Abstract
Background 5-Fluorouracil is a pyrimidine analogue that inhibits DNA synthesis and is commonly used in the treatment of carcinomas of the breast, gastrointestinal tract and genitourinary tract. Excessive tearing that resolves on cessation of treatment is commonly described as a side effect of the drug. Permanent stenosis of the punctum and canaliculus is extremely rare, with only 12 cases reported in the world literature. We present three cases of established lacrimal outflow obstruction in patients who were treated with CMF (cyclophosphamide, methotrexate, 5-fluorouracil), a widely used regimen for metastatic breast cancer.
Patient 1 had right distal stenosis of her lower canaliculus and was syringed patent during dacryocystography with resolution of epiphora.
Patient 2 had proximal blockage of all canaliculi and underwent bilateral canaliculo-dacryocystorhinostomy with silicone tubes that temporarily relieved symptoms until tube removal. The proximal canalicular blockage recurred due to underlying extensive fibrosis.
Patient 3 had right proximal common canalicular stenosis and left distal canalicular blocks but declined surgery.
Conclusion With the rise in the incidence of breast carcinoma it is important that the attention of both ophthalmologists and oncologists should be drawn to the potential ocular toxicity of systemic 5-fluorouracil chemotherapy, which may lead to lacrimal canalicular fibrosis with permanent epiphora. The management of these patients is challenging as there is a continuous spectrum of canalicular involvement from focal to diffuse; therefore early referral is recommended. Moreover as no consensus has been reached as how best to manage this unique small group of patients, we review the literature and discuss the implications for treatment.
Similar content being viewed by others
Article PDF
References
Jacobs EM, Luce JK, Wood DA . Treatment of cancer with weekly intravenous 5-fluorouracil. Cancer 1968;22:1233–8.
Caravella LP, Burns JA, Zangmeister M . Punctal-canalicular stenosis related to systemic fluorouracil therapy. Arch Ophthalmol 1981;99:284–6.
Seiff SR, Shorr N, Adams T . Surgical treatment of punctal-canalicular fibrosis from 5-fluorouracil therapy. Cancer 1985;56:2148–9.
Brink HMA, Beex LVAM . Punctal and canalicular stenosis associated with systemic fluorouracil therapy. Doc Ophthalmol 1995;90:1–6.
Greenspan E . Combination cytotoxic chemotherapy in advanced disseminated breast cancer. J Mt Sinai Hosp 1972;33:1–27.
Kende G, Sirki SR, Thomas PRM, et al. Blurring of vision: a previously undescribed complication of cyclophosphamide therapy. Cancer 1979;44:69–71.
Jack MK, Hicks JD . Ocular complications in high dose chemoradiotherapy and marrow transplantation. Ann Ophthalmol 1981;13:709–11.
Fraunfelder FT, Meyers SM . Ocular toxicity of antineoplastic agents. Ophthalmology 1983;90:1–3.
Imperia PS, Lazarus HM, Lass JH . Ocular complications of systemic cancer therapy. Surv Ophthalmol 1989;34:220–30.
Bonadonna G, Brusamolino E, Pinuccia V, Rossi A, Brugnatelli L, Brambilla C, et al. Combination chemotherapy as an adjuvant treatment in operable breast cancer. N Engl J Med 1976;294:405–10.
Doroshow JH, Locker GY, Gasterland DE, et al. Ocular irritation from high dose methotrexate therapy: pharmacokinetics of drug in the tear film. Cancer 1981;48:2158–62.
Stern WH, Guerin CJ, Erickson PA, Lewis GP, Anderson DH, Fisher SK . Ocular toxicity of fluorouracil after vitrectomy. Am J Ophthalmol 1983;96:43–51.
Shapiro MS, Thoft RA, Friend J, Parrish RK, Gressel MG . 5-Fluorouracil toxicity to the ocular surface epithelium. Invest Ophthalmol Vis Sci 1985;26:580–3.
Straus DJ, Mausolf FA, Ellerby RA, McCracken JD . Cicatricial ectropion secondary to 5-fluorouracil therapy. Med Pediatr Oncol 1977;3:15–9.
Hammersley J, Luce JK, Florent TR, Burkholder MM . Excessive lacrimation from fluorouracil treatment. JAMA 1973;225:747–8.
Christophidis N, Vajda FJE, Lucas I, Drummer O, Moon WJ, Louis WJ . Excessive lacrimation associated with detectable concentrations of 5FU in tears and plasma. Proc Aust Soc Clin Exp Pharmacol 1977;23:56.
Aisner J, Weinberg V, Perloff R, Weiss M, Korzun A, et al. Chemotherapy versus chemoimmunotherapy (CAF v CAFP v CMF Each ± MER) for metastatic carcinoma of the breast: a CALGB study. J Clin Oncol 1987: 5;1523–33.
Jones LT . Epiphora. II. Its relation to the anatomical structures and surgery of the medial canthal region. Am J Ophthalmol 1957;43:203–12.
Becker BB . Tricompartmental model of the lacrimal pump mechanism. Ophthalmology 1992;99:1139–45.
Hurwitz JJ . Canalicular diseases. In: Hurtwitz JJ, editor. The lacrimal system. New York: Lippincott-Raven, 1996:139–47.
Veirs ER, Brindley GO . Management of canalicular obstruction. Adv Ophthalmic Plast Reconstruct Surg 1984;3:165–9.
Barishak R, Romano A, Stein R . Obstruction of lacrimal sac caused by topical epinephrine. Ophthalmologica 1969;159:373–9.
Silkiss R, Axelrod RN, Iwach AG, Vassiliadis A, Hennings DR . Transcanalicular THGYAG dacryocystorhinostomy. Ophthalmic Surg 1992;23:351–3.
Author information
Authors and Affiliations
Additional information
Presented as a poster to the Annual Congress of the Royal College of Ophthalmologists, Birmingham, May 1997
Rights and permissions
About this article
Cite this article
Lee, V., Bentley, C. & Olver, J. Sclerosing canaliculitis after 5-fluorouracil breast cancer chemotherapy. Eye 12, 343–349 (1998). https://doi.org/10.1038/eye.1998.83
Issue Date:
DOI: https://doi.org/10.1038/eye.1998.83
Keywords
This article is cited by
-
Changes in tear volume and ocular symptoms of patients receiving oral anticancer drug S-1
Journal of Pharmaceutical Health Care and Sciences (2018)
-
Predictive factors for ocular complications caused by anticancer drug S-1
Japanese Journal of Ophthalmology (2016)
-
Chemotherapeutische Nebenwirkungen im Augenbereich
Spektrum der Augenheilkunde (2005)