5-Fluorouracil and ocular toxicity.

Abstract

Reply EDITOR,-We thank Dr Miller for his interest and commentary about our paper on pleomorphic adenomas of the lacrimal gland.We are unable to answer the question of whether the chances of spillage of tumour cells into surrounding tissues is less if the whole of the tumour is removed immediately after biopsy or after an interval of several days. Theoretically, biopsy with frozen section can reduce contact between normal tissue and the biopsy site. Biopsy will be trans-septal, however, whereas excision of lacrimal pleomorphic adenomas should use a lateral orbitotomy approach, so that there is potential for seeding of tumour cells during the surgical manoeuvres. Furthermore, the histopathological differential diagnosis of lacrimal gland lesions is more difficult with frozen section material than with appropriately stained paraffin sections.Thankfully the majority of pleomorphic adenomas can be correctly diagnosed using the clinical and radiological criteria outlined in our paper. In these cases there is no need for a biopsy and the tumour can be removed with an intact capsule.Our recommendation against biopsy of pleomorphic adenomas is based upon the landmark cinicopathological review of Font and Gamel'; a view strengthened by the high rate of recurrence in a large series ofChinese patients,2 many ofwhom were biopsied. With the current follow up intervals, our paper is unable to either confirm, or refute, this issue. This condition was previously termed spastic entropion but the spastic component is secondary to ocular irritation by inturning lashes. The author makes the mistake of trying to treat the effect rather than the cause of the condition and states that scars interrupt the continuity of the pretarsal part of the orbicularis muscle, thus eliminating the spasm which contributes to the entropion. While this may be partly true in the very short term, one has only to look at the orbicularis function of patients who have had a 'total' orbicularis myectomy for blepharospasm to appreciate that three burns would have a negligible effect on the function of the orbicularis muscle.The author documents one recurrence of entropion in 50 procedures but the means of assessment is not stated. This is best evaluated by asking the patient to squeeze shut the eyelids and assessing the lids on opening.In the series of photographs presented, there is clearly hyperpigmentation at the sites of the burns and this should be remembered as a side effect. El-Kasaby recommends this procedure for patients who are 'infirm and bedridden'. Most entropion surgery is performed using local anaesthesia and takes no longer than 15 to 20 minutes and addresses the underlying aetiology.Modern oculoplastic surgeons such as Coffin in Europe and Anderson in the United States have greatly advanced our understanding of the anatomy and physiology of the normal and abnormal eyelid and orbital structures. They have both stressed the systematic approach to evaluation of oculoplastic problems and devised specific operations to address the underlying probl...

Patients' experiences of chemotherapy: side‐effects associated with 5‐fluorouracil + folinic acid in the treatment of colorectal cancer

“…These studies tend to focus on survival rates and provide only cursory data on sideeffects. Studies which have specifically investigated sideeffects of 5-FU have attended to a narrow range of problems, principally stomatitis, skin reactions and ocular effects (Cristophidis et al, 1979;Pfeiffer et al, 1990;Umstead et al, 1991;Forbes et al, 1993;Hurwitz, 1993;Stevens et al, 1993;Verdi, 1993). There exists little literature on other side-effects, despite their clinical importance; diarrhoea, for example, although found to be life-threatening in patients undergoing 5-FU therapy (Writh et al, 1991), has hardly been investigated.…”

“…Christophidis et al (1979) found 5-FU in the tears only of patients who suffered these reactions. Other ocular effects include dryness, photophobia and lid ectropion (Forbes et al, 1993;Hurwitz, 1993).…”