1. 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

2. 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

3. 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

4. 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:

5. 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%)

6. 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

7. 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)

8. 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

9. Clinical Features Characteristic feature Total eyes, N=32 (%)
Mean ± SD Schirmer test (median, range) mm
11 ± 5.8 (13, )
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

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

11. 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

12. 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%)

13. 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