Persistent Corneal Epithelial Defect Associated With Erlotinib Treatment

PURPOSE: To report a case of persistent corneal epithelial erosion in a patient undergoing treatment with erlotinib for her lung cancer. METHODS: Report of a 79-year-old woman who presented with a persistent corneal epithelial defect associated with infectious keratitis that waxed and waned for 5 months despite treatment. She had been diagnosed with lung cancer and was being treated with erlotinib, a reversible epidermal growth factor receptor (EGFR) inhibitor. RESULTS: The keratitis required a biopsy to establish the diagnosis of Staphylococcus epidermidis keratitis. The infectious keratitis was successfully treated; however, her pain and the epithelial defect persisted. She discontinued the erlotinib treatment. Within 2 weeks, the abrasion healed and had no recurrence. CONCLUSIONS: This report is, to our knowledge, the first description of a nonhealing corneal erosion and infectious keratitis possibly associated with erlotinib toxicity. EGFR is expressed in basal epithelial cells across the cornea and limbal basal cells; it is considered imperative for corneal epithelial cell proliferation and wound healing. Erlotinib is mediated through inhibition of EGFR, which is a highly promising area in molecularly targeted chemotherapies. It will become increasingly important for ophthalmologists to recognize and treat side effects of chemotherapies interfering with the epithelial growth factor pathway.