Blepharitis and Dry eyes in
Aromatase Inhibitor Users
Kiran Turaka, M.D.
Kristin M. Hammersmith, M.D.
Jennifer M. Nottage, M.D.
Christopher J. Rapuano, M.D.
Wills Eye Institute, Philadelphia PA
The authors have no financial interest
in the subject matter of this e-poster
Introduction
Anastrazole (Arimidex®)
 Aromatase inhibitor (AI), suppress estrogen synthesis from
androgens
 Used as an adjuvant therapy in breast/ovarian cancer
treatment
 Ocular side effects of AI’s: retinal hemorrhages, visual
disturbances, hemiretinal artery occlusion
 Androgen deficiency has been linked to meibomian gland
dysfunction
Picture courtesy www. medscape.com
Purpose




Few studies reported the higher prevalence of moderate
to severe dry eye syndrome in older women
None of the studies noted the prevalence of ocular
surface symptoms and signs among AI users
We observed that several patients who presented with
dry eye symptoms were using anastrazole
Investigation of an association between anastrazole and
dry eye syndrome
Methods



1
Retrospective chart review
Computerized search of Wills Cornea Service
electronic health records between from August 2008
to April 2010 for patients on Anastrazole
Results were compared with the age-matched controls
from a published study by Schaumberg et al.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%)
Treatment of Primary Cancer:
Surgery: 9 (56%)
 Chemotherapy: 4 (25%)
 Radiotherapy: 2 (13%)


Mean ± SD age: 67 ± 13 years (range 50-95)
Medical conditions





Diabetes mellitus: 5 (31%)
Hypertension: 5 (31%)
Hyperthyroidism: 2 (13%)
Hypercholesterolemia: 1 (6%)
Cardiac arrhythmia: 1 (6%)
Ocular disorders at presentation
and treatment*






Dry eyes: 6 (38%)
Glaucoma: 5 (31%)
Blepharitis: 4 (25%)
Fuch’s dystrophy: 4
(25%)
Keratoconus: 2 (13%)
PBK, ptosis (6%), fungal
ulcer, chronic
conjunctivitis: 1 (6%)
each







Tear supplement: 5 (31%)
Anti-glaucoma: 5 (31%)
Topical sodium Chloride:
3 (19%)
No treatment: 3 (19%)
Topical antibiotics: 2
(13%)
Cyclosporine: 2 (13%)
Anti allergic: 1 (6%)
* Few patients had more than one condition at presentation and a combination of topical medications
Presenting Ocular Symptoms*
Characteristic feature
Total patients, N= 16 (%)
Irritation/foreign body sensation
8 (50)
Blurring vision
7 (44)
Tearing
4 (25)
Redness
2 (13)
Prior Punctal plug use
2 (13)
Asymptomatic
2 (13)
Photosensitivity
1 (6)
Among
the control population (65-69 years), dryness and
irritation were found in 5.7% and 0.6% respectively. More than one
symptom was found in 9.5%
* Few patients had more than one symptom
Clinical Features
Characteristic feature
Total eyes, N= 32 (%)
Blepharitis
25 (78)
Decreased/poor tear film
16 (50)
Superficial Punctate Keratitis
11 (34)
Follicular injection
5 (17)
Follicular reaction
5 (17)
Corneal edema
2 (6)
Iritis
2 (6)
Ectropion/entropion
1 (3)
Mean ± SD Schirmer test (median, range) mm
11 ± 5.8 (13, 0.5-18)
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
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:
 Improvement dry eye symptoms: 7 (64%)
 Persistent dry eye symptoms: 3 (27%)
 Mild discomfort: 1 (9%)
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 agematched control population1
Anastrazole is likely a contributing factor to dry eye
symptoms
A larger scale investigation is necessary to evaluate this
correlation further