Abstract
Purpose :
To present cases of punctal and canalicular stenosis following treatment of ocular surface squamous neoplasia with topical 5-fluorouracil 1% eye drops.
Methods :
A retrospective chart review of patients with ocular surface squamous neoplasia (OSSN) treated with topical 5FU as primary or adjuvant treatment between 2013 and 2021 was performed. Patients diagnosed with punctal or canalicular stenosis during or after use of topical 5FU were included in the study. Four patients were identified who met these criteria. We report the clinical findings and treatment for each patient.
Results :
Five eyes of four patients were included in this study out of a total of 303 charts reviewed for an incidence of 1.3%. For this subset, the mean age at initiation of 5FU was 61 (range 53-69). Most patients were male (75%), white (75%), and non-Hispanic (100%). Five eyes were treated with topical 5FU for a mean of 4.87 cycles (standard deviation, SD 2.0). The most common presenting symptom was epiphora, which presented at a mean of 4.6 months after initiating topical 5FU. Two patients who developed epiphora at 4.3 and 10.3 months after initiating 5FU eye drop therapy underwent surgical intervention (external dacryocystorhinostomy and punctoplasty, respectively) after evaluation by an oculoplastic specialist confirmed punctal and canalicular stenosis, respectively. A third patient developed epiphora of the left eye after two cycles of 5FU. Clinical examination showed mild punctal stenosis and the puncta were dilated in the office with resolution of symptoms. The fourth patient received 5FU in both eyes and reported epiphora at 3.2 months in the left eye and 3.9 months in the right. Fortunately, left eye epiphora resolved after stopping therapy but the right eye epiphora persisted. An oculoplastic evaluation revealed right punctal stenosis. The patient’s symptoms resolved following punctal dilation.
Conclusions :
Punctal or canalicular stenosis is a rare adverse effect of topical 5FU eye drops that may require surgical treatment.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.