Elsevier

Ophthalmology

Volume 108, Issue 5, May 2001, Pages 994-995
Ophthalmology

Canalicular stenosis secondary to docetaxel (taxotere): A newly recognized side effect

https://doi.org/10.1016/S0161-6420(00)00640-0Get rights and content

Abstract

Objective

To report a newly recognized side effect of a commonly used antineoplastic agent, docetaxel, in three patients with metastatic breast cancer.

Design

Observational case reports.

Participants

Three patients with metastatic breast cancer who received weekly docetaxel chemotherapy.

Main outcome measures

Occurrence of epiphora and severity of punctal and canalicular fibrosis secondary to docetaxel.

Results

In three patients receiving weekly docetaxel, canalicular stenosis and resultant epiphora developed shortly after start of their treatment. Discontinuation of drug several months after initiation of therapy did not lead to resolution of symptoms in two of the three patients.

Conclusions

Epiphora is a newly recognized side effect of docetaxel and may occur more frequently with weekly cycles of this drug. The mechanism for epiphora seems to be punctal and canalicular stenosis. This side effect, in advanced cases, is not reversible with discontinuation of the drug. Patients being administered weekly cycles of docetaxel should be screened for epiphora and canalicular stenosis, and treatment in the form of silicone intubation or punctoplasty should be considered in early stages to prevent the need for conjunctivodacryocystorhinostomy.

Section snippets

Patients and methods

Patient A, a 37-year-old woman, was treated for metastatic breast cancer with docetaxel. She received weekly docetaxel, 40 mg/m2 (75 mg) intravenously, with dexamethasone coverage, in combination with trastuzumab (Herceptin, Genentech, San Francisco, CA) for a total of 20 doses. She experienced fluid retention secondary to docetaxel, and the cancer worsened on treatment. She was referred to the ophthalmology clinic approximately 2 months after discontinuation of docetaxel with a chief complaint

Discussion

Excessive tearing, presumably as a result of conjunctivitis, has been described as a side effect of docetaxel treatment.7 We described three patients in whom epiphora developed secondary to punctal or canalicular stenosis during treatment with docetaxel. Canalicular stenosis has been described in association with other chemotherapeutic agents such as 5-fluorouracil,8, 9 but, to our knowledge, it has not been reported as a side effect of docetaxel. The mechanism of canalicular stenosis could be

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