October is Breast Cancer Awareness Month. Because breast cancer can lead to orbital cancer, and breast cancer treatments can negatively affect the eyes, it makes sense to discuss the optometrist’s role in managing breast cancer patients.

Orbital cancer
Of the orbital cancers, which are rare, 28% to 58% are caused by breast cancer.¹ Therefore, when a patient divulges their breast cancer diagnosis, the optometrist should be especially vigilant in looking for cysts, lymphomas, neurogenic tumors and vascular lesions, all of which are red flags for orbital cancer.

Also, the OD should be mindful of possible symptoms, such as double vision, exophthalmos, and decreased or transient vision. In addition to questioning breast cancer patients about these symptoms during visits, the optometrist should educate them about these possible symptoms, so these patients can immediately contact their optometrist, should they experience them.

Treatment effect
Chemotherapy, selective estrogen receptor modulators (SERMS), and aromatase inhibitors for breast cancer can negatively affect the eye.

Chemotherapy decreases estrogen. This can cause a decrease in lacrimal and meibomian gland production, creating dry eye disease.

Something else to keep in mind: Prior to every chemotherapy infusion treatment, it is typical for the patient to be given a steroid intravenously, as it decreases inflammation and pain, and increases appetite. Steroids exacerbate cataract formation, so this is something else the OD should keep on their radar when seeing these patients.

SERMS, used after chemotherapy to bind to estrogen receptors to block estrogen, are also associated with ocular dryness, which can cause blurred vision, tearing, and a gritty burning sensation.

The SERM Tamoxifen has been associated with glaucoma, keratopathy, ophthalmic vein thrombosis, optic neuritis, and retinopathy. As a result, the OD should perform a baseline exam, including color vision testing, optical coherence tomography, and a retinal exam on patients using this medication.

Additionally, the optometrist should see these patients every four-to-six months to monitor them for chronic maculopathy and a loss of vision, which could result in permanent vision loss.

Further, the OD should have the patient consult their oncologist, should the optometrist note any of the aforementioned findings.

Aromatase inhibitors inhibit estrogen synthesis rather than block- ing it. These treatments are for post-menopausal breast cancer pa- tients who use them two-to-three years after SERM treatment. The ocular side effects of these treatments, while rare, can include dry eyes, retinal detachments, artery occlusion, and uveitis.

A personal connection
I am a breast cancer survivor. So, my own journey with this disease has made me hyper aware of the information provided above when managing breast cancer patients.

Because breast cancer is connected to the eye and October is Breast Cancer Awareness Month, I invite all my colleagues to keep a particularly watchful eye for the items discussed here this month.

Reference:

1. Razem B, Slimani F. An early orbital metastasis from breast cancer: A case report. Int J Surg Case Rep. 2021; 78: 300–302. Published online 2020. doi: 10.1016/j.ijscr.2020.12.049