A five-case retrospective report has linked a tissue factor-targeted antibody-drug conjugate, TF-ADC-MMAE, to severe, non-infectious ocular surface toxicity. The case series, published in BMC Ophthalmology, describes Grade 3 or higher outcomes in five consecutive male patients with metastatic pancreatic adenocarcinoma. Across a Phase III trial cohort of 116 patients receiving the drug, the reported incidence was 4.3% (5/116). Imaging and clinical evaluation documented multifaceted damage spanning corneal ulceration, meibomian gland dropout, tear-film instability, and sub-basal nerve plexus injury. Importantly, the study also reports that microbiology and metagenomic next-generation sequencing supported a sterile, non-infectious etiology in ulcerative cases, narrowing the differential diagnosis for clinicians managing similar ADC-related adverse events. For the ADC pipeline, the signal adds to a growing need for clearer risk stratification and ocular monitoring protocols in targets and payload chemistries that may affect anterior segment structures.