Epiphora in patients receiving systemic 5-fluorouracil therapy.
Hassan A. Hurwitz JJ. Burkes RL.
Department of Ophthalmology, Mount Sinai Hospital, University of Toronto, Ont.
OBJECTIVE: To determine the prevalence of tearing and canalicular fibrosis in patients receiving systemic 5-fluorouracil (5-FU) therapy and the reversibility of the symptoms when treatment is stopped. DESIGN: Prospective study. SETTING: University-affiliated tertiary care hospital in Toronto. PATIENTS: Thirty patients (17 men and 13 women aged 38 to 81 years) with advanced gastrointestinal carcinoma receiving intravenous 5-FU therapy as palliative (weekly) treatment (20 patients) or adjunctive (cycle) treatment (10 patients). OUTCOME MEASURES: Tearing, eyelid changes and canalicular fibrosis during and after treatment. Patients who experienced tearing were advised to massage and wipe the lower eyelids in an upward direction. RESULTS: Tearing and canalicular fibrosis developed in 10 patients (50%) and 3 patients (15%) respectively in the palliative treatment group; no patient in the adjunctive treatment group experienced these side effects. In the palliative treatment group, the patients who experienced tearing received double the dose of 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 the 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 findings suggest that the prevalence of tearing and canalicular fibrosis in patients receiving systemic 5-FU therapy as palliative treatment is related to the total dose and duration of treatment. Such side effects are less likely in those receiving adjunctive therapy. The epiphora is often reversible on stopping therapy if canalicular fibrosis has not yet developed.