SCLEROSING CANALICULITIS AFTER 5-FLUOROURACIL BREAST-CANCER CHEMOTHERAPY

Background 5-Fluorouracil is a pyrimidine analogue that inhibits DNA s ynthesis and is commonly used in the treatment of carcinomas of the br east, gastrointestinal tract and genitourinary tract. Excessive tearin g that resolves on cessation of treatment is commonly described as a s ide effect of the drug. Permanent stenosis of the punctum and canalicu lus is extremely rare, with only 12 cases reported in the world litera ture. We present three cases of established lacrimal outflow obstructi on in patients who were treated with CMF (cyclophosphamide, methotrexa te, 5-fluorouracil), a widely used regimen for metastatic breast cance r. Patient 1 had right distal stenosis of her lower canaliculus and wa s syringed patent during dacryocystography with resolution of epiphora . Patient 2 had proximal blockage of all canaliculi and underwent bila teral canaliculo-dacryocystorhinostomy with silicone tubes that tempor arily relieved symptoms until tube removal. The proximal canalicular b lockage recurred due to underlying extensive fibrosis. Patient 3 had r ight 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 ophtha lmologists and oncologists should be drawn to the potential ocular tox icity of systemic 5-fluorouracil chemotherapy, which may lead to lacri mal canalicular fibrosis with permanent epiphora. The management of th ese patients is challenging as there is a continuous spectrum of canal icular 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 a nd discuss the implications for treatment.