Kiran Turaka MD Kristin M Hammersmith MD Jennifer M Nottage MD Christopher J Rapuano MD Wills Eye Institute Philadelphia PA The authors have no financial interest in the subject matter of this eposter ID: 775298
Download Presentation The PPT/PDF document " Blepharitis and Dry eyes in Aromatase I..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
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 PAThe authors have no financial interest in the subject matter of this e-poster
Slide2Introduction
Anastrazole (Arimidex®)Aromatase inhibitor (AI), suppress estrogen synthesis from androgensUsed as an adjuvant therapy in breast/ovarian cancer treatmentOcular 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
Slide3Purpose
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
Slide4Methods
Retrospective chart reviewComputerized 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.
Slide5Results
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)
Slide6Medical conditions
Diabetes mellitus: 5 (31%)
Hypertension: 5 (31%)
Hyperthyroidism: 2 (13%)
Hypercholesterolemia: 1 (6%)
Cardiac arrhythmia: 1 (6%)
Slide7Ocular 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
Slide8Presenting 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
Characteristic feature
Total patients, N= 16 (%)
Irritation/foreign body sensation
8 (50)
Blurring vision
7 (44)
Tearing
4 (25)
Redness
2 (13)
Prior Punctal plug use
2 (13)
Asymptomatic
2 (13)
Photosensitivity
1 (6)
Slide9Clinical Features
Characteristic feature
Total eyes, N= 32 (%)
Blepharitis
25 (78)
Decreased/poor tear film
16 (50)
Superficial Punctate Keratitis
11 (34)
Follicular injection
5 (17)
Follicular reaction
5 (17)
Corneal edema
2 (6)
Iritis
2 (6)
Ectropion/entropion
1 (3)
Mean ± SD Schirmer test (median, range) mm
11 ± 5.8 (13, 0.5-18)
Slide10Slit lamp photograph showing blepharitis and crusts (A), and superficial punctate keratitis (B) on fluorescein staining
Slide11Treatment
Tear supplement: 15 patients
Lubricating ointment/gel: 3 patients
Antibiotic ointment: 3 patients
Punctal plugs: 2 patients
Cyclosporine (topical 0.05%): 2 patients
Slide12Summary 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%)
Slide13Conclusions
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
A larger scale investigation is necessary to evaluate this correlation further