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Bita Esmaeli - One of the best experts on this subject based on the ideXlab platform.
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evaluation and management of chemotherapy induced Epiphora punctal and canalicular stenosis and nasolacrimal duct obstruction
Ophthalmic Plastic and Reconstructive Surgery, 2017Co-Authors: Constanza Mansur, Margaret L Pfeiffer, Bita EsmaeliAbstract:PURPOSE: 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. CONCLUSION: 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.
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prospective study of incidence and severity of Epiphora and canalicular stenosis in patients with metastatic breast cancer receiving docetaxel
Journal of Clinical Oncology, 2006Co-Authors: Bita Esmaeli, Sapna Amin, Vicente Valero, R B Adinin, Rebecca Arbuckle, Roberto Banay, Edgardo RiveraAbstract:Purpose To determine the incidence and severity of Epiphora and canalicular stenosis in patients receiving docetaxel weekly or every 3 weeks. Patients and Methods In this prospective trial, each patient underwent an ophthalmologic examination and probing and irrigation of the lacrimal drainage apparatus at baseline and every 4 to 6 weeks after initiation of docetaxel. During each visit, Epiphora and canalicular stenosis were graded. Patients with Epiphora were treated with tobramycin and dexamethasone drops. If Epiphora worsened or if findings on probing and irrigation suggested further canalicular narrowing, silicone intubation was offered. Results Twenty-eight patients received docetaxel weekly, and 28 patients received docetaxel every 3 weeks. Eighteen patients (64%) who received weekly docetaxel developed Epiphora. Epiphora was mild in seven patients, moderate in five, and severe in six. Nine patients had resolution of Epiphora with tobramycin and dexamethasone administration. Nine patients had worsened canalicular stenosis; six underwent surgery. The median cumulative docetaxel dose was 496.5 mg at onset of Epiphora and 889.5 mg at surgery. Eleven patients (39%) who received docetaxel every 3 weeks developed Epiphora. The median cumulative docetaxel dose at onset of Epiphora in this group was 420 mg. Epiphora was mild in nine patients, moderate in one, and severe in one. Nine patients had resolution of Epiphora with tobramycin and dexamethasone administration. Two patients underwent surgery. Conclusion Epiphora occurred in 64% of patients in the weekly group and in 39% of patients in the every-3-weeks group. Moderate or severe canalicular stenosis was seen in about one-third of patients in the weekly group and in none of the patients in the every-3-weeks group.
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canalicular and nasolacrimal duct blockage an ocular side effect associated with the antineoplastic drug s 1
American Journal of Ophthalmology, 2005Co-Authors: Bita Esmaeli, Dominick Golio, Linda Lubecki, Jaffer A AjaniAbstract:Purpose To report canalicular stenosis as a side effect of the new antineoplastic agent S-1. Design Interventional case series. Methods Three patients who received S-1 for treatment of gastrointestinal cancer at a tertiary cancer center were evaluated and treated for Epiphora. Results Two patients were found to have severe canalicular stenosis and nasolacrimal duct blockage after approximately 6 months of S-1 therapy. One patient underwent dacryocystorhinostomy with silicone tube placement on one side and dacryocystorhinostomy and Pyrex glass tube placement on the other side. The other patient declined a surgical intervention. One additional patient with Epiphora had punctal stenosis early in the course of S-1 therapy. His Epiphora resolved after probing and irrigation and 4 weeks of topical corticosteroid therapy. Conclusions Canalicular and nasolacrimal duct blockage is a previously unreported side effect of S-1 and should be recognized and treated at its earliest possible stage so that complete closure of the canaliculi can be avoided.
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canalicular stenosis as the underlying mechanism for Epiphora in patients receiving weekly docetaxel
Oncologist, 2001Co-Authors: Bita Esmaeli, Gabriel N HortobagyiAbstract:Weekly administration of docetaxel has emerged as a valuable alternative to an every-3-weeks administration of this drug for treatment of metastatic breast cancer. Baselga and Tabernero should be commended on their informative review of the advantages and side effects of weekly docetaxel administration [1]. The authors state that “a new toxicity of frequent tearing and visual problems, which is generally mild and manageable, may also occur” with weekly administration of docetaxel [1]. Epiphora (excessive tearing) has been reported in up to 50% of patients receiving weekly docetaxel [2]. We believe it is prudent for the readers of The Oncologist to be aware of the mechanism for Epiphora in patients receiving weekly docetaxel. We have identified anatomic narrowing of the canaliculi (the first portion of the tear drainage apparatus) as the underlying mechanism for Epiphora in at least 23 patients who received weekly docetaxel at a dose of 35-40
Ho Young Song - One of the best experts on this subject based on the ideXlab platform.
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lacrimal system obstruction treated with lacrimal polyurethane stents outcome of removal of occluded stents
Radiology, 1998Co-Authors: Ho Young Song, Hyunki Yoon, Sung-gwon Kang, Kyubo SungAbstract:PURPOSE: To describe the short- and long-term outcomes of the removal of occluded stents. MATERIALS AND METHODS: With fluoroscopic guidance, 571 lacrimal polyurethane stents were placed in 502 patients with Epiphora due to obstruction of the lacrimal system. Of the 571 stents, 142 were removed 2 weeks to 42 months (mean, 7 months) after placement because of recurrent Epiphora, and the lacrimal system was irrigated with saline solution through the lacrimal point. RESULTS: Stent removal was well tolerated. Mild epistaxis occurred in one patient and was controlled with a nasal pack. Recurrent Epiphora was due to obstruction of the stent with mucoid material in 49 (35%) of 142 systems and granulation tissue in 93 (65%) systems. After stent removal, 73 (51%) of the 142 lacrimal systems showed improvement of Epiphora, with a patent lacrimal system at 7-day follow-up dacryocystography. During the follow-up of 2 weeks to 49 months (mean, 22 months) after stent removal, patency was maintained in 24 (33%) of the 73...
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Complete obstruction of the nasolacrimal system. Part I. Treatment with balloon dilation.
Radiology, 1993Co-Authors: Ho Young Song, Hyosook Ahn, Cheon-kyu Park, Sam-hyun Kwon, Chong-soo Kim, K C ChoiAbstract:Fluoroscopically guided balloon dilation in treatment of complete obstruction of the nasolacrimal system was assessed in 39 eyes of 35 patients. All patients had severe Epiphora. With nasal endoscopic guidance, a 0.018-inch guide wire was introduced through the superior punctum into the inferior meatus of the nasal cavity and was pulled out through the nasal aperture with a hemostat. A deflated angioplasty balloon catheter was passed retrograde over the guide wire through the inferior meatus until it straddled the stricture. Balloons were dilated with water-soluble contrast medium. No major complications occurred. At 7 days after balloon dilation, Epiphora decreased in 22 of 39 eyes; 17 demonstrated complete resolution of severe Epiphora, and five showed incomplete resolution. At 2 months, improvement had not been maintained in 10 of the 22 eyes. This technique for treatment of complete obstruction of the nasolacrimal system is simple and safe, but the high failure and recurrence rates in this study are n...
H Bohlman - One of the best experts on this subject based on the ideXlab platform.
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perforated punctal plug in the treatment of partial punctal stenosis
Optometry - Journal of The American Optometric Association, 2003Co-Authors: H BohlmanAbstract:Background: Epiphora is a common finding among elderly patients. Common etiologies of Epiphora include lid-globe appositional abnormalities, ocular surface disorders, and lacrimal excretory obstruction Case Report: A patient reported with symptoms of unilateral, nonpainful Epiphora The cause was determined to be punctal stenosis and the patient was managed with a perforated punctal plug. Conclusion: Punctal stenosis is one of several disorders that may cause a lacrimal excretory obstruction. Common methods of treatnient mclude repeated dilation and irrigation, as well as various surgical procedures described in the literature Eye care practitioners should be aware of the availability of perforated punctal plugs and their usefulness in treatment of the partially stenosed punctum.
K C Choi - One of the best experts on this subject based on the ideXlab platform.
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Complete obstruction of the nasolacrimal system. Part I. Treatment with balloon dilation.
Radiology, 1993Co-Authors: Ho Young Song, Hyosook Ahn, Cheon-kyu Park, Sam-hyun Kwon, Chong-soo Kim, K C ChoiAbstract:Fluoroscopically guided balloon dilation in treatment of complete obstruction of the nasolacrimal system was assessed in 39 eyes of 35 patients. All patients had severe Epiphora. With nasal endoscopic guidance, a 0.018-inch guide wire was introduced through the superior punctum into the inferior meatus of the nasal cavity and was pulled out through the nasal aperture with a hemostat. A deflated angioplasty balloon catheter was passed retrograde over the guide wire through the inferior meatus until it straddled the stricture. Balloons were dilated with water-soluble contrast medium. No major complications occurred. At 7 days after balloon dilation, Epiphora decreased in 22 of 39 eyes; 17 demonstrated complete resolution of severe Epiphora, and five showed incomplete resolution. At 2 months, improvement had not been maintained in 10 of the 22 eyes. This technique for treatment of complete obstruction of the nasolacrimal system is simple and safe, but the high failure and recurrence rates in this study are n...
Kyubo Sung - One of the best experts on this subject based on the ideXlab platform.
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lacrimal system obstruction treated with lacrimal polyurethane stents outcome of removal of occluded stents
Radiology, 1998Co-Authors: Ho Young Song, Hyunki Yoon, Sung-gwon Kang, Kyubo SungAbstract:PURPOSE: To describe the short- and long-term outcomes of the removal of occluded stents. MATERIALS AND METHODS: With fluoroscopic guidance, 571 lacrimal polyurethane stents were placed in 502 patients with Epiphora due to obstruction of the lacrimal system. Of the 571 stents, 142 were removed 2 weeks to 42 months (mean, 7 months) after placement because of recurrent Epiphora, and the lacrimal system was irrigated with saline solution through the lacrimal point. RESULTS: Stent removal was well tolerated. Mild epistaxis occurred in one patient and was controlled with a nasal pack. Recurrent Epiphora was due to obstruction of the stent with mucoid material in 49 (35%) of 142 systems and granulation tissue in 93 (65%) systems. After stent removal, 73 (51%) of the 142 lacrimal systems showed improvement of Epiphora, with a patent lacrimal system at 7-day follow-up dacryocystography. During the follow-up of 2 weeks to 49 months (mean, 22 months) after stent removal, patency was maintained in 24 (33%) of the 73...