Cancer Treatment May Affect Ocular Rosacea

Ocular toxicity is common during adjuvant therapy for early breast cancer and is largely the result of ocular irritation stemming from chemotherapy, a retrospective study suggests.

Ocular toxicity "may be disturbing" for women, investigators note in the February 1st issue of Cancer, and "may justify secondary preventive measures" for those women who develop ocular irritation after an initial cycle of chemotherapy.

By contrast, ocular toxicity during hormonal therapy with a selective estrogen receptor modulator (SERM) alone "seems rather rare," Dr. Lorenzo Gianni from Ospedale degli Infermi in Rimini, Italy and colleagues report, and, therefore, "does not appear to justify a regular program of ocular examination."

Nonetheless, "nurses and physicians should pay attention and inform patients about possible side effects for a prompt ocular evaluation in case of ocular complaints," Dr. Gianni said.

The research team culled data on the incidence and timing of ocular toxicity after adjuvant chemoendocrine treatment for early breast cancer in 4948 women from seven International Breast Cancer Study Group Trials conducted between 1978 and 1999. The women were randomized to receive endocrine therapy with a SERM (tamoxifen or toremifene) alone or with chemotherapy.

A total of 580 instances of ocular toxicity were reported in 538 women (10.9%) during adjuvant treatment, mainly during chemotherapy, Dr. Gianni and colleagues report.

Forty-five women (0.9%) had ocular toxicity during tamoxifen or toremifene therapy alone but only 30 (0.6%) of these cases were deemed possibly related to tamoxifen or toremifene.

"Impaired visual acuity, ocular irritation and cataract were the most frequent side effects, while no cases of confirmed retinopathy were reported," Dr. Gianni said.

In most cases, ocular toxicity developed within the first two months of treatment, with a plateau at the end of chemotherapy. In most of cases, ocular toxicity was no higher than Grade 1 (75%).

For a variety of reasons, it is "very likely that we have underestimated the incidence of ocular toxicity," the authors note in their report.

"The fear of ocular toxicity," Dr. Gianni concluded, "should not influence the (treatment) decision in most cases, but for patients with pre-existing ocular disease the use of an aromatase rather than tamoxifen may be appropriate, keeping in mind that aromatase inhibitors have not been as fully evaluated for ocular and other adverse events."

Dry Eyes Common With Ocular Rosacea

The dry eye syndrome, which often accompanies ocular rosacea, can also be treated with non-preserved artificial tears, as often as 4 times a day or more. Another ocular treatment is a home humidifier which may also add valuable moisture to the air. If these treatments for the symptoms of ocular rosacea are not sufficient, more drastic treatments may be needed. One such ocular treatment involves closure of the tear drainage ducts which is accomplished with silicone plugs, which are reversible, or punctal cautery (a burning of the tear duct openings), which is a relatively permanent ocular treatment.

Eye Problems Not Always Caused By Rosacea

'Hay fever eyes'Seasonal allergic conjunctivitis is the eye equivalent of hay fever and affects up to 25 per cent of the general population. The eyes become itchy, watery and red in the summer pollen season - usually from exposure to grass and tree pollen.
A more severe form of this disease seen in children is vernal conjunctivitis where the symptoms are more intense. The eyes are very sticky with a stringy discharge and pain occurs especially when opening the eyes on waking. The eyelid inner membranes swell with the conjunctiva developing a cobblestone appearance, corneal damage may even occur if the condition is left untreated.
Perennial allergic conjunctivitis tends to occur all year round with house dust mite and cat allergy. The symptoms are usually milder than those in seasonal allergic conjunctivitis.

'Eczema eyes'
Atopic keratoconjunctivitis although rare is the most severe manifestation of allergic eye disease occurring predominantly in adult males. It is the eye equivalent of severe eczema. This persistent condition results in constant itching, dry eyes, blurred vision and is associated with corneal swelling and scarring. Eyelid eczema and infection are common and lens cataracts may develop over time.

Contact lens allergy
Contact lens wearers may develop giant papillary conjunctivitis triggered by the constant local irritation of the contact lenses on the conjunctival surfaces. The lining of the upper eyelid is usually most affected. Disposable contact lenses may help settle symptoms but occasionally contact lens wearing has to be suspended.
Never use steroid eye drops unless under the direct supervision of a doctor. Steroid eye drops although very effective for treating eye allergies can lead to unwanted side effects such as glaucoma, cataract formation and encourage infections of the eye with resultant corneal scarring.

Tips To Soothe Dry Eye In Winter

 Dry eyes and irritation are more common in the winter due to the drier conditions within the environment.
 With rosacea the combination of dry eyes and the facial symptoms of rosacea often occur together. Keeping the eyes and skin well hydrated will go a long way to correcting the problem.

Hydrate internally by increasing your fluid intake as the body and eyes are over 50% water. Using a home humidifier or other means to raise the humidity at home or work place can be benefical.

Artificial tears are an over the counter options for milder instances of dry eye.

Jojoba oil applied to the skin can also aid in maintaining proper moisture levels.