Surgical treatment of canalicular stenosis in patients receiving docetaxel weekly

Objective: To describe the surgical treatment and outcomes in patients with metastatic breast cancer and canalicular stenosis caused by weekly treatment with docetaxel. Methods: This case series included 10 patients with persistent epiphora due to weekly docetaxel treatment, who were evaluated by probing and irrigation of the tear drainage apparatus and were found to have significant canalicular stenosis. The severity of canalicular stenosis was graded clinically. Each patient underwent bicanalicular silicone intubation or dacryocystorhinostomy (DCR) with placement of either a silicone tube (canaliculo DCR) or a pyrex glass tube (conjunctivo DCR). Results: Seven patients (12 eyes) underwent bicanalicular silicone intubation. Three patients (5 eyes) required canaliculo DCR with the placement of a silicone tube. In 2 patients (3 eyes), the degree of canalicular stenosis was severe enough to require conjunctivo DCR with the placement of a pyrex glass tube. All 10 patients had complete resolution of epiphora immediately after surgery. Four patients continued to receive docetaxel after surgery. In patients who underwent bicanalicular silicone intubation, the silicone stent was kept in place for the duration of docetaxel therapy. There were no surgical or anesthesia-related complications. At a mean follow-up time of 9 months after surgery, all but 1 patient (1 eye) remained asymptomatic. The interval between initiation of docetaxel therapy and surgery was significantly higher in patients who required DCR compared with those who had silicone intubation. The mean cumulative dose of docetaxel at the time of surgery was higher in patients who required DCR than in patients who had silicone intubation, but this difference was not statistically significant. Conclusions: Canalicular stenosis secondary to weekly treatment with docetaxel should be treated with bicanalicular silicone intubation early in the course of docetaxel therapy. Failure to treat this adverse effect early may likely lead to severe and irreversible canalicular stenosis, which may necessitate conjunctivo DCR with the placement of a permanent pyrex glass tube.