Fezza J P, Wesley R E, Klippenstein K A
Department of Ophthalmology, Vanderbilt University Medical Center and Columbia HCA Center for Research Education, Nashville, TN, USA.
Ophthalmic Surg Lasers. 1999 Feb;30(2):105-8.
5-FU administered systemically for cancer treatment can cause punctal and canalicular stenosis leading to symptoms of tearing. While some patients receiving 5-FU have resolution of their tearing with cessation of the drug, many patients require surgical treatment of their lacrimal outflow system. We studied the severity of punctal and canalicular stenosis in patients on 5-FU and the various treatments required to correct symptoms of tearing.
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 evaluated by slit lamp exam, and probing and irrigation of the lacrimal outflow system.
All patients demonstrated bilateral punctal and canalicular stenosis on exam. Fifteen of the 19 patients underwent surgery with 4 declining any surgical intervention. Of those 15 patients who underwent surgery; 5 had bilateral silicone tube intubation, 3 had bilateral conjunctivodacryocystorhinostomies (CDCR), 1 had a silicone tube on one side and a CDCR on the other side, 1 had a bilateral DCR, 4 had bilateral punctal 3-snip procedures, and 1 failed bilateral silicone tube intubation and will require bilateral CDCR.
This is the largest single study in the literature evaluating patients 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 intervention 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 stenosis of the lacrimal outflow system. Physicians should be aware that early recognition and treatment of tearing in patients on 5-FU with silicone tubes may salvage the canalicular system and prevent the need for CDCR.
全身性应用5-氟尿嘧啶（5-FU）进行癌症治疗可导致泪点和泪小管狭窄，从而引发流泪症状。虽然一些接受5-FU治疗的患者在停药后流泪症状会缓解，但许多患者需要对其泪液引流系统进行手术治疗。我们研究了接受5-FU治疗的患者泪点和泪小管狭窄的严重程度以及纠正流泪症状所需的各种治疗方法。
对19例接受全身性5-FU治疗且有流泪主诉的患者（16例结肠癌患者和3例乳腺癌患者）进行回顾性研究。治疗方式基于裂隙灯检查评估的泪点狭窄情况以及泪液引流系统的探查和冲洗。
所有患者检查时均表现为双侧泪点和泪小管狭窄。19例患者中有15例接受了手术，4例拒绝任何手术干预。在接受手术的15例患者中，5例行双侧硅胶管植入术，3例行双侧结膜泪囊鼻腔吻合术（CDCR），1例一侧行硅胶管植入术，另一侧行CDCR，1例行双侧泪囊鼻腔吻合术（DCR），4例行双侧泪点三剪法手术，1例双侧硅胶管植入术失败，需要行双侧CDCR。
这是文献中评估接受全身性5-FU治疗患者流泪后遗症及治疗情况的最大规模单中心研究。虽然我们在19例患者中发现了不同程度的泪点和泪小管狭窄，但几乎所有患者的狭窄程度都严重到需要用硅胶管或CDCR进行手术干预。在我们的研究中，15例选择手术的患者中有4例（26.7%）因泪液引流系统永久性严重狭窄而需要行CDCR。医生应意识到，对接受5-FU治疗且有流泪症状的患者早期识别并用硅胶管进行治疗，可能挽救泪小管系统并避免需要行CDCR。
