Punctal and canalicular stenosis associated with systemic fluorouracil therapy

Abstract

Ocular side effects of systemic fluorouracil include excessive lacrimation, due to punctal and canalicular stenosis and fibrosis. Obstruction of the tear ducts after systemic therapy with fluorouracil is more frequent than is assumed. Five patients with breast cancer and punctal or canalicular stenosis are presented. Although complaints of epiphora usually resolve two weeks after cessation of systemic therapy, local antibiotics and steroids may be indicated. In patients with persisting complaints, and patients treated with fluorouracil for a prolonged period of time, prophylactic intubation of the tear ducts with silastic tubes has been advocated. (Conjunctivo)dacryocystorhinostomy may be unavoidable.

Dacryoendoscopic observation and incidence of canalicular obstruction/stenosis associated with S-1, an oral anticancer drug

“…Punctal and canalicular stenosis following systemic 5-FU therapy are also reported [5,6]. Hassan et al [7] report patients with canalicular fibrosis who received 5-FU treatment for three times the duration and at 2.6 times the total dose as that for patients without fibrosis.…”

“…5-FU has a relatively large inhibitory effect on rapidly dividing cells, including epithelial cells, cancer cells and hematopoietic cells. Canalicular fibrosis is reported in association with 5-FU and some of its derivatives, as well as with other chemotherapeutic agents, including docetaxel [2][3][4][5][6][7]. Canalicular blockage and corneal epithelial lesions associated with S-1 are also reported in the literature [8][9][10]; however, the rate of crisis and quantitative analysis are not reported.…”

Sclerosing canaliculitis after 5-fluorouracil breast cancer chemotherapy

“…This was followed by subsequent reports in a variety of patients undergoing chemotherapy for breast or gastrointestinal malignancies with 5FU as the sole cytotoxic agent or in conjunction with other antimetabolites. 3,4 It is important to differentiate the effects of topical application versus parenteral 5FD. Topical applications only exposes the ocular surface transiently to high levels of the drug, which is rapidly washed away by perfusion of normal saline, only minimal amounts entering the lacrimal system.…”

Lacrimal canalicular stenosis associated with systemic 5‐fluorouracil therapy

“…Canalicular fibrosis leading to permanent, intractable epiphora may, however, develop in some patients on prolonged high doses of 5FU. Eighteen such cases have been previously reported in the literature (Brink & Beex 1995;Caravella et al 1981;Haidak et al 1978;Hassan et al 1998;Lee et al 1998;Seiff et al 1985;Straus et al 1977). It is difficult to categorically prove that 5FU was the actual cause of the stenosis of the puncta and canaliculi in our two cases or the cases previously reported in the literature, but evidence points towards 5FU as the causative agent.…”

“…There is no consensus about the management of this condition. Recommendations are varied, ranging from simple measures such as wiping the eyelid in an upward direction (Hassan et al 1998) and topical antibiotics and steroids (Brink & Beex, 1995) to prophylactic intubation of the tear passages with silicon tubes (Caravella et al 1981). We have, therefore, reviewed the literature and discussed the treatment options.…”