Epiphora in patients receiving systemic 5-fluorouracil therapy

Area of Science:

• Ophthalmology
• Oncology
• Gastroenterology

Background:

• Systemic 5-fluorouracil (5-FU) is a common chemotherapy agent.
• Ocular side effects of 5-FU, such as tearing and canalicular fibrosis, can impact patient quality of life.

Purpose of the Study:

• To investigate the incidence of tearing and canalicular fibrosis in patients undergoing 5-FU therapy.
• To assess the reversibility of these ocular symptoms upon cessation of 5-FU treatment.

Main Methods:

• Prospective study conducted at a tertiary care hospital.
• 30 patients with advanced gastrointestinal carcinoma received either palliative or adjunctive 5-FU therapy.
• Ocular symptoms including tearing and canalicular fibrosis were monitored during and after treatment.

Main Results:

• Tearing occurred in 50% and canalicular fibrosis in 15% of patients receiving palliative 5-FU; no side effects were noted in the adjunctive group.
• Higher 5-FU dose and longer treatment duration were associated with increased tearing in the palliative group.
• Canalicular fibrosis was linked to significantly longer treatment duration and higher cumulative 5-FU dose.
• Epiphora resolved in four out of seven patients with tearing but without fibrosis after stopping 5-FU treatment.

Conclusions:

• The prevalence of 5-FU-induced tearing and canalicular fibrosis is dose and duration-dependent, particularly with palliative therapy.
• Adjunctive 5-FU therapy appears to carry a lower risk of these ocular side effects.
• Epiphora is often reversible upon discontinuation of 5-FU, provided that canalicular fibrosis has not yet developed.