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Blepharitis and Dry eyes in Aromatase Inhibitor 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 .

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Blepharitis and Dry eyes in Aromatase Inhibitor Users

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  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 • Androgen deficiency has been linked to meibomian gland dysfunction Picture courtesy www. medscape.com

  3. 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

  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; 136:318-26.

  5. 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)

  6. Diabetes mellitus: 5 (31%) Hypertension: 5 (31%) Hyperthyroidism: 2 (13%) Hypercholesterolemia: 1 (6%) Cardiac arrhythmia: 1 (6%) Medical conditions

  7. 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

  8. Presenting Ocular Symptoms* • 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

  9. Clinical Features

  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

  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: • 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%)

  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

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