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Department of Internal Medicine (S.M.J.); Division of Endocrinology, Diabetes and Metabolism (R.T.K., V.D.); Department of Ophthalmology (K.V.C., J.A.F., J.A.B.); Department of Physiology and Cell Biology (S.M.J.); and Department of Radiology, Division of Nuclear Medicine (R.T.K.), The Ohio State University, Columbus, Ohio 43210
Address all correspondence and requests for reprints to: Richard T. Kloos, M.D., The Ohio State University, 446 McCampbell Hall, 1581 Dodd Drive, Columbus, Ohio 43210-1296. E-mail: kloos-1{at}medctr.osu.edu.
Abstract
Ophthalmic complications of 131I therapy, including ocular dryness, have been recently investigated and described. However, nasolacrimal drainage system obstruction (NDSO), complicating 131I therapy, has not been previously well appreciated or characterized. One of our patients developed bilateral complete nasolacrimal duct obstruction after 131I therapy that prompted awareness of this potential complication. Over 16 months, 423 patients with epithelial-derived thyroid cancer were provided routine clinical care; 390 of these patients had received 131I ablation or therapy, and 10 patients subsequently reported epiphora. All had evidence of NDSO disease after a mean cumulative 131I dose of 17,279 ± 2,923 MBq (467 ± 79 mCi), with a mean individual 131I dose of 6,660 ± 555 MBq (180 ± 15 mCi). Symptoms appeared 6.5 ± 1.4 (range, 3–16) months after the last 131I dose, whereas the mean time from symptom onset to correct diagnosis was 18 ± 5 months. A causal relationship between 131I administration and NDSO is strongly suspected. Patients reporting epiphora should be evaluated promptly by an oculoplastic surgeon.
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