Visual impairments associated with the treatment of malignant tumors of the female reproductive system: a literature review and practical recommendations for oncogynecologists

Ophthalmictoxicity has become increasingly relevant upon introduction of novel anticancer agents – targeted therapies, immunotherapies, and endocrine treatments. Women with malignancies of the reproductive system, including ovarian, endometrial, and cervical cancers have been receiving treatments associated with potential visual impairments more frequently. This review consolidates the data on ocular adverse events associated with key drug classes used in gynecologic oncology: BRAF (B-Raf proto-oncogene, serine/threonine kinase) inhibitors, MEK inhibitors (mitogen-activated protein kinase kinase) inhibitors, immune checkpoint inhibitors (ICIs), including PD-1 (programmed cell death protein 1), PD-L1 (programmed cell death-ligand 1), and CTLA-4 (cytotoxic T-lymphocyte-associated protein 4), antiangiogenic agents targeting VEGF (vascular endothelial growth factor) and VEGFR (vascular endothelial growth factor receptor), as well as selective estrogen receptor modulators (SERMs), aromatase inhibitors, and PARP (poly(ADP-ribose) polymerase) inhibitors. Particular attention is paid to the most common and clinically significant toxicities, including uveitis, keratitis, dry eye syndrome, macular edema, retinopathy, optic neuritis, and rarer but severe complications such as retinal vein occlusion and retinal detachment. In addition, it also presents differentiated approaches to diagnosing and managing ophthalmic toxicity related to the specific drug class. The importance of multidisciplinary collaboration between oncologists, gynecologists, and ophthalmologists is emphasized to ensure timely identification and management of visual impairments. Practical recommendations are provided for screening, monitoring, and managing patients at risk of ocular complications, including referral algorithms and treatment modification strategies. The article aims to increase awareness among gynecologic oncologists regarding ocular toxicity and optimize the clinical management of affected patients.