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 in the subject matter of this e-poster

2. Purpose Anastrazole (Arimidex®) Aromatase inhibitor (AI), suppress estrogen synthesis from the androgens Aromatase inhibitor (AI), suppress estrogen synthesis from the androgens Used as an adjuvant therapy in breast/ovarian cancer treatment Used as an adjuvant therapy in breast/ovarian cancer treatment Investigation of an association between anastrazole and dry eye syndrome Investigation of an association between anastrazole and dry eye syndrome

3. Methods Retrospective chart review Retrospective chart review Computerized search of Wills Cornea Service electronic health records between from August 2008 to April 2010. 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 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.

4. Results Total patients on anastrazole=16 Caucasian women Total patients on anastrazole=16 Caucasian women Breast cancer= 15 (94%) Breast cancer= 15 (94%) Ovarian cancer = 1 (6%) Ovarian cancer = 1 (6%) Mean ± SD age was 67 ± 13 years (range 50-95) Mean ± SD age was 67 ± 13 years (range 50-95) Best corrected VA was better than 20/40 in 24 (75%) Best corrected VA was better than 20/40 in 24 (75%)

5. Systemic Features Characteristic feature Total patients, N= 16 (%) Treatment of primary cancer Surgery Surgery 9 (56) Chemotherapy Chemotherapy 4 (25) Radiotherapy Radiotherapy 2 (13) Past medical history Diabetes Mellitus Diabetes Mellitus 5 (31) Hypertension Hypertension 5 (31) Hypercholesterolemia Hypercholesterolemia 1 (6) Hyperthyroidism Hyperthyroidism 2 (13)

6. 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 PBK, Ptosis, allergic conjunctivitis, fungal ulcer, chronic conjunctivits 1 each (6)

7. 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 Among the control population (65-69 years), dryness and irritation were found in 5.7% and 0.6% respectively. 1 Among the control population (65-69 years), dryness and irritation were found in 5.7% and 0.6% respectively. 1

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

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

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

11. Summary at the Last follow-up No. of patients at the follow up = 11 (69%) No. of patients at the follow up = 11 (69%) No of patients lost to follow up= 5 (31%) No of patients lost to follow up= 5 (31%) No of patients on Anastrazole = 10 (91%) No of patients on Anastrazole = 10 (91%) Mean ± SD follow-up = 14 ± 7.7 months (range 2-25) Mean ± SD follow-up = 14 ± 7.7 months (range 2-25) After treatment of dry eyes: After treatment of dry eyes: Persistent dry eye symptoms = 3 (27%) Persistent dry eye symptoms = 3 (27%) Mild discomfort = 1 (9%) Mild discomfort = 1 (9%) Best corrected VA was better than 20/40 in 18 (82%) Best corrected VA was better than 20/40 in 18 (82%) Tumor status: Tumor status: Remission of breast cancer = 9 (81%) Remission of breast cancer = 9 (81%) Remission of ovarian cancer = 1 (9%) Remission of ovarian cancer = 1 (9%) Systemic metastasis = 1 (9%) Systemic metastasis = 1 (9%)

12. Conclusions The prevalence of ocular surface disease appears to be higher in the patients taking anastrazole than in age-matched control population 1 The prevalence of ocular surface disease appears to be higher in the patients taking anastrazole than in age-matched control population 1 Anastrazole is likely a contributing factor to dry eye symptoms Anastrazole is likely a contributing factor to dry eye symptoms A larger scale investigation is necessary to evaluate this correlation further A larger scale investigation is necessary to evaluate this correlation further