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 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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