Abstract
Purpose :
This study is the first to look at signs of dry eye in women undergoing breast cancer treatment with Aromatase Inhibitors (AI). The purpose was to evaluate the effects of oestrogen suppression, with AI treatment, on symptoms and signs of dry eye in postmenopausal women. A sub-aim was to evaluate effects of treatment on ocular and systemic pain.
Methods :
This was a cross-sectional, observational, single visit study. 56 postmenopausal women (mean age 64.1+7.9 years) and 52 age-matched postmenopausal women undergoing AI treatment for breast cancer (mean age 66.6+9.0; median duration of AI use 1.3 years, IQR=3.0) were recruited. Questionnaires were administered to assess pain (Pain Sensitivity Questionnaire [PSQ], Ocular Pain Assessment Survey [OPAS])and ocular surface symptoms (Ocular Surface Disease Index [OSDI], Meibomian Gland Dysfunction-14 question [MGD14]). The presence of dry eye was determined by the OSDI. Eyelid margins (capping, telangiectasia), meibomian gland expressibility, tear break up time (NIBUT), tear volume (phenol red thread) and ocular surface staining (fluorescein, lissamine green) were evaluated. Differences between groups for frequency and severity of dry eye symptoms, MGD14 and pain questionnaire scores and clinical signs were evaluated using Chi-square, T-test and Mann-Whitney U test.
Results :
Almost half of each group reported dry eye symptoms, defined as OSDI>12 (48% control, 46% AI). PSQ scores were significantly worse in the AI group (p=0.04). Frequency and severity of dry eye symptoms, MGD14 and ocular pain symptoms (OPAS) were not significantly different between women treated with AIs and untreated women. In the AI group, meibomian gland expressibility was significantly worse (p=0.003). There were no differences in any other clinical signs between groups.
Conclusions :
Oestrogen suppression, with AI treatment, appears to reduce meibum expressibility and increase pain sensitivity. The frequency and severity of dry eye symptoms were not significantly different with AI treatment. Reduced meibum expressibility seen in women taking AI treatment, may result in reduced tear film stability and ocular surface irritation. Assessment of dry eye status and meibomian glands should be included in clinical consultations of women treated with AIs.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.