Clinical and in vivo confocal microscopy findings in patients receiving tamoxifen citrate.

PURPOSE

: To describe the deposition rate of tamoxifen in the cornea and observe its impact on the cornea with confocal microscopy.

METHODS

: Forty-four eyes of 22 women receiving tamoxifen at a dosage of 20 mg/day for at least 6 months for the adjuvant treatment of breast cancer and 30 eyes of 15 healthy age-matched women were examined for corneal drug deposition by slitlamp after pupil dilation. Ultrasound pachymetry, specular microscopy, in vivo confocal microscopy, and Schirmer tear test were also performed in all patients.

RESULTS

: The mean duration of tamoxifen intake was 21.6 +/- 7.9 months (range, 13-44 months), and the mean cumulative dose was 12.9 +/- 4.7 g (range, 7.8-26.4 g). Drug depositions in the inferior paracentral cornea were identified in 32 (72%) eyes at pupil-dilated slitlamp examination. There were no significant differences between eyes with keratopathy, those without keratopathy, and control eyes in regard to the mean Schirmer test scores, mean central corneal thickness, mean endothelial cell count, mean basal epithelium cell density, mean anterior and posterior stromal keratocyte density, and mean endothelial cell density (P > 0.05). No pathologic alteration of structure was observed with in vivo confocal microscopy at any corneal level in patients receiving tamoxifen.

CONCLUSIONS

: Low-dose tamoxifen use was associated with corneal depositions in 72% of patients. Slitlamp examination performed with pupil dilation was helpful in detection of subtle tamoxifen-related deposits. Amelioration of in vivo confocal microscopy systems may be helpful in accurate imaging of the paracentral and peripheral cornea.