Inomata Daniela, Hoshi Sujin, Alcântara Camila Pontes Bessa Campêlo, Hiraoka Takahiro, Tasaki Kuniharu, Oshika Tetsuro, Matayoshi Suzana
Department of Ophthalmology, Santa Cruz Hospital, R. Santa Cruz, 398, Vila Mariana, São Paulo, Brazil.
Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba City, Ibaraki, Japan.
Am J Ophthalmol Case Rep. 2022 Feb 3;25:101344. doi: 10.1016/j.ajoc.2022.101344. eCollection 2022 Mar.
Radioiodine therapy, a standard treatment for differentiated thyroid carcinomas, is associated with several adverse events including lacrimal drainage system obstruction. Herein, we describe the first case of duct lumen recanalization using dacryoendoscopy for lacrimal passage obstruction and stenosis after radioiodine therapy.
A 48-year-old female treated with radioiodine therapy for differentiated thyroid carcinoma 5 years prior presented with epiphora in both eyes. Dacryocystography showed nasolacrimal duct stenosis in the right eye and nasolacrimal duct obstruction in the left eye. Dacryoendoscopic examination revealed right common canalicular polyps, fibrosis in the right lacrimal sac, right nasolacrimal duct stenosis, and left upper and common canaliculus stenosis. Lacrimal passage recanalization with the insertion of a nasolacrimal stent tube using dacryoendoscopy was performed on the right eye. This successfully resolved the epiphora.
Dacryoendoscopic examination for epiphora after radioiodine therapy may help detect early-stage nasolacrimal passage obstruction/stenosis. This condition can be resolved by recanalization and insertion of a lacrimal tube, without the need for a more invasive surgical approach such as dacryocystorhinostomy.
放射性碘治疗是分化型甲状腺癌的标准治疗方法，它会引发包括泪道系统阻塞在内的多种不良事件。在此，我们报告首例使用泪道内窥镜对放射性碘治疗后泪道阻塞和狭窄进行管腔再通的病例。
一名48岁女性，5年前接受放射性碘治疗分化型甲状腺癌，现出现双眼溢泪症状。泪囊造影显示右眼鼻泪管狭窄，左眼鼻泪管阻塞。泪道内窥镜检查发现右侧泪小管息肉、右侧泪囊纤维化、右侧鼻泪管狭窄以及左侧上泪小管和泪总管狭窄。对右眼采用泪道内窥镜插入鼻泪支架管进行泪道再通术。该操作成功解决了溢泪问题。
放射性碘治疗后对溢泪进行泪道内窥镜检查有助于检测早期鼻泪道阻塞/狭窄。这种情况可通过再通和插入泪管解决，无需采用如泪囊鼻腔吻合术等更具侵入性的手术方法。
