Fonseca Fabricio Lopes da, Lunardelli Patrícia, Matayoshi Suzana
Setor de Plástica Ocular, Divisão de Clínica Oftalmológica, Hospital das Clínicas, Faculdade de Medicina,Universidade de São Paulo - USP - São Paulo (SP), Brasil.
Arq Bras Oftalmol. 2012 Mar-Apr;75(2):97-100. doi: 10.1590/s0004-27492012000200005.
To report the finding of nasolacrimal drainage system obstruction associated with radio iodine therapy and to review clinical data and the surgical treatment outcome of this rare complication.
We retrospectively analyzed ophthalmological data of patients with history of thyroid carcinoma that underwent radioactive iodine I-131 therapy and were referred to lacrimal surgery.
17 patients with thyroid cancer treated with thyroidectomy and radioactive iodine I-131 therapy presented symptomatic nasolacrimal duct obstruction after 13.2 months following cancer treatment. 11 patients presented bilateral epiphora, 8 had lacrimal sac mucocele. Age range was 30 to 80 years, 10 patients had less than or equal to 49 years. The mean cumulative dose of radioiodine was 571 mCi (range: 200-1200 mCi). Nasal obstruction symptoms and increased salivary glands were also present in 53% of patients. All subjects underwent dacryocystorhinostomy. Dilation of the lacrimal sac and increased intraoperative bleeding was also observed in 3 younger patients. Complete epiphora and dacryocystitis resolution after surgery occurred in 82.4%, and partial in 17.6% (3 patients that still presented unilateral relapse after correction of bilateral obstruction). Mean follow-up was 6 months (range: 2-24 months).
Cumulative high dose of radioiodine, nasal and salivary gland dysfunction are associated with lacrimal drainage obstruction. We observed a great percentage of younger patients presenting dacryocystitis when compared to the idiopathic dacryostenosis. Radioactive iodine uptake by nasolacrimal duct mucosa with subsequent inflammation, edema and fibrosis seems to have a relationship to lacrimal duct obstruction. The knowledge of this complication is important for the study and proper management of these patients.
报告放射性碘治疗相关的鼻泪管引流系统阻塞的发现，并回顾这一罕见并发症的临床资料及手术治疗结果。
我们回顾性分析了接受过甲状腺癌放射性碘I-131治疗并转诊至泪道手术的患者的眼科资料。
17例接受甲状腺切除术及放射性碘I-131治疗的甲状腺癌患者在癌症治疗后13.2个月出现了有症状的鼻泪管阻塞。11例患者出现双侧溢泪，8例有泪囊黏液囊肿。年龄范围为30至80岁，10例患者年龄小于或等于49岁。放射性碘的平均累积剂量为571毫居里（范围：200 - 1200毫居里）。53%的患者还存在鼻塞症状及唾液腺增大。所有受试者均接受了泪囊鼻腔吻合术。3例较年轻的患者术中还观察到泪囊扩张及出血增多。术后82.4%的患者溢泪和泪囊炎完全缓解，17.6%（3例在双侧阻塞矫正后仍有单侧复发）部分缓解。平均随访时间为6个月（范围：2 - 24个月）。
放射性碘的累积高剂量、鼻腔及唾液腺功能障碍与泪道引流阻塞有关。与特发性泪道狭窄相比，我们观察到有很大比例的年轻患者出现泪囊炎。鼻泪管黏膜摄取放射性碘，随后发生炎症、水肿和纤维化，似乎与泪道阻塞有关。了解这一并发症对于这些患者的研究和恰当管理很重要。
