A Case of Radiation-Induced Optic Neuropathy and Retinopathy after Radiation Therapy, Chemotherapy, and Immunotherapy for Brain Metastasis


  • Brittney Jimenez Optometrist
  • Angelina Tran
  • Lisa Huang
  • Bhagya Segu


radiation retinopathy, optic disc edema, radiation optic neuropathy, external beam radiation, chemotherapy


Radiation-induced optic neuropathy and retinopathy are associated with higher dose radiation therapy and can lead to devastating vision loss. This case report follows a 72-year-old Hispanic male with extensive stage IV small cell lung cancer and brain metastasis who presented with radiation-induced optic neuropathy and retinopathy. The patient’s cancer treatment included whole brain external radiation therapy, chemotherapy, immunotherapy, and thoracic radiation therapy prior to his eye examination. Consideration should be given to the size of individual fractions administered during radiation therapy in patients concomitantly undergoing chemotherapy and immunotherapy when managing radiation-induced ocular sequelae.


Peeler CE, Cestari DM. Radiation optic neuropathy and retinopathy with low dose (20 Gy) radiation treatment. Am J Ophthalmol Case Rep. 2016;29;3:50-53.

Hong KH, Chang SD. A case of radiation retinopathy of left eye after radiation therapy of right brain metastasis. Korean J Ophthalmol. 2009;23(2):114-7.

Zamber RW, Kinyoun JL. Radiation retinopathy. West J Med. 1992 Nov;157(5): 530-3. Erratum in: West J Med 1993;158(2):201.

Ferguson I, Huecker J, Huang J, McClelland C, Van Stavern G. Risk factors for radiation-induced optic neuropathy: a case-control study. Clin Exp Ophthalmol. 2017;45(6):592-597.

Ferguson I, Huang J, Levi L, et al. Radiation Optic Neuropathy After Whole-Brain Radiation Therapy. J Neuroophthalmol. 2019;39(3):383-387.

Pavle D, Madhura AT, Grant TL, et al. Factors Associated with Occurrence of Radiation-induced Optic Neuropathy at “Safe” Radiation Dosage, Seminars in Ophthalmol. 2018;33(4):581-588.

Rose K, Krema H, Durairaj P, et al. Retinal perfusion changes in radiation retinopathy. Acta Ophthalmol. 2018;96(6):e727-e731.

Wang D, Au A, Duker JS, et al. PAMM and the ischemic cascade associated with radiation retinopathy. Am J Ophthalmol Case Rep. 2020; 8:20.

Giuliari GP, Sadaka A, Hinkle DM, et al. Current treatments for radiation retinopathy. Acta Oncol. 2011;50(1):6-13.

Van den Bergh AC, Dullaart RP, Hoving MA, et al. Radiation optic neuropathy after external beam radiation therapy for acromegaly. Radiother Oncol. 2003;68(2):95-100.

Reichstein D. Current treatments and preventive strategies for radiation retinopathy. Curr Opin Ophthalmol. 2015;26(3):157-66.

Eckstein D, Riechardt AL, Heufelder J, et al. Radiation-Induced Optic Neuropathy: Observation versus Intravitreal Treatment: Can Visual Acuity Be Maintained by Intravitreal Treatment? Am J Ophthalmol. 2019;208:289-294.

Chan RC, Shukovsky LJ. Effects of irradiation on the eye. Radiology. 1976;120(3):673-5.

Gass JD. A fluorescein angiographic study of macular dysfunction secondary to retinal vascular disease. VI. X-ray irradiation, carotid artery occlusion, collagen vascular disease, and vitritis. Arch Ophthalmol. 1968;80(5):606-17.

Archer DB. Doyne Lecture. Responses of retinal and choroidal vessels to ionising radiation. Eye (Lond). 1993;7(1):1-13.

Archer DB, Gardiner TA. Ionizing radiation and the retina. Curr Opin Ophthalmol. 1994;5(3):59-65.

Danesh-Meyer HV. Radiation-induced optic neuropathy. J Clin Neurosci. 2008;15(2):95-100.

Finger PT, Kurli M. Laser photocoagulation for radiation retinopathy after ophthalmic plaque radiation therapy. Br J Ophthalmol. 2005;89(6):730-8.

Martin D. Handbook of skull base surgery 1st edition. Acta Chir Belg. 2017;117(1):67.




How to Cite

Jimenez, B., Tran, A., Huang, L., & Segu, B. (2023). A Case of Radiation-Induced Optic Neuropathy and Retinopathy after Radiation Therapy, Chemotherapy, and Immunotherapy for Brain Metastasis. Canadian Journal of Optometry, 85(1), 73–82. Retrieved from https://openjournals.uwaterloo.ca/index.php/cjo/article/view/4944



Clinical Research