EPIPHORA IN PATIENTS RECEIVING SYSTEMIC 5-FLUOROURACIL THERAPY

Objective: To determine the prevalence of tearing and canalicular fibr osis in patients receiving systemic 5-fluorouracil (5-FU) therapy and the reversibility of the symptoms when treatment is stopped. Design: P rospective study. Setting: University-affiliate tertiary care hospital in Toronto. Patients: Thirty patients (17 men and 13 women aged 38 to 81 years) with advanced gastrointestinal carcinoma receiving intraven ous 5-FU therapy as palliative (weekly) treatment (20 patients) or adj unctive (cycle) treatment(10 patients). Outcome measures: Tearing, eye lid changes and canalicular fibrosis during and after treatment. Patie nts who experienced tearing were advised to massage and wipe the lower eyelids in an upward direction. Results: Tearing and canalicular fibr osis developed in 10 patients (50%) and 3 patients (15%) respectively in the palliative treatment group; no patient in the adjunctive treatm ent group experienced these side effects. In the palliative treatment group, the patients who experienced tearing received double the dose o f 5-FU (p = 0.03) and received treatment for twice as long (p = 0.042) as those who did not experience tearing. Of the patients with tearing , those in whom canalicular fibrosis developed received treatment for three times as long as those without fibrosis and received 2.6 times t he total dose (p < 0.000). Of the seven patients with tearing in whom canalicular fibrosis did not develop, four stopped 5-FU treatment, and 2 to 4 weeks later the epiphora disappeared. Conclusions: Our finding s suggest that the prevalence of tearing and canalicular fibrosis in p atients receiving systemic 5-FU therapy as palliative treatment is rel ated to the total dose and duration of treatment, Such side effects ar e less likely in those receiving adjunctive therapy. The epiphora is o ften reversible on stopping therapy if canalicular fibrosis has not ye t developed.