Ocular toxicity in low-dose tamoxifen: a prospective study.
OBJECTIVE
To look at the incidence, symptomatology, course and reversibility of low-dose tamoxifen ocular toxicity.


METHODS
Sixty-five women with breast cancer, on tamoxifen oral therapy (20 mg/day), and a totally normal eye examination, were prospectively followed up. A full ophthalmic evaluation was done every 6 months, for a median of 30 months (range 4-79 months). Any sign of toxicity in the cornea, lens, retina or optic nerve was looked for, whether associated with a change in visual acuity or not.


RESULTS
Ocular toxicity was documented in 8 patients, giving an incidence of 12%. Seven patients had keratopathy in the form of subepithelial deposits, whorls and linear opacities. Three of these patients had a concurrent symptomatic bilateral pigmentary retinopathy that warranted discontinuation of therapy. One patient developed bilateral optic neuritis that left her with optic nerve pallor and a decrease in vision. The patients who had the toxicity had a significantly higher tamoxifen cumulative dose (p = 0.03), and were longer on treatment (p = 0.04), than the non-affected ones. The keratopathy changes were reversible upon discontinuation of the drug.


CONCLUSIONS
Prompt reporting of symptoms and yearly ophthalmic examinations are mandatory in patients on tamoxifen to detect toxic effects while these are still reversible.
Noureddin
B N
BN
Department of Ophthalmology, American University of Beirut, Lebanon. bndean@aub.edu.lb
Seoud
M
M
Bashshur
Z
Z
Salem
Z
Z
Shamseddin
A
A
Khalil
A
A
D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy; D003316:Corneal Diseases / Q000139:chemically induced; D004334:Drug Administration Schedule; D005128:Eye Diseases / Q000139:chemically induced*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009902:Optic Neuritis / Q000139:chemically induced; D011446:Prospective Studies; D012164:Retinal Diseases / Q000139:chemically induced; D013629:Tamoxifen / Q000008:administration & dosage / Q000009:adverse effects*; D014792:Visual Acuity / Q000187:drug effects
D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen