Burns J A, Morgenstern K E, Cahill K V, Foster J A, Jhiang S M, Kloos R T
Department of Ophthalmology, Division of Oculoplastic Surgery, The Ohio State University, Columbus, Ohio, USA.
Ophthalmic Plast Reconstr Surg. 2004 Mar;20(2):126-9. doi: 10.1097/01.iop.0000117340.41849.81.
To report the finding of nasolacrimal drainage system obstruction associated with I(131) therapy for thyroid carcinoma from an updated and expanded cohort.
Patients with a history of epithelial derived thyroid carcinoma who had tearing were offered referral for evaluation by an oculoplastic surgeon. Patients underwent nasolacrimal probing and irrigation procedures with localization of their nasolacrimal obstruction. Therapy for the site of obstruction was instituted.
Clinically significant tearing was identified in 26 patients, all of whom had previously undergone I(131) therapy (n = 563). Nineteen patients were evaluated and confirmed to have nasolacrimal drainage system obstruction; 7 have yet to be formally evaluated. Areas of obstruction included nasolacrimal duct, common canaliculus, and, rarely, distal upper and lower canaliculi. Patients were treated with a variety of modalities including silicone intubation, balloon dacryoplasty, dacryocystorhinostomy, and conjunctival dacryocystorhinostomy.
The use of I(131) for thyroid carcinoma is associated with a 3.4% incidence of documented nasolacrimal drainage obstruction and an overall 4.6% incidence of documented or suspected obstruction. The true incidence may be higher, since - I(131) treated individuals were neither systematically evaluated nor questioned about tearing. It has yet to be established if the obstructions result from local toxicity caused by the passive flow of radioactive iodine containing tears through these tissues or the active uptake and concentration of I(131) in lacrimal drainage system tissues through the sodium/iodide supporter.
报告来自一个更新和扩大队列的与甲状腺癌碘（I）-131治疗相关的鼻泪引流系统阻塞的研究结果。
有上皮源性甲状腺癌病史且有流泪症状的患者被转介至眼整形外科医生处进行评估。患者接受鼻泪探通和冲洗程序，并对鼻泪阻塞部位进行定位。对阻塞部位进行治疗。
26例患者被确定有临床上显著的流泪症状，所有这些患者此前均接受过碘（I）-131治疗（n = 563）。19例患者接受了评估并被确诊有鼻泪引流系统阻塞；7例尚未进行正式评估。阻塞部位包括鼻泪管、泪总管，以及罕见的上下泪小管远端。患者接受了多种治疗方式，包括硅胶插管、球囊泪道成形术、泪囊鼻腔吻合术和结膜泪囊鼻腔吻合术。
甲状腺癌使用碘（I）-131治疗与记录在案的鼻泪引流阻塞发生率3.4%以及记录在案或疑似阻塞的总发生率4.6%相关。实际发生率可能更高，因为接受碘（I）-131治疗的个体既未进行系统评估，也未被询问流泪情况。目前尚不清楚这些阻塞是由含放射性碘的泪液被动流经这些组织所导致的局部毒性引起，还是由碘（I）-131通过钠/碘转运体在泪道引流系统组织中的主动摄取和浓聚引起。
