Hassan A, Hurwitz J J, Burkes R L
Department of Ophthalmology, Mount Sinai Hospital, University of Toronto, Ont.
Can J Ophthalmol. 1998 Feb;33(1):14-9.
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.
Prospective study.
University-affiliated tertiary care hospital in Toronto.
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).
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.
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.
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.
确定接受全身性5-氟尿嘧啶（5-FU）治疗的患者流泪和泪小管纤维化的发生率，以及停止治疗后症状的可逆性。
前瞻性研究。
多伦多大学附属三级护理医院。
30例（17例男性和13例女性，年龄38至81岁）晚期胃肠道癌患者，接受静脉注射5-FU作为姑息性（每周）治疗（20例患者）或辅助性（周期性）治疗（10例患者）。
治疗期间及治疗后的流泪情况、眼睑变化和泪小管纤维化。建议出现流泪的患者向上按摩并擦拭下眼睑。
姑息治疗组分别有10例患者（50%）出现流泪，3例患者（15%）出现泪小管纤维化；辅助治疗组无患者出现这些副作用。在姑息治疗组中，出现流泪的患者接受的5-FU剂量是未出现流泪患者的两倍（p = 0.03），治疗时间也是未出现流泪患者的两倍（p = 0.042）。在出现流泪的患者中，发生泪小管纤维化的患者接受治疗的时间是未发生纤维化患者的三倍，总剂量是2.6倍（p < 0.000）。在7例出现流泪但未发生泪小管纤维化的患者中，4例停止了5-FU治疗，2至4周后溢泪消失。
我们的研究结果表明，接受全身性5-FU姑息治疗的患者中流泪和泪小管纤维化的发生率与治疗的总剂量和持续时间有关。接受辅助治疗的患者出现此类副作用的可能性较小。如果尚未发生泪小管纤维化，停止治疗后溢泪通常是可逆的。
