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Journals / Anatolian Current Medical Journal / 2026 / Volume: 8 Issue: 1

The impact of systemic aromatase inhibitor therapy on the tear film, meibomian glands, and corneal endothelium

Sistemik aromataz inhibitörü tedavisinin gözyaşı filmi, meibomian bezleri ve kornea endoteline etkisi

Erdem Dursun(KIRIKKALE ÜNİVERSİTESİ, TIP FAKÜLTESİ)0000-0002-4320-9336
Selim Yalçın(Kırıkkale Üniversitesi Tıp Fakültesi Onkoloji)0000-0003-1970-2849
Oğuzhan Akça(Kırıkkale Üniversitesi Tıp Fakültesi Göz Hastalıkları)0009-0006-9976-858X
Seval Çobanoğlu Öztürk(Kırıkkale Üniversitesi Tıp Fakültesi Göz Hastalıkları)0000-0002-6349-7136
Zafer Onaran(Kırıkkale Üniversitesi Tıp Fakültesi Göz Hastalıkları)0000-0001-8603-601X
Nuray Bayar Muluk(Kırıkkale Üniversitesi Tıp Fakültesi KBB)0000-0003-3602-9289
Pages
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Publication Date
2026-01-06
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Conclusion: In conclusion, our findings suggest that systemic AI therapy is associated with increased subjective dry eye symptoms and subtle changes in corneal endothelial morphology in postmenopausal women with breast cancer.

📌 3 Key Takeaways

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Objective & Hypothesis:Aims: Aromatase inhibitors (AIs) are commonly used as adjuvant endocrine therapy in postmenopausal women with hormone receptor-positive breast cancer.
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Key Findings & Data:Methods: This cross-sectional study included a total of 60 postmenopausal female participants, divided into two groups: 29 patients receiving systemic aromatase inhibitor therapy for hormone receptor-positive breast cancer (AI group), and 31 agematched healthy controls (control group).
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Conclusion & Impact:Conclusion: In conclusion, our findings suggest that systemic AI therapy is associated with increased subjective dry eye symptoms and subtle changes in corneal endothelial morphology in postmenopausal women with breast cancer.
🔬Design:Research Article
📍Scope:Comprehensive Sample
⚙️Variables:Aromatase inhibitors · breast cancer · ocular surface

Abstract

Aims: Aromatase inhibitors (AIs) are commonly used as adjuvant endocrine therapy in postmenopausal women with hormone receptor-positive breast cancer. The aim of this study is to investigate the effects of systemic AI treatment on tear film stability, meibomian gland structure, and corneal endothelial cell characteristics by comparing patients receiving AIs with age-matched healthy controls, using a combination of noninvasive ocular surface diagnostics and anterior segment imaging. Methods: This cross-sectional study included a total of 60 postmenopausal female participants, divided into two groups: 29 patients receiving systemic aromatase inhibitor therapy for hormone receptor-positive breast cancer (AI group), and 31 agematched healthy controls (control group). All participants underwent a complete ophthalmological examination, slit-lamp biomicroscopy, and dilated fundus examination. Ocular surface disease-related symptoms and signs were recorded. In addition, corneal endothelial parameters were also evaluated. Results: A total of 60 postmenopausal women were enrolled in the study. There was no statistically significant difference in age between the groups (p=0.741). The mean Ocular Surface Disease Index (OSDI) score was 23.1±11.5 (range: 10-46) in the AI group and 16.2±6.8 (range: 10-34) in the control group, with a statistically significant difference observed (p=0.005). No statistically significant differences were found in tests evaluating other ocular surface parameters. Specular microscopy analysis revealed that the mean coefficient of variation (CV) values were significantly higher in the AI group (42.9±6.6) compared to the control group (33.7±3.4; p<0.001). Additionally, the hexagonal cell ratio (HEX, %) was significantly lower in the AI group (42.7±4.9) than in the control group (46.1±5.0; p=0.014). Conclusion: In conclusion, our findings suggest that systemic AI therapy is associated with increased subjective dry eye symptoms and subtle changes in corneal endothelial morphology in postmenopausal women with breast cancer.

Özet

Amaç Aromataz inhibitörleri (AI'lar), hormon reseptörü pozitif meme kanseri olan postmenopozal kadınlarda adjuvan endokrin tedavide yaygın olarak kullanılmaktadır. Bu çalışmanın amacı, noninvaziv oküler yüzey tanıları ve ön segment görüntülemeyi bir arada kullanarak, AI alan hastaları yaşları eşleşen sağlıklı kontrol grubuyla karşılaştırarak, sistemik AI tedavisinin gözyaşı filmi stabilitesi, meibomian bez yapısı ve kornea endotel hücre özellikleri üzerindeki etkilerini araştırmaktır. Metod Bu kesitsel çalışma, toplam 60 postmenopozal kadın katılımcıyı içermekte olup, iki gruba ayrılmıştır: hormon reseptörü pozitif meme kanseri için sistemik aromataz inhibitörü tedavisi alan 29 hasta (AI Grubu) ve yaşları eşleştirilmiş 31 sağlıklı kontrol (Kontrol Grubu). Tüm katılımcılar tam bir oftalmolojik muayene, yarık lamba biyomikroskopi ve dilate fundus muayenesinden geçirildi. Oküler yüzey hastalığına bağlı semptom ve bulgular kaydedildi. Ayrıca, kornea endotel parametreleri de değerlendirildi. Bulgular Çalışmaya toplam 60 postmenopozal kadın katıldı. Gruplar arasında yaş açısından istatistiksel olarak anlamlı bir fark yoktu (p=0,741). Ortalama Oküler Yüzey Hastalığı İndeksi (OSDI) skoru AI grubunda 23,1 ± 11,5 (aralık: 10–46) ve kontrol grubunda 16,2 ± 6,8 (aralık: 10–34) idi ve istatistiksel olarak anlamlı bir fark gözlendi (p=0,005). Diğer oküler yüzey parametrelerini değerlendiren testlerde istatistiksel olarak anlamlı bir fark bulunmamıştır. Speküler mikroskopi analizi, ortalama varyasyon katsayısı (CV) değerlerinin AI grubunda (42,9 ± 6,6) kontrol grubuna (33,7 ± 3,4; p<0,001) kıyasla anlamlı olarak daha yüksek olduğunu ortaya koymuştur. Ek olarak, altıgen hücre oranı (HEX, %) AI grubunda (42,7 ± 4,9) kontrol grubuna (46,1 ± 5,0; p=0,014) göre anlamlı olarak daha düşüktü. Sonuç Sonuç olarak, bulgularımız sistemik AI tedavisinin, meme kanseri olan postmenopozal kadınlarda subjektif kuru göz semptomlarının artması ve kornea endotel morfolojisinde ince değişikliklerle ilişkili olduğunu göstermektedir.

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Cite This Article

Dursun, E., Yalçın, S., Akça, O., Öztürk, S. Ç., Onaran, Z., Muluk, N. B. (2026). The impact of systemic aromatase inhibitor therapy on the tear film, meibomian glands, and corneal endothelium. Anatolian Current Medical Journal, Volume: 8 Issue: 1. https://doi.org/10.38053/acmj.1818870

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References (24)

  1. Johnston SR, Dowsett M. Aromatase inhibitors for breast cancer: lessons from the laboratory. Nat Rev Cancer. 2003;3(11):821-831. doi:10.1038/nrc 1211
  2. Tomao F, Spinelli G, Vici P, et al. Current role and safety profile of aromatase inhibitors in early breast cancer. Expert Rev Anticancer Ther. 2011;11(8):1253-1263. doi:10.1586/era.11.96
  3. Wickham LA, Gao J, Toda I, Rocha EM, Ono M, Sullivan DA. Identification of androgen, estrogen and progesterone receptor mRNAs in the eye. Acta Ophthalmol Scand. 2000;78(2):146-153. doi:10.1034/j. 1600-0420.2000.078002146.x
  4. Nuzzi R, Caselgrandi P. Sex hormones and their effects on ocular disorders and pathophysiology: current aspects and our experience. Int J Mol Sci. 2022;23(6):3269. doi:10.3390/ijms23063269
  5. Rahimi Darabad R, Suzuki T, Richards SM, et al. Does estrogen deficiency cause lacrimal gland inflammation and aqueous-deficient dry eye in mice? Exp Eye Res. 2014;127:153-160. doi:10.1016/j.exer.2014.07. 017
  6. Gorimanipalli B, Khamar P, Sethu S, Shetty R. Hormones and dry eye disease. Indian J Ophthalmol. 2023;71(4):1276-1284. doi:10.4103/IJO.IJO_2887_22
  7. Ağın A, Kocabeyoglu S, Yucel Gencoglu A, Aksoy S, Karakaya J, Irkec M. The effects of systemic aromatase inhibitors on meibomian glands and corneal structure. Eye (Lond). 2022;36(6):1185-1193. doi:10.1038/s41 433-021-01612-z
  8. Serban D, Costea DO, Zgura A, et al. Ocular side effects of aromatase inhibitor endocrine therapy in breast cancer-a review. In Vivo. 2022;36 (1):40-48. doi:10.21873/invivo.12674
  9. Inglis H, Boyle FM, Friedlander ML, Watson SL. Dry eyes and AIs: if you don't ask you won't find out. Breast. 2015;24(6):694-698. doi:10.1016/j.breast.2015.08.008
  10. Wang Li-X, Deng Ying P. Androgen and meibomian gland dysfunction: from basic molecular biology to clinical applications. Int J Ophthalmol. 2021;14:915-922. doi:10.18240/ijo.2021.06.18
  11. Sullivan DA, Sullivan BD, Evans JE, et al. Androgen deficiency, meibomian gland dysfunction, and evaporative dry eye. Ann N Y Acad Sci. 2002:966:211-222. doi:10.1111/j.1749-6632.2002.tb04217.x
  12. Suzuki T, Minami Y, Komuro A, et al. Meibomian gland physiology in pre- and postmenopausal women. Invest Ophthalmol Vis Sci. 2017;58(2): 763-771. doi:10.1167/iovs.16-20811
  13. McKay TB, Priyardarsini S, Karamichos D. Sex hormones, growth hormone, and the cornea. Cells. 2022;11(2):224. doi:10.3390/cells11020 224
  14. Turaka K, Nottage JM, Hammersmith KM, Nagra PK, Rapuano CJ. Dry eye syndrome in aromatase inhibitor users. Clin Exp Ophthalmol. 2013; 41:239-243. doi:10.1111/j.1442-9071.2012.02865.x
  15. Cuzick J, Sestak I, Forbes JF, et al. Anastrozole for prevention of breast cancer in high-risk postmenopausal women (IBIS-II): an international, double blind, randomised placebo-controlled trial. Lancet. 2014;383: 1041-1048. doi:10.1016/S0140-6736 (13)62292-8
  16. Chatziralli I, Sergentanis T, Zagouri F, et al. Ocular surface disease in breast cancer patients using aromatase inhibitors. Breast J. 2016;22:561-564. doi:10.1111/tbj.12633
  17. Gibson E, Stapleton F, Dear R, Wolffsohn JS, Golebiowski B. Dry eye signs and symptoms in aromatase inhibitor treatment and the relationship with pain. Ocul Surf. 2020;18:108–1013. doi:10.1016/j.jtos. 2019.10.008
  18. Tekin K, Sekeroglu MA, Kiziltoprak H, Yilmazbas P. Corneal densitometry in healthy corneas and its correlation with endothelial morphometry. Cornea. 2017;36(11):1336-1342. doi:10.1097/ICO.000000 0000001363
  19. Chaurasia S, Vanathi M. Specular microscopy in clinical practice. Indian J Ophthalmol. 2021;69(3):517–524. doi:10.4103/ijo.IJO_574_20
  20. Gupta PK, Berdahl JP, Chan CC, et al. The corneal endothelium: clinical review of endothelial cell health and function. J Cataract Refract Surg. 2021;47(9):1218-1226. doi:10.1097/j.jcrs.0000000000000650
  21. De Piano M, Abicca I, Dinu V, et al. Expression of hormones' receptors in human corneal endothelium from fuchs' dystrophy: a possible gender' association. J Clin Med. 2024;13(13):3787. doi:10.3390/jcm1313 3787
  22. Han S, Mueller C, Wuebbolt C, et al. Selective effects of estradiol on human corneal endothelial cells. Sci Rep. 2023;13(1):15279. doi:10.1038/s41598-023-42290-z
  23. Suzuki T, Kinosha Y, Tachibana M, et al. Expression of sex steroid hormone receptors in human cornea. Curr. Eye Res. 2001;22(1):28-33. doi:10.1076/ceyr.22.1.28.6980
  24. Machairoudia G, Kazantzis D, Chatziralli I, et al. Prevalence and risk factors of dry eye disease in patients treated with aromatase inhibitors for breast cancer. Clin Exp Optom. 2024;107(4):415-419. doi:10.1080/08164622.2023.2239247