Journal of Allergy & Therapy

Abstract

Endoscopic Management of Acquired Nasolacrimal Duct Obstruction Secondary to Radioactive Iodine Treatment for Thyroid Malignancy

Vijay R. Ramakrishnan, Vikram D. Durairaj and Todd T. Kingdom*

Introduction: Radioactive iodine (RAI) has been used in the management of thyroid malignancy for over 60 years. Established side effects of xerophthalmia, xerostomia, and sialadenitis are well known, and may occur in a dose-dependent manner. Acquired nasolacrimal duct obstruction (NLDO) has recently been described, with an estimated occurrence in 4% of patients receiving substantial doses of RAI for malignancy. To date, there are no published efforts of endoscopic management of this disease process.

Objectives: Given that thyroid malignancy and the use of RAI appear to be increasing in annual incidence, we aim to raise awareness of this common therapeutic side effect and to describe our success with endoscopic management of this condition.

Methods: Retrospective review of 5 patients (10 sides) treated for acquired NLDO secondary to RAI therapy. Subjective and objective outcomes were reviewed after powered endoscopic dacryocystorhinostomy (DCR).

Results: With a mean follow-up of 16.2 months, subjective assessment of epiphora and objective measurement of anatomic patency by saline irrigation and endoscopic visualization were recorded. Out of 10 procedures performed on 5 patients, subjective improvement and anatomic patency were achieved in 10/10 sides (100%).

Conclusions: NLDO secondary to RAI therapy is a newly recognized phenomenon. Endoscopic management of this disease process has not been previously reported. Our results in a small cohort compare favorably to other treatment modalities in this patient population, and appear to be on par with success rates for this procedure in the general population. Physicians who manage patients with thyroid malignancy should be aware of this potential side effect of RAI therapy and understand the basics of its diagnosis and management.