Bilateral radiation retinopathy in a patient with Ewing sarcoma of the left sinonasal cavity with orbital extension

A 25 year old with Ewing sarcoma of the left sinonasal cavity with orbital extension who had undergone chemotherapy and proton beam therapy presented with bilateral painless reduced vision. She was diagnosed with radiation retinopathy and treated with anti-VEGF injections. This is a rare case where the contralateral eye has been affected by radiation treatment. Factors increasing the retinopathic effects of radiation include increased radiation dosage, increased fraction size, concomitant vascular disease, and concurrent use of chemotherapy. It is essential that all patients subjected to head and neck radiotherapy are consented to this adverse side effect, including the contralateral eye being affected.