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Elaine Downie, Cat Burkat; Topical facial 5-fluourouracil and epiphora: Is there an association?. Invest. Ophthalmol. Vis. Sci. 2020;61(7):2940.
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Systemic 5-fluourouracil (5-FU) is well-known to be associated with nasolacrimal duct obstruction (NLDO). Topical 5-FU applications (ie. Efudex) to the face are frequently prescribed by dermatologists or primary care physicians for widespread actinic damage, and basal or squamous cell carcinomas; to our knowledge, no cases of nasolacrimal stenosis have been associated with topical facial administration of 5-FU. This study reviewed cases of patients who presented with epiphora after receiving courses of topical facial 5-FU.
Case series review of patients seen for tearing or epiphora in the last 3 years who presented with NLDO in the setting of recent topical facial 5-FU use.
76-year-old male presented with several years of epiphora bilaterally. He had no history of sinonasal disease, surgeries, or facial trauma. He had no exposure to systemic medications known to be associated with stenosis of the lacrimal outflow tract. He had a history of topical 5-FU use for non-melanoma facial skin cancers, with several 6-week treatment cycles yearly for 5 years. Exam demonstrated partial NLDO, punctal stenosis and punctal ectropion. Review of all patient charts seen for tearing or epiphora in the last 3 years also revealed 7 other patients who had punctal stenosis, canalicular stenosis, or NLDO in the setting of topical facial 5-FU within the past 18 months of presentation. Two patients also demonstrated cicatricial ectropion, likely secondary to topical 5-FU.
Eight patients (age range 59-87 yrs) were identified in the last 3 years who had topical 5-FU facial treatments within 18 months prior to presenting with epiphora. Pharmacokinetics state a 2.4% systemic absorption of topical 5-FU, with one article suggesting that systemic absorption is 15-75 times higher through diseased skin. It is possible that chronic or high dose topical 5-FU on the face may lead to lacrimal outflow stenosis and cicatricial changes similar to those seen in systemic 5-FU use. Further studies are needed to determine if topical facial treatment through diseased skin is absorbed systemically, or if periocular applications spread directly to the ocular surface, to potentiate epiphora.
This is a 2020 ARVO Annual Meeting abstract.
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