Surgical treatment of canalicular stenosis in patients receiving docetaxelweekly

Objective: To describe the surgical treatment and outcomes in patients with metastatic breast cancer and canalicular stenosis caused by weekly treatme nt with docetaxel. Methods: This case series included 10 patients with persistent epiphora due to weekly docetaxel treatment, who were evaluated by probing and irrigatio n of the tear drainage apparatus and were found to have significant canalic ular stenosis. The severity of canalicular stenosis was graded clinically. Each patient underwent bicanalicular silicone intubation or dacryocystorhin ostomy (DCR) with placement of either a silicone tube (canaliculo DCR) or a pyrex glass tube (conjunctivo DCR). Results: Seven patients (12 eyes) underwent bicanalicular silicone intubati on. Three patients (5 eyes) required canaliculo DCR with the placement of a silicone tube. In 2 patients (3 eyes), the degree of canalicular stenosis; was severe enough to require conjunctivo DCR with the placement of a pyrex glass tube. All 10 patients had complete resolution of epiphora immediatel y after surgery. Four patients continued to receive docetaxel after surgery . In patients who underwent bicanalicular silicone intubation, the silicone stent was kept in place for the duration of docetaxel therapy, There were no surgical or anesthesia-related complications. At a mean follow-up time o f 9 months after surgery, all but 1 patient (1 eye) remained asymptomatic. The interval between initiation of docetaxel therapy and surgery was signif icantly higher in patients who required DCR compared with those who had sil icone intubation. The mean cumulative close of docetaxel at the time of sur gery was higher in patients who required DCR than in patients who had silic one intubation, but this difference was not statistically significant. Conclusions: Canalicular stenosis secondary to weekly treatment with doceta xel should be treated with bicanalicular silicone intubation early in the c ourse of docetaxel therapy. Failure to treat this adverse effect early may likely lead to severe and irreversible canalicular stenosis, which may nece ssitate conjunctivo DCR with the placement of a permanent pyrex glass tube.