This retrospective comparative cross-sectional study evaluated corneal epithelial changes in 132 postmenopausal women: 45 receiving a CDK4/6 inhibitor (ribociclib, palbociclib, or abemaciclib) plus an aromatase inhibitor (CDKAI group), 44 on aromatase inhibitor monotherapy, and 43 age-matched controls with no systemic oncologic therapy.
Punctate epitheliopathy (PE) was present in 44.4% of CDKAI group eyes vs. 4.7% in the aromatase inhibitor-only group and 2.3% in controls (P < .001); all moderate (13.3%) and severe/complicated (8.9%) PE cases were exclusive to the CDKAI group. Vortex keratopathy appeared in 13.3% of CDKAI patients vs. 0% in both comparator groups (P = .025). Tear film parameters and symptom scores (OSDI) did not differ across groups.
- Retrospective cross-sectional design prevents establishing causality or temporal progression of corneal changes. - Incomplete OSDI response rate in the CDKAI group limits conclusions about true symptom burden. - PE severity was not associated with treatment duration, leaving the dose–response relationship unclear.
Patients on CDK4/6 inhibitor therapy for HR+ breast cancer should have proactive corneal surface evaluation with fluorescein staining, even if they report few ocular symptoms. Vortex keratopathy and punctate epitheliopathy can occur in the absence of measurable tear film dysfunction, suggesting a direct cytostatic mechanism rather than dry-eye–related injury.
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