Dry eye disease as a side effect of cancer treatment

We learn more about dry eye disease in cancer patients receiving aromatase inhibitor treatment.

What is dry eye disease? 

Dry eye disease (DED) is a condition with many different definitions. However, all these definitions present with the same core elements. DED is defined as: “A disorder of the tear film due to tear deficiency or excessive evaporation, which causes damage to the interpalpebral ocular surface and is associated with symptoms of ocular discomfort.”1

The definition of DED includes the multifactorial nature of the disease as well as ocular symptoms and tear film instability.1 

Roughly 344 million people worldwide suffer from DED symptoms, and as many as three out of every four ophthalmic patients have at least one dry eye symptom.2,3

The classification of dry eye includes a deficiency in any (or a combination) of the three layers of the tear film, which include the mucin, watery and oily layers.1 

How does DED affect cancer patients on aromatase inhibitor treatment? 

Aromatase inhibitors (AIs) are the golden standard of care in post-menopausal women with metastatic, hormone-receptor-positive breast cancer. These drugs have shown very promising results in treating diagnosed patients.4-8 

It has, however, been noted that there is an increased prevalence of DED in patients treated with AIs. 

Subsequent research has indicated that the prevalence of DED in these patients is up to 50% more compared to patients not receiving AI treatment.4-8 

Patients commonly experience ocular symptoms, such as blurred vision, irritation or foreign body sensation in the eye, redness, tearing, and sensitivity to light. These named symptoms are well-described as being associated with DED.8 If not treated, the condition may become worse, to the extent that quality of life in these patients is reduced as a result.9

Females more prone to DED

Females are possibly more prone to DED due to hormones playing a role during AIs treatment. The two most important role players are androgens and oestrogens.4 Even though the roles of these hormones are both important, they are different in nature. Androgens are important in the regulation of the immune system and functioning of the lacrimal and meibomian glands that are respectively responsible for the secretion of the watery and oily layers of the tear film. 

The exact contribution of oestrogen to the tear film is not fully understood. However, it’s known that AIs treatment lowers oestrogen levels. 

In a recent study, a two-fold increase in DED symptoms in post-menopausal women undergoing AI treatment has been reported.4,10  

Can DED be treated? 

DED is a chronic condition and treatment starts with a visit to your eye care professional for the assessment of DED.7

The Systane range of dry eye products is a very effective way of treating DED as this range of products has been researched extensively. Clinical data has confirmed its efficacy in reducing the symptoms of DED and improving tear film stability. In symptomatic DED patients, Systane initiates a significant improvement in all ocular irritation symptoms, ocular redness, and a reduction in dry spots on the cornea. 6,11,12 

The Systane range is unique in its therapeutic and symptomatic working, by forming a visco-elastic matrix on the ocular surface that enables therapeutic repair and protection of damaged epithelial cells. The matrix that consists of cross-links between hydroxypropyl guar (HP-Guar) and borate, maintains demulcents for longer on the damaged areas of the ocular surface to enhance the formation of new epithelial cells. The demulcents (polyethylene glycol and propylene glycol) further ensure immediate symptomatic relief to the patient and better stability of the tear film. 

Systane Complete offers the added benefit of nano-technology that increases the efficacy and spread of the drop over a bigger area of the ocular surface. 6,13

The Systane range offers multi-dose and unit dose (preservative-free) options. The range includes a product for every type of DED, whether it is an aqueous, lipid, or mixed deficiency of the tear film.12,13 

Consult your local eye care professional to evaluate and diagnose the type of dry eye that you may be suffering from. 


  1. Gibson E., Stapleton F., Dear R., Wolffsohn J.S., Golebiowski B. (2019) Dry eye signs and symptoms in aromatase inhibitor treatment and the relationship with pain. The Ocular Surface Article accepted for publication: 19 October 2019. https://linkinghub.elsevier.com/retrieve/pii/S1542012419300527
  2. Schneider R., Barakat A., Pippen J., Osborne C. (2011) Aromatase inhibitors in the treatment of breast cancer in post-menopausal female patients: an update. Dove Medical Press 3; 113-125. https://linkinghub.elsevier.com/retrieve/pii/S1542012419300527
  3. Versura P., Profazio V., Campos E.C. (2008). One month of Systane® improves ocular surface parameters in subjects with moderate symptoms of ocular dryness. Clinical ophthalmology. 2(3); 629-635. https://www.dovepress.com/one-month-use-of-systanesupregsup-improves-ocular-surface-parameters-i-peer-reviewed-article-OPTH
  4. Inglis H., Boyle F.M., Friedlander M.L., Watson S.L. (2015) Dry eyes and AIs: If you don’t ask you won’t find out. Breast 24(6); 694-698. https://www.ncbi.nlm.nih.gov/pubmed/26422124
  5. Turaka K., Nottage J.M., Hammersmith K., Nagra P., Rapuano C. (2013) Dry eye syndrome in aromatase inhibitor users. Clinical & Experimental Ophthalmology. 41(3)https://www.ncbi.nlm.nih.gov/pubmed/22957932
  6. Abelson M.B., Lines L. (2006) Hormones in Dry-Eye: A Delicate Balance. Review of Ophthalmology 23 February 2006. https://www.reviewofophthalmology.com/article/hormones-in-dry-eye-a-delicate-balance
  7. DEWS 2017 Report. https://www.tearfilm.org/dewsreport/pdfs/TOS-0502-DEWS-noAds.pdf
  8. Willcox M.D.P., Argüeso P., Georgiev G.A., Holopainen J.M., Laurie G.W., Millar T.J., Papas E.B., Rolland J.P., Schmidt T.A., Stahl U., Suarez T., Subbaraman L.N., Uçakhan O.O., Lyndon J. (2017) TFOS DEWS II Tear Film Report. The Ocular Surface 15(3); 366-403. https://www.ncbi.nlm.nih.gov/pubmed/28736338
  9. Online: https://systane.myalcon.com/eye-care/systane/products/ Retrieved 9 December 2019 Gifford P., Evans B.J., Morris J. (2006) A clinical evaluation of Systane®. Contact Lens Anterior Eye. 29(1); 31-40. https://www.sciencedirect.com/science/article/pii/S136704840600004X?via%3Dihub