TAMOXIFEN-ASSOCIATED EYE DISEASE - A REVIEW

Purpose: The oral antiestrogen tamoxifen has demonstrated efficacy in the treatment of metastatic breast cancer and as adjuvant therapy in e arly-stage disease, Clinical trials of tamoxifen in chemoprevention of breast cancer among high-risk women have focused attention on potenti al adverse effects of long-term tamoxifen use, including the possibili ty of ocular toxicity. This review evaluates the published case report s, clinical series, and clinical trial data on ocular toxicities attri buted to tamoxifen. Clinical issues of surveillance, differential diag nosis, and management of tamoxifen-related eye disease are discussed. Design: National Library of Medicine online bibliographic services wer e used to identify case reports and clinical studies of ocular adverse effects that occurred in patients receiving tamoxifen published throu gh the fall of 1994. The medical literature relevant to issues raised by the reports and studies was similarly identified and reviewed. Resu lts: Case reports and case series identify crystalline retinal deposit s, macular edema, and corneal changes as potential tamoxifen ocular to xicities, Extensive retinal lesions and macular edema with visual impa irment have been reported in a few patients receiving high-dose tamoxi fen, Less extensive retinal changes may occur in patients receiving lo w doses for long periods, and isolated retinal crystals may be observe d in patients without visual symptoms. Conclusion: Ocular toxicity is uncommon in the current clinical setting of long-term, low-dose tamoxi fen use, Physicians should be aware of the potential for ocular toxici ty among patients receiving the drug and should assure appropriate sur veillance and prompt evaluation of visual complaints.