Corneal edema with a systemic epidermal growth factor recept
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A 70-year-old male patient was referred with a subacute onset of corneal edema. He had a background of metastatic non–small cell lung cancer that was positive for an EGFR mutation on biopsy. At presentation he had been on an EGFR receptor inhibitor, erlotinib at a dose of 150 mg a day for 20 months. On ocular examination, his visual acuity was 6/6 OD and 6/60 OS, with normal intraocular pressures bilaterally. On slit-lamp examination, his right cornea had early signs of deep stromal edema. His left cornea had punctate epithelial erosions, deep stromal edema, and Descemet’s membrane folds. There were no features of intraocular inflammation, trichomegaly or ectropion. After discussion with his oncologist, the patient was switched to gefitinib, and corneal edema resolved completely within 6 days. At 1 month his visual acuity had returned to 6/9 OS.

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