Features
Tamoxifen is a commonly used antiestrogen oral medication that has been used in the management of breast cancer since the 1970s. This medication is particularly effective as an adjuvant therapy in postsurgical advanced estrogen-receptor positive breast cancer. Though this medication is relatively well tolerated, it has rarely been known to cause ocular toxicity including a crystalline retinopathy with long-term use. Tamoxifen ocular toxicity was initially attributed to the higher dosing of this agent that ranged from 60 to 100 mg/day with an accumulative dosing of greater than 100 g over a period of 12 months. More recently, there have been reports of tamoxifen ocular toxicity even with the low-dose therapy of 20 to 40 mg/day and a cumulative dose of as low as 8 g. Tamoxifen toxicity can manifest in different structures of the eye such as a crystalline keratopathy, crystalline lens opacities or cataract, inner retinal deposits with or without edema, and less commonly as an optic neuropathy.
90.1.1 Common Symptoms
It may be asymptomatic. Progressive decline in visual acuity with or without distortion may occur; may manifest as color vision deficiency.
90.1.2 Exam Findings
Tamoxifen toxicity can be detected in various types of ocular tissue causing a crystalline keratopathy, cataract formation, crystalline retinopathy, and optic neuropathy. Toxic retinopathy or maculopathy presents as small retractile yellow or white deposits, predominantly located in the paramacular region and do tend to increase in number with worsening toxicity (▶ Fig. 90.1). The crystalline deposits may also be associated with underlying retinal pigmentary changes as well as macular edema with a blunted foveal light reflex.
Fig. 90.1 Color fundus photograph of the (a,b) right eye and (c,d) left eye demonstrating bilateral macular crystals in the central macular area (left), more visible on the high magnification view (right).
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
