Secondary dry eye disease in breast cancer patients: a pilot study

Abstract

Purpose

To investigate ocular surface alterations associated with oncological therapy in patients with hormone receptor-positive (HR+) breast cancer.

Methods

In this prospective pilot study, 30 HR + breast cancer patients and 10 age-matched healthy controls were evaluated at three time points: before surgery (T0), one week after surgery before starting therapy (T1), and after 12 months of antiestrogenic treatment (T2). Clinical assessments included Ocular Surface Disease Index (OSDI), Visual Function Questionnaire-25 (VFQ-25), Schirmer test type I, tear break-up time (TBUT), Meibomian gland dysfunction (MGD) score, and corneal and conjunctival staining. Gene expression of IL-6 and ICAM-1 was analyzed via impression cytology.

Results

No differences were observed between cancer patients and controls at baseline. After surgery (T1), patients reported increased OSDI scores (p < 0.05), reduced TBUT (p < 0.01), and worse MGD scores (p < 0.01). After 12 months of treatment (T2), MGD scores, Schirmer test values, and ocular staining worsened significantly (p < 0.01), along with a decline in VFQ-25 scores (p < 0.05). IL-6 and ICAM-1 expression were significantly upregulated at T2. Postmenopausal women experienced more severe ocular surface dysfunction than premenopausal patients.

Conclusions

Antiestrogen therapy in HR + breast cancer patients induces progressive ocular surface dysfunction, driven by chronic inflammation and epithelial damage. These findings highlight the importance of recognizing ocular symptoms in this population and support further studies evaluating the role of routine ophthalmologic monitoring in survivorship care.