Dry eye signs and symptoms in aromatase inhibitor treatment and the relationship with pain

Emma Gibson, Fiona Stapleton, Rachel Dear, James S. Wolffsohn, Blanka Golebiowski

Research output: Contribution to journalArticlepeer-review


Purpose: Aromatase inhibitors (AIs) limit the synthesis of oestrogen in peripheral tissues thus lowering levels of oestrogen. The primary aim was to evaluate whether women treated with AIs have altered dry eye symptoms and signs. A sub-aim was to investigate whether symptoms of dry eye in postmenopausal women were associated with symptoms of non-eye pain, ocular pain and self-rated pain perception. 

Methods: This cross-sectional, observational, single visit study recruited 56 postmenopausal women (mean age 64.1 + 7.9 years) and 52 undergoing AI treatment (mean age 66.6 + 9.0). Ocular symptoms (OSDI, MGD14) and pain questionnaires (PSQ, OPAS) were administered and signs of dry eye and meibomian gland dysfunction were evaluated. 

Results: Almost half of each group reported dry eye symptoms, defined as OSDI>12 (48% control, 46% AI). The PSQ score was significantly higher in the AI group (p = 0.04). Neither frequency or severity of dry eye (or MGD) symptoms scores were significantly different between groups. In the AI group, meibomian gland expressibility score was worse (p = 0.003); there were no differences in any other signs. Higher OSDI scores were associated with higher OPAS eye-pain scores (r = 0.49, p < 0.001), but not OPAS non-eye pain (r = 0.09, p = 0.35). Pain perception (PSQ) showed a moderate positive association with OPAS eye-pain (r = 0.30, p = 0.003). 

Conclusions: In this study elevated ocular symptoms were observed in both the AI treated and the untreated groups, with no difference between the groups. Women undergoing AI treatment for early stage breast cancer had worse meibum expressibility score and increased pain perception compared to an untreated group of women.

Original languageEnglish
Pages (from-to)108-113
Number of pages6
JournalOcular Surface
Issue number1
Early online date24 Oct 2019
Publication statusPublished - Jan 2020

Bibliographical note

© 2019, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/

Funding: University International Postgraduate Award (UIPA) Scholarship


  • Aromatase inhibitors
  • Breast cancer
  • Dry eye
  • Meibomian gland dysfunction
  • Oestrogen
  • Pain


Dive into the research topics of 'Dry eye signs and symptoms in aromatase inhibitor treatment and the relationship with pain'. Together they form a unique fingerprint.

Cite this