title: Evaluation and Management of Chemotherapy-Induced Epiphora, Punctal and Canalicular Stenosis, and Nasolacrimal Duct Obstruction.
abstract: OBJECTIVE
  To describe the frequency, mechanisms, and treatment of epiphora caused by chemotherapeutic agents.
  
  
  METHODS
  Review of relevant articles published in PubMed.
  
  
  RESULTS
  The chemotherapeutic drugs best documented to cause epiphora are 5-fluorouracil and docetaxel; with both of these drugs, the main mechanism underlying epiphora is canalicular stenosis. Drugs less commonly reported to cause epiphora include S-1, capecitabine, imatinib, topical mitomycin C, and radioactive iodine for treatment of papillary thyroid carcinoma. While all the above-mentioned drugs can be associated with epiphora, some drugs and administration schedules cause only punctal and canalicular inflammation, whereas others cause significant canalicular stenosis. For example, weekly administration of docetaxel is far more likely to cause canalicular stenosis than every-3-weeks administration. The literature suggests that, in patients who receive weekly docetaxel, silicone stenting at the first sign of recurrent or progressive canalicular stenosis can prevent severe irreversible canalicular stenosis and avoid the need for a conjunctivodacryocystorhinostomy. S-1 and radioactive iodine have been reported to cause nasolacrimal duct obstruction. Early recognition of punctal and canalicular stenosis or nasolacrimal duct blockage and early intervention with topical steroids and canalicular stenting in patients at risk for permanent canalicular scarring are important to avoid the need for more invasive and complicated procedures.
  
  
  CONCLUSIONS
  A variety of chemotherapeutic agents have been reported to cause epiphora, and some of these drugs have also been documented to cause obstructions of the lacrimal drainage system. Early recognition and management of epiphora is important and leads to better outcomes.
authors.affiliation: *Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A.; †Department of Ophthalmology, Orbit, Lacrimal and Eyelid Surgery, Hospital de Clínicas Jose de San Martin, Universidad de Buenos Aires, Buenos Aires, Argentina; and ‡Ruiz Department of Ophthalmology and Visual Science, The University of Texas Medical School at Houston, Houston, Texas, U.S.A.
authors.forename: Constanza
authors.initials: C
authors.lastname: Mansur
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Pfeiffer
authors.forename: Bita
authors.initials: B
authors.lastname: Esmaeli
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D006801:Humans; D007766:Lacrimal Apparatus Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D007767:Lacrimal Duct Obstruction / Q000139:chemically induced
chemical_list: D000970:Antineoplastic Agents