Fluorouracil (5-FU) Eye Drop
Information for
Patients
You
have been prescribed 5-FU eye drops to treat your squamous cell carcinoma in
situ or superficial spread from invasive carcinoma after excision. A major
benefit of topical chemotherapy is that it kills potential tumor cells over the
entire conjunctiva, eradicating not only visible tumor but also any microscopic
disease that cannot be seen clinically.
5FU
is a cytotoxic agent, preventing cells from proliferating by inhibiting DNA. It
can be harmful if misused. It is therefore important that you handle your drops
with care, using them only as prescribed.
How often should I use my eye drops?
One
drop should be instilled into the affected eye four times daily, spaced evenly
apart. The time of day that the drops are used is not important but the even
spacing of drop administration throughout the day is. One example of the correct way to place drops
would be to use one drop at 7am, 12pm, 5pm, and 10pm.
The
ocular oncology provider will discuss the length of treatment with you. Each
course of therapy is followed by a rest period of about 1-3 weeks, when the
drops are not used. There will be several courses of treatment.
PLAN:
weeks on:
weeks on:
Weeks
off:
Repeat:
The
drops are stable for 7 days if kept at room temperature. Do NOT
store these drops in the fridge as a low temperature may make the drops
inactive. Avoid exposing the drops to excessive heat (i.e., >40°C.)
Please
return empty bottle to the USC Eye Institute for appropriate disposal. We also
recommend that you use gloves when placing the eye drops.
Should
you need to use other eye drops at the same time of day, please leave at least five minutes between the different
drops to prevent one drop from diluting the other.
If
you have been asked to instill FML (fluorometholone) drops, this is a steroid
drop that helps with inflammation on the surface of the eye, please shake the
drop bottle for 30 seconds before applying the drop.
How do I use my eye drops?
Make sure you have a
clean tissue available for use and that your special container is nearby.
If you are to apply
your drops lying down, place a towel where your head will rest so as to catch
any accidental spillage of drops.
Place a paper towel on
a flat surface where you will be putting your 5-FU bottle. Ensure that the box
of paper tissues is to hand as well as two small gauze pads.
Apply a thin layer of
Vaseline to the skin around your eye, including the upper and lower eyelids and
between the eyelashes.
Wash and dry your
hands, then put on a fresh pair of disposable gloves.
Remove the dropper cap
from the container. Inspect the dropper tip and dry the edge of the dropper if
an extra drop has formed.
If you have an
assistant, ask him or her to put on rubber gloves.
Lie down with your head
resting on the towel.
Gently pull down the
lower eyelid of the eye being treated, using the dropper place one drop into
the eye. Do not administer more than one
drop.
Try not to touch the
eyedropper to your eye. Your assistant can help you hold the bottle in the correct
position or instill the drop for you. Try not to blink as this is done.
Have
your assistant mop up any drop that spills out of the eye, using the gauze pad.
Turn the bottle right
way up without delay. Replace the dropper cap and close the drop bottle
immediately.
Press on the inner end
of the lower lid margin to close the punctum (i.e., the opening of the tear
duct) for about a minute. This is done to prevent the drop flowing down the
duct to your nose.
If any drops spill onto
your cheek, you should immediately wipe them away with a tissue, which should
be discarded using the special container. Then wash the affected area with warm
water and soap. Bathe the area with a dilute bicarbonate solution (three
teaspoons of sodium bicarbonate powder into 200 ml of water) to prevent the
skin becoming red and irritated. The 8.4% bicarbonate solution can be picked up
at a local pharmacy over the counter. You can moisten a tissue with some
bicarbonate solution and use this to clean your lids and remove the Vaseline.
Any spillage onto the
floor should be mopped away with a paper towel, which should be disposed of
using the special container.
Wash
your hands thoroughly after applying the drops.
Put
the drop bottle back in the refrigerator.
Put
the used gloves and all used tissues and gauze pads in the toxic waste
container.
Are there any side effects from the treatment?
The
chemotherapy drops may sting at first. They usually cause the eye to become
inflamed, watery, and sensitive to light, with redness and swelling of the
eyelids. If the reaction becomes severe you should seek advice from the ocular
oncology provider. Sometimes simultaneous treatment with steroid drops, such as
fluorometholone, which acts only on the ocular surface, without penetrating the
eye may be helpful. Additionally, you may use preservative free artificial
tears or ointment for any discomfort and/or a warm or cold compress (15min
on/15min off).
Chemotherapy
drops only affect tumor cells close to the surface of the conjunctiva (i.e., in
the epithelium); they do not penetrate deep into the conjunctiva and are
therefore ineffective for invasive tumor.
In
about a third of patients, the ocular disease is not eliminated by the topical
chemotherapy, so that the tumor persists or recurs after months or years.
Life-long surveillance is therefore necessary in all patients. Biopsy may be
needed in the future to determine whether there is any active microscopic
disease.
Persistent
corneal ulceration and haziness can occur if the chemotherapy impairs the
conjunctiva’s ability to regenerate. This problem is more likely to occur with
high doses of chemotherapy or prolonged treatment.
The
chemotherapy drops can cause blockage of the tear ducts, (specifically, the
puncta) to result in a permanently watery eye. Some doctors therefore ask the
patient to press on the tear duct for five minutes after instilling drops, or
they insert plugs to try to prevent this complication. Others do not wish to
prevent the chemotherapy agents from entering the tear ducts in case any tumor
cells have seeded into these passages.
These
eye drops do not result in detectable levels of the drug in the blood.
Follow-up
It would be advisable for you to attend
our clinic at least once every month during your treatment so that we can
manage any side effects. If you experience significant discomfort we would like
to see you without delay.
After completion of your therapy, you
need to be reviewed after 3 to 6 months for several years and eventually once a
year, indefinitely.
Contraindications
These drops should be avoided in pregnancy and in the presence of any
conditions predisposing to corneal ulceration (e.g., herpetic keratitis). After
any eye operation, these drops should be avoided before the surgical wound has
healed and this takes about 2 weeks. Safety
for use in pregnancy has not yet been established. Handling of drops is
not recommended during pregnancy. Care should be taken if there is any risk of
pregnancy or if breastfeeding.
Are there any alternative treatments available?
There
may be other treatments available and the doctor will have discussed these with
you. If you feel that you need any further information please feel free to ask
your provider.
What will happen if I don’t have any treatment?
Your
tumor may continue to grow. This might make treatment more difficult and could
make the eye painful. There may be an increased risk of tumor spread out of the
eye and to other parts of the body.
How will I receive my drops?
The
drops will be supplied to you one week at a time, once a month, from a special
pharmacy:
Leiter’s Compounding Pharmacy
1700
Park Avenue, San Jose, CA
Tel:
800 292 6772
This
is necessary because the drops do not contain any preservative.
Is there anything else I should know?
Remember that the eye
drops have been prescribed for you only and you must never let anyone else use
them.
The eye drops will
likely need to be refrigerated. You can store them safely by placing the bottle
in a glass jar, container with a lid, or plastic bag.
The drops can be toxic
if used incorrectly, so please ensure that they are stored in a safe place out
of the reach of children.
Both men and women
should use birth control methods during and for three months following
treatment with chemotherapy eye drops to prevent possible fetal damage.
Further Information
If you have any questions, please
contact the USC Roski Eye Institute: 323-442-6335
Your Ocular Oncology Service
Jonathan Kim, MD
Jesse Berry, MD
We would appreciate any feedback and
suggestions.
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