Periorbital oedema and epiphora as ocular side effects of imatinib mesylate (Gleevac) [15]

Patients:12 patients were studied. Study duration: 1 year.

TypeofStudy:This letter to the editor reported a case series of patients who developed epiphora and periorbital edema as the main ocular side effects of Glivec treatment. Retrospective study.

DosageDuration:Initial dose was 400 mg once daily (mean dose, 540 ± 187 mg) orally. Duration not stated.

Indications:12 patients with unspecified indications.

Results:All 12 patients had epiphora as their primary ocular complaint during Glivec therapy. All of them also had periorbital edema. 3/12 patients had conjunctival chemosis and 3/12 additional patients had conjunctivochalasis. Punctal or canalicular stenosis or nasolacrimal duct blockage was not observed in any of the 12 patients with epiphora. Findings on the rest of the ocular examination were within the normal limits in all 12 patients. 1 patient had severe periorbital edema that necessitated surgical removal of large festoons in the lower eyelids to restore visual function. In the other 11 patients, periorbital edema was mild to moderate and was treated conservatively. 2/11 patients were treated with furosemide and 1/11 patient was treated with topical prednisolone acetate and reported improvement in their epiphora. The other 8/11 patients were observed as their symptoms were not severe enough to justify treatment or they were not interested in taking any additional medications for their symptoms. Glivec was not discontinued in any of the patients.

AdverseEffects:All 12 patients developed epiphora and periorbital edema. In addition, patients had conjunctival chemosis (3) and conjunctivochalasis (3).

AuthorsConclusions:In summary, epiphora in patients receiving imatinib mesylate appears to be caused in part by periorbital edema and can be managed conservatively in most cases. In patients with epiphora whose symptoms do not resolve spontaneously, the use of oral diuretics and topical steroids may be helpful in improving the symptoms and signs of epiphora and periorbital edema. In patients with unusually severe periorbital edema, surgical excision of periocular soft tissues may be necessary to improve function.

FreeText:Patients were treated with Glivec in a clinical trial setting. The initial dosage of Glivec 400 mg but the protocols permitted increase or decrease of the dosage or discontinuation of Glivec. Concomitant drugs were furosemide and prednisolone acetate. Tests: ophthalmologic examination, including slit-lamp biomicroscopy, dilated retinal examination, and probing and irrigation of all four canaliculi and nasolacrimal ducts.