Blepharitis and Dry eyes in Aromatase

Inhibitor UsersKiran Turaka, M.D.Kristin M. Hammersmith, M.D.

Jennifer M. Nottage, M.D.Christopher J. Rapuano, M.D.

Wills Eye Institute, Philadelphia PAThe authors have no financial interest in the subject matter of this e-poster

Purpose Anastrazole (Arimidex®) Aromatase inhibitor (AI), suppress

estrogen synthesis from the androgens

Used as an adjuvant therapy in breast/ovarian cancer treatment

Investigation of an association between anastrazole and dry eye syndrome

Methods Retrospective chart review Computerized search of Wills

Cornea Service electronic health records between from August 2008 to April 2010.

Results were compared with the age-matched controls from a published study by Schaumberg et al.1

1. Schaumberg DA, Sullivan DA, Buring JE, Dana MR. Prevalence of dry eye syndrome among US women. Am J Ophthalmol 2003; 136:318-26.

Results Total patients on anastrazole=16

Caucasian women Breast cancer= 15 (94%) Ovarian cancer = 1 (6%) Mean ± SD age was 67 ± 13 years

(range 50-95) Best corrected VA was better than

20/40 in 24 (75%)

Systemic FeaturesCharacteristic feature Total patients, N= 16

(%)Treatment of primary

cancer Surgery 9 (56) Chemotherapy 4 (25) Radiotherapy 2 (13)Past medical history Diabetes Mellitus 5 (31) Hypertension 5 (31) Hypercholesterolemia 1 (6) Hyperthyroidism 2 (13)

Associated Ocular conditions

Characteristic feature Total patients, N=16 (%)

Blepharitis 4 (25)Fuch’s dystrophy 4 (25)Dry eye 6 (38)Glaucoma 2 (13)Keratoconus 2 (13)PBK, Ptosis, allergic

conjunctivitis, fungal ulcer, chronic conjunctivits

1 each (6)

Ocular Symptoms Characteristic feature Total patients, N= 16

(%)Blurring vision 7 (44)Redness 2 (13)Irritation/foreign body sensation

8 (50)

Tearing 4 (25)Photosensitivity 1 (6)Prior Punctal plug use 2 (13)Asymptomatic 2 (13) Among the control population (65-69 years),

dryness and irritation were found in 5.7% and 0.6% respectively.1

Clinical Features

Characteristic feature Total eyes, N=32 (%)

Mean ± SD Schirmer test (median,

range) mm11 ± 5.8 (13, 0.5-

18)Decreased tear film 8 (25)Poor tear film 8 (25)Belpharitis 25 (78)Ectropion/entropion 1 (3)Follicular conjunctivitis/injection 10 (31)Superficial Punctate Keratitis 11 (34)Corneal edema 2 (6)Iritis 2 (6)

Slit lamp photograph showing blepharitis and crusts (A), and superficial punctate keratitis (B) on fluorescein staining

Treatment Tear supplement: 15 patients Lubricating ointment/gel: 3 patients Antibiotic ointment: 3 patients Punctal plugs: 2 patients Cyclosporine (topical 0.05%): 2

patients Warm compresses: 2 patients

Summary at the Last follow-up No. of patients at the follow up = 11 (69%) No of patients lost to follow up= 5 (31%) No of patients on Anastrazole = 10 (91%) Mean ± SD follow-up = 14 ± 7.7 months

(range 2-25) After treatment of dry eyes:

Persistent dry eye symptoms = 3 (27%) Mild discomfort = 1 (9%)

Best corrected VA was better than 20/40 in 18 (82%)

Tumor status: Remission of breast cancer = 9 (81%) Remission of ovarian cancer = 1 (9%) Systemic metastasis = 1 (9%)

Conclusions The prevalence of ocular surface

disease appears to be higher in the patients taking anastrazole than in age-matched control population1

Anastrazole is likely a contributing factor to dry eye symptoms

A larger scale investigation is necessary to evaluate this correlation further