Blepharitis and Dry eyes in Aromatase Inhibitor Users

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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 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 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 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 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 Hypercholesterolemia 1 (6) Hyperthyroidism

Associated Ocular conditions Characteristic feature Total patients, N=16 (%) Blepharitis 4 (25) Fuch’s dystrophy Dry eye 6 (38) Glaucoma 2 (13) Keratoconus 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 Asymptomatic 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 Total eyes, N=32 (%) Mean ± SD Schirmer test (median, range) mm 11 ± 5.8 (13, 0.5-18) Decreased tear film 8 (25) Poor tear film Belpharitis 25 (78) Ectropion/entropion 1 (3) Follicular conjunctivitis/injection 10 (31) Superficial Punctate Keratitis 11 (34) Corneal edema 2 (6) Iritis

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