Ocular surface, ocular adnexal, and lacrimal complications associated with the use of systemic 5-fluorouracil.
OBJECTIVE
To determine the prevalence rates and associated characteristics of patients who have ocular surface, ocular adnexal, and lacrimal complications associated with the systemic use of the cancer chemotherapeutic agent 5-Fluorouracil (5-FU).


METHODS
An exposure-based cohort study was designed. Adult patients who had completed at least 3 months of systemic 5-FU therapy within the past 5 years were eligible for enrollment. Study subjects had a detailed medical history taken with emphasis on preexisting conditions known to be associated with the development of ocular surface, ocular adnexal, and lacrimal complications. An ocular examination was then performed. A complete nasolacrimal system evaluation was performed if symptoms or findings were identified. The prevalence was then determined for each ocular symptom and each ocular finding identified that was not present pretreatment. An exploratory analysis was then performed to identify patient characteristics that might influence the likelihood of developing any of the above complications.


RESULTS
Fifty-two patients were enrolled in the study. The prevalence rates of the following ocular abnormalities were calculated: ocular irritation, 5.8%; blepharitis, 3.8%; conjunctivitis, 3.8%; keratitis, 3.8%; eyelid dermatitis, 5.8%; cicatricial ectropion, 1.9%; tearing, 26.9%; punctal-canalicular stenosis, 5.8%; and blurred vision, 11.5%. Blacks had tearing at a significantly higher rate when compared with whites (P = 0.022, 2-sided Fisher exact test). Three patients had permanent complications that will require surgery for correction. Of the 7 patients who had a single abnormality, 6 had tearing and one had eyelid dermatitis. All of the 8 patients who had multiple findings had tearing as one of their abnormalities.


CONCLUSIONS
Ninety-three percent of the patients who had an ocular abnormality had tearing as one of the complications. Patients who are receiving systemic 5-FU and begin to tear should have an ocular examination, looking for ocular surface, ocular adnexal, and lacrimal complications.
Eiseman
Andrew S
AS
Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA. andrew.eiseman@na.amedd.army.mil
Flanagan
Joseph C
JC
Brooks
Alfred B
AB
Mitchell
Edith P
EP
Pemberton
Clifford H
CH
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D015331:Cohort Studies; D003875:Drug Eruptions / Q000453:epidemiology / Q000378:metabolism / Q000473:pathology; D005128:Eye Diseases / Q000139:chemically induced* / Q000453:epidemiology / Q000378:metabolism / Q000473:pathology; D005141:Eyelid Diseases / Q000139:chemically induced* / Q000453:epidemiology / Q000378:metabolism / Q000473:pathology; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007766:Lacrimal Apparatus Diseases / Q000139:chemically induced* / Q000453:epidemiology / Q000378:metabolism; D008297:Male; D013666:Tears / Q000378:metabolism; D014786:Vision Disorders / Q000139:chemically induced* / Q000453:epidemiology / Q000378:metabolism; D044465:White People / Q000706:statistics & numerical data
D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil