The treatment of punctal and canalicular stenosis in patients on systemic 5-FU

PURPOSE: 5-FU administered systemically for cancer treatment can cause punc tal and canalicular stenosis leading to symptoms of tearing. While some pat ients receiving 5-FU have resolution of their tearing with cessation of the drug, many patients require surgical treatment of their lacrimal outflow s ystem. We studied the severity of punctal and canalicular stenosis in patie nts on 5-FU and the various treatments required to comet symptoms of tearin g. METHODS: Nineteen patients (16 with colon cancer and 3 with breast cancer) who were treated with systemic 5-FU with complaints of tearing were studied retrospectively. Treatment modalities were based on punctal stenosis evalu ated by slit lamp exam, and probing and irrigation of the lacrimal outflow system. RESULTS: All patients demonstrated bilateral punctal and canalicular stenos is on exam. Fifteen of the 19 patients underwent surgery with 4 declining a ny surgical intervention. Of those 15 patients who underwent surgery; 5 had bilateral silicone tube intubation, 3 had bilateral conjunctivodacryocysto rhinostomies (CDCR), 1 had a silicone tube on one side and a CDCR on the ot her side, 1 had a bilateral DCR, 4 had bilateral punctal 3-snip procedures, and I failed bilateral silicone tube intubation and will require bilateral . CDCR. CONCLUSION: This is the largest single study in the literature evaluating p atients on systemic 5-FU for the sequela and treatment of tearing. Although we found varying degrees of punctal and canalicular stenosis among our 19 patients, almost all had stenosis severe enough to warrant surgical interve ntion with either silicone tubes or CDCR. In our study 4 of 15 patients who elected surgery (26.7 %) required CDCR, because of the permanent, severe s tenosis of the lacrimal outflow system. Physicians should be aware that ear ly recognition and treatment of tearing in patients on 5-FU with silicone t ubes may salvage the canalicular system and prevent the need for CDCR.