Nasolacrimal Duct Obstruction after Radioactive Iodine Therapy for Thyroid Cancer

Moon Won Hwang; Eung Lee; Jae Wook Yang

doi:10.3341/jkos.2014.55.1.1

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Hwang, Lee, and Yang: Nasolacrimal Duct Obstruction after Radioactive Iodine Therapy for Thyroid Cancer

Original Article

J Korean Ophthalmol Soc 2014;55(1):1-6.

Published online: 7 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.1.1

Nasolacrimal Duct Obstruction after Radioactive Iodine Therapy for Thyroid Cancer

Moon Won Hwang, MD^1,², Eung Lee, MD^1,², Jae Wook Yang, MD, PhD^1,²

¹Department of Ophthalmology, Inje University Pusan Paik Hospital, Inje University College of Medicine, Busan, Korea

²Therapeutics Center for Ocular Neovascular Disease, Busan, Korea

Address reprint requests to Jae Wook Yang, MD, PhD Department of Ophthalmology, Inje University Pusan Paik Hospital, #75 Bokji-ro, Busanjin-gu, Busan 614-735, Korea, Tel: 82-51-890-6016, Fax: 82-51-890-6329, E-mail: oculoplasty@gmail.com

Received 8 June 201320 July 2013 Accepted 29 October 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the clinical manifestation of nasolacrimal duct obstruction after radioactive iodine therapy for thyroid cancer.

Methods

The authors examined 622 patients who were treated with radioactive iodine therapy after the operation for thyroid cancer from January 2009 to December 2011. Fourteen patients (18 eyes) were diagnosed nasolacrimal duct obstruction based on the lacrimal irrigation test, lacrimal probing test and dacryocystography in our oculoplastic clinic. We an-alyzed the dose of radioactive iodine therapy, number of treatments, clinical manifestation and treatment type by retro-spectively reviewing the patients’ medical records.

Results

The mean radioactive iodine dose (215.7 ± 23.1 mCi, p = 0.01) and the mean number of treatments (1.36 ± 0.50, p < 0.001) were significantly greater in 14 patients who had nasolacrimal duct obstruction than in patients who did not. The average onset of tearing symptoms occurred 10.2 months after radioactive iodine therapy. The mean time between correct diagnosis and therapy was 18.4 months. Three patients (3 eyes) had occlusion at the common cannaliculus and 11 patients (15 eyes) had occlusion at the nasolacrimal duct. Ten patients (13 eyes) underwent endonasal dacryocysto-rhinostomy for complete obstruction and 4 patients (5 eyes) underwent silicone tube intubation for partial obstruction.

Conclusions

Nasolacrimal duct obstruction is a rare complication associated with radioactive iodine therapy for thyroid cancer, thus, clinicians should be aware of this complication and refer patients with symptoms of epiphora to the oculoplastic department for specialized evaluation and treatment.

Keywords: Nasolacrimal duct obstruction, Radioactive iodine, Thyroid cancer

References

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Figure 1.

In forty-year-old woman (Case 13), dacryocystography (A: Coronary view; B: Right Oblique view) shows complete obstruction of the right lacrimal pathway at the level of the Krause’s valve (arrow) and pervious and morpho-logically normal left lacrimal pathway (arrow head).

Figure 2.

Survival analysis graph. The follow-up time from the initiation of radioactive iodine therapy is indicated on the horizontal axis and the prevalence of nasolacrimal duct obstruction is indicated on the vertical axis. Prevalance was 0.3% at 4 months, 0.9% at 8 months, 1.9% at 12 months, and 2.1% at 16 months. Total prevalance was 2.2%. Mean out-break time was 10.2 months.

Table 1.

Basic characteristics comparison between NLD obstruction group and non-NLD obstruction group

		NLD obstruction (n = 14)	non-NLD obstruction (n = 608)	p-value
Age (years)		45 ± 6	48 ± 11	0.19^*
Sex	Male (%)	1 (7.1)	101 (16.6)	0.41^†
	Female (%)	13 (92.9)	507 (83.4)
¹³¹I radiation doses (mCi)		215.7 ± 87.2	146.8 ± 68.0	0.01^*
Number of ¹³¹I radiation therapy		1.36 ± 0.5	1.07 ± 0.3	<0.001^†

Values are presentated as mean ± SD or number (%).

^* Mann-Whitney U test

^† Pearson Chi-square test.

Table 2.

Clinical data of 14 patients, dermographics, findings and treatment

Case	Sex/ Age	131I radiation doses (mCi)	Months until ocular symptoms	Initial presenting symptoms	Eye	Months until diagnosis	Obstruction site & grade	Treatment
1	F/62	150	5	Epiphora	OD	10	CC(t)	DCR
2	F/45	150	14	Epiphora	OS	4	NLD(pt)	STI
3	F/47	150	16	Epiphora,	OS	5	NLD(t)	DCR
		170		discharge
4	M/40	170	6	Epiphora	OD	3	CC(t)	DCR
		170
5	F/46	150	4	Epiphora	OS	15	NLD(pt)	STI
6	F/41	150	8	Epiphora	OU	6	NLD(t)	DCR
7	F/47	160	4	Epiphora	OD	9	NLD(pt)	STI
				Discharge
8	F/38	150	8	Epiphora	OS	8	NLD(t)	DCR
9	F/51	150	10	Epiphora	OU	11	NLD(pt) → NLD(t)	STI → DCR
		130
10	F/40	180	11	Epiphora	OU	3	NLD(t)	DCR
		180
11	F/48	150	9	Epiphora	OU	7	NLD(t)	DCR
		180
12	F/38	180	14	Epiphora	OS	14	CC(t)	DCR
13	F/48	150	18	Epiphora	OD	13	NLD(t)	DCR
14	F/45	150	16	Epiphora	OS	7	NLD(pt)	STI

CC = common canaliculus; (t) = total obstruction; DCR = endonasal dacryocystorhinostomy; NLD = nasolacrimal duct; (pt) = partial obstruction; STI = silicone tube intubation.

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