Surgical procedures and outcomes in patients with tear drainage system disorders associated with the anticancer agent S-1

PURPOSE: S-1 is a first-line oral anti-cancer drug widely used in Japan. This study evaluated surgical outcomes for S-1-associated tear drainage system disorders (S-1/TDSD) and explored strategies to improve outcomes. STUDY DESIGN: Multicenter, retrospective observational study. METHODS: Fifty-one patients (89 sides; 31 men and 20 women; mean age ± SD, 68.7 ± 10.7 years; range 49─85 years) with S-1/TDSD were included. Surgical procedures performed were: three-snip procedure; exploratory horizontal part canaliculotomy; probing with tube placement; and conjunctivodacryocystorhinostomy with Jones tube insertion. RESULTS: The cases were classified as: punctal occlusion (Group a, 34 sides), both stenosed canaliculi (Group b, 2 sides), patent canaliculus and mono-canalicular obstruction (CO) (Group c, 9 sides), one soft or tightCO and contralateral softCO (Group d, 13 sides), tightCOs in both canaliculi (Group e, 27 sides), and common CO (Group f, 4 sides). The three-snip procedure for Group a was successful in 32 of 34 sides (94.1%). Probing with intubation for Group b was successful in all cases (2/2). Conjunctivodacryocystorhinostomy for Group e was successful in 15 of 20 sides (75.0%) and dacryoendoscopic canaliculo-incision for Group e was successful in 4 of 4 sides (100%). However, exploratory horizontal part canaliculotomy and probing for Groups c and d were successful in 14%─42% of cases. CONCLUSION: The three-snip procedure for punctal occlusions showed favorable outcomes but procedures preserving the canaliculus, especially in patients with horizontal CO, did not yield good results, even for an affected single canaliculus.