapy has been increasingly employed in the treatment of a variety of tumors. The authors report the rarely documented side effect of trichiasis with the use of Afatinib in a patient with spinal chordoma and review-related literature. A 67-year-old lady was referred to the oculoplastic service with a 3-month history of ocular irritation and pain associated with blurred vision. She has a 4-year history of spinal chordoma treated with daily Afatinib 50 mg over the past 6 months. Clinical examination revealed trichomegaly and trichiasis affecting all 4 eyelids associated with blepharitis, conjunctival, and corneal abrasion on fluorescein staining. Hypertrichosis of the eyebrow bilaterally was also present. Afatinib and other epidermal growth factor receptor tyrosine kinase inhibitor-associated changes to eyelash and eyebrow hair is a result of epidermal growth factor receptor pathway activation in keratinocytes results in remodeling of the hair follicle. This results in the variation in the severity of clinical presentation of trichiasis.

Publication types

  • Case Reports

MeSH terms

  • Afatinib / adverse effects*
  • Afatinib / therapeutic use
  • Aged
  • Chondroma / drug therapy
  • Eyelids / pathology*
  • Female
  • Humans
  • Protein Kinase Inhibitors / adverse effects
  • Protein Kinase Inhibitors / therapeutic use
  • Slit Lamp Microscopy
  • Spinal Neoplasms / drug therapy
  • Trichiasis / chemically induced*
  • Trichiasis / diagnosis


  • Protein Kinase Inhibitors
  • Afatinib