Vision Problems in Childhood Cancer Survivors

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Some cancer treatments can cause vision problems in childhood cancer survivors.

Many vision problems can be treated. It is important for survivors to have their eyes checked regularly to catch problems as early as possible.

How the eye works

The eyes are in the part of skull known as the orbit or eye socket.
A thin layer of tissue called the conjunctiva covers and protects the eyes and eyelids.
The lacrimal gland makes tears. They drain into a tiny canal called the lacrimal duct.
Light enters the eye through a clear layer of tissue called the cornea.
The cornea bends and focuses the light.
It sends it through an opening in the eye called the pupil.
Behind the pupil is the lens of the eye.
The lens focuses light onto the retina, the light sensitive tissue lining the inside of the eye.
The nerve cells in the retina change the light into electrical impulses and send them through the optic nerve to the brain.

Cancer treatments that may cause vision problems

Radiation to the brain or eye socket
Radioiodine (I-131) treatment
Chemotherapy with busulfan
Corticosteroids such as prednisone and dexamethasone
Certain chemotherapy drugs such as dactinomycin and doxorubicin when given in combination with radiation therapy.

Other factors that may increase the risk of vision problems

Chronic graft versus host disease after hematopoietic cell transplant (also called bone marrow transplant or stem cell transplant)
Diabetes
High blood pressure
Frequent exposure to sunlight

Vision problems that may occur after cancer treatment

Cataracts – A condition in which the lens of the eye becomes cloudy. Cataracts usually develop slowly over time. Cataracts can be removed surgically.
Xerophthalmia – Dry eyes from decreased tear production. This can be treated with eye drops and ointments.
Lacrimal duct atrophy – Shrinking of the lacrimal duct, which drains tears from the eyes. It can result in excessive tearing. If this become a serious problem, it can be treated with a surgical procedure.

Other eye problems may happen in survivors treated radiation doses of 30 Gy or more.

Less common vision problems after cancer treatment

Orbital hypoplasia – Underdevelopment of the eye and nearby tissues. This can result in small eye and eye socket. Usually no treatment is needed. In severe cases, it may be possible to rebuild the bones around the eye.
Enophthalmos – Sunken eyeball with the eye socket. Plastic surgery may be an option.
Keratitis – Swelling of the cornea. It can cause pain and light sensitivity. This may be treated with eye drops and ointments. Wearing an eyepatch while sleeping may help with symptoms.
Telangiectasias – Swelling of blood vessels in the white part of the eye. These usually don’t cause symptoms but can be a problem because of how they look.
Retinopathy – Damage to the retina, which can cause vision loss. It can be treated with laser surgery.
Maculopathy – Damage to the macula. This is the area of central vision within the retina.
Optic chasm neuropathy – Damage to the nerves that send visual information to the brain.
Papillopathy – Swelling of the area where the optic nerve enters the eye.
Glaucoma – Increased pressure within the eye. It can harm the optic nerve and cause vision loss.

Signs and symptoms of vision problems

Blurry vision
Double vision
Blind spots
Sensitivity to light
Poor night vision
Fading or yellowing of colors
Need for frequent changes in glasses or contact lens prescriptions
Persistent irritation of surface of eye or eyelids
Excessive tearing/ watering of eyes
Pain within the eye
Dry eyes

What cancer survivors can do for vision health

Know your risk and monitor your health

Know your risk of eye problems. Ask your doctor if you received treatments that increase your risk.
Share a copy of your Survivorship Care Plan with health care providers. It includes details about your cancer treatment and health problems that may occur because of your treatment.

Recommended screenings for vision health

Have an evaluation by an eye specialist (ophthalmologist or optometrist) at least once a year. The examination should include vision screening, examination for cataracts, and a careful look at the internal structures of the eye. An ophthalmologist is a medical doctor who specializes in eye and vision care. An optometrist is a vision specialist but not a medical doctor.
People who have vision problems are encouraged to be seen regularly by an ophthalmologist.
It is important to follow the recommendations of your eye specialist.
People who have had radioiodine treatment are encouraged to go to an ophthalmologist if they have excessive tearing.

Eye injury prevention for cancer survivors

Everyone should take steps to protect your eyes and vision:

Wear sunglasses with ultraviolet (UV) protection when in bright sunlight.
When playing sports, wear proper protective eyewear fitted by an eye care expert.
Avoid toys with sharp, protruding, or projective parts.
Never play with fireworks or sparklers.
Use care when handling hazardous household chemicals.
Wear protective eyewear when doing lawn work.
Seek immediate medical attention if you have an eye injury.

Services for vision-impaired

Services are available for people 21 and younger through local public school districts or referral agencies. This is provided through the Individuals with Disabilities Education Act.

Survivors in K-12 public schools can receive classroom accommodations through a 504 plan or Individualized Educational Program (IEP) Plan.

The Americans with Disabilities Act guarantees people with vision problems equal access to public events, spaces, and opportunities.

Other Resources

For more information about disability services for people with vision problems, visit the American Foundation for the Blind’s Disability Rights Resources for People with Vision Loss.

For more information about eye health after childhood cancer treatment, read Children’s Oncology Group’s Keeping Your Eyes Healthy and Cataracts.

To learn more about general eye health, read the National Eye Institute’s Keep Your Eyes Healthy.

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Reviewed: May 2020