Download Blepharitis and dry eyes in aromatase inhibitor (anastrazole) users

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
 None of the studies reported the incidence of ocular
surface symptoms and signs among AI users
Purpose
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We observed that several patients who presented
with dry eye symptoms were using anastrazole
The purpose was to investigate whether was an
association between anastrazole and dry eye
syndrome
Methods
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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
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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 Features
Characteristic 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.
* Few patients had more than one symptom
Clinical Features
Characteristic feature
Mean ± SD Schirmer test (median, range) mm
Total eyes, N=32 (%)
11 ± 5.8 (13, 0.5-18)
Decreased tear film
8 (25)
Poor tear film
8 (25)
Belpharitis
Ectropion/entropion
25 (78)
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
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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
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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
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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