Longitudinal ocular surface assessment of tisotumab vedotin-associated conjunctivitis in metastatic cervical cancer: a case report

Tisotumab vedotin is a tissue factor-targeting antibody–drug conjugate used to treat recurrent or metastatic cervical cancer. Although effective, its use is frequently associated with ocular adverse events, including conjunctivitis, dry eye disease, and corneal keratopathy. However, real-world longitudinal reports integrating ocular surface findings with patient-reported outcomes are limited. A 57-year-old female with metastatic cervical cancer developed bilateral ocular discomfort and subjective visual disturbance approximately 2.5 months after initiating tisotumab vedotin. At the initial ophthalmic presentation on September 1, 2025, slit-lamp examination showed bilateral conjunctival hyperemia, discharge, pseudomembrane-like conjunctival lesions, and superficial punctate corneal epitheliopathy, without a confluent epithelial defect, corneal ulceration, or stromal involvement. Best-corrected visual acuity (BCVA) was 0.046 logMAR in the right eye and 0.097 logMAR in the left eye, unchanged from the immediately preceding examination. The ocular events were classified as Common Terminology Criteria for Adverse Events (CTCAE) v5.0 Grade 1 conjunctivitis and Grade 1 keratitis. Topical treatment with preservative-free sodium hyaluronate, 0.1% betamethasone, 1.5% levofloxacin, and neomycin/prednisolone ophthalmic ointment was initiated. At the short-interval follow-up on September 8, 2025, the conjunctival findings and subjective symptoms had improved without worsening of corneal epithelial involvement or decline in BCVA; the next scheduled tisotumab vedotin infusion was administered on September 11, 2025, following ophthalmic reassessment in close collaboration with the gynecologic oncology department. Longitudinal evaluation included BCVA, intraocular pressure (IOP), the Japanese version of the Ocular Surface Disease Index (J-OSDI), Dry Eye–Related Quality-of-Life Score, tear film breakup time, corneal fluorescein staining score, Schirmer test I, and CTCAE grading of conjunctivitis and keratitis. Patient-reported symptoms improved relatively early, whereas corneal staining and Schirmer test I values remained abnormal or fluctuated. No sustained IOP elevation, glaucoma treatment, corneal ulceration, conjunctival scarring, symblepharon, or clinically meaningful visual loss occurred. This case demonstrates that early ophthalmic intervention combined with structured longitudinal ocular surface assessment may support individualized multidisciplinary decisions regarding subsequent anticancer treatment. Integrating objective ocular surface testing with patient-reported outcomes may improve the recognition and management of tisotumab vedotin-associated ocular adverse events.