Secondary acquired nasolacrimal duct obstruction after radioiodine therapy

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access


Secondary acquired nasolacrimal duct obstruction after radioiodine therapy is among rare complications, but it requires treatment at an early stage. The symptoms of secondary acquired nasolacrimal duct obstruction are tearing, eye redness, discharge at ocular surface, a mass growing at lacrimal sac site. Discussed complication occurs after radioiodine therapy in dose of 150 mCi, the rate of occurrence is dose-depended. There are no clinical guidelines for preventing of this complication, but there are reports of nasolacrimal duct preventive intubation and about developing of new drug agents that block an action of the protein that uptakes iodine in the nasolacrimal duct mucosa. For diagnosing special diagnostic procedures and an ophthalmologist consultation are required. For the correction of this complication, conservative treatment (with low efficacy) and special surgical treatment are used, including nasolacrimal duct recanalization with different techniques and anastomosis between nasolacrimal duct and nasal cavity formation. In cases of early patient encounter, it is possible to use more functional and less invasive surgical techniques, in cases of late encounter, more invasive surgical techniques are used.

About the authors

Vasily D. Yartsev

Scientific Research Institute of Eye Diseases

Author for correspondence.
ORCID iD: 0000-0003-2990-8111
SPIN-code: 4151-4946

PhD, research scientist of lacrimal pathology department

Russian Federation, 119021, Russia, Moscow, Rossolimo st., 11a

Eugenia Atkova

Sientific Research Institute of Eye Diseases

ORCID iD: 0000-0001-9875-6217
SPIN-code: 1186-4060

PhD. chief of lacrimal pathology department

Russian Federation, 119021, Russia, Moscow, Rossolimo st., 11a


  1. Румянцев П.О., Коренев С.В. История появления терапии радиоактивным йодом. Клиническая и экспериментальная тиреоидология. - 2015. - Т. 11. - №4. - C. 51-55. doi:doi: 10.14341/ket2015451-55. [Rumiantsev P.O., Korenev S. V. The history of radioiodine therapy beginnings Clinical and experimental thyriodidology. 2015;11(4):51-55. doi: 10.14341/ket2015451-55. (in Russ.)]
  2. Seidlin S.M., Rossman I., Oshry E., Siegel E. Radioiodine therapy of metastases from carcinoma of the thyroid; a 6-year progress report. J Clin Endocrinol Metab. 1949;9(11):1122-1137, illust. doi: 10.1210/jcem-9-11-1122.
  3. Lee S.L. Complications of radioactive iodine treatment of thyroid carcinoma. J Natl Compr Canc Netw. 2010;8(11):1277-1286; quiz 1287.
  4. Van Nostrand D. The benefits and risks of I-131 therapy in patients with well-differentiated thyroid cancer. Thyroid. 2009;19(12):1381-1391. doi: 10.1089/thy.2009.1611.
  5. Solans R., Bosch J.A., Galofre P., Porta F., Rosello J., Selva-O'Callagan A., Vilardell M. Salivary and lacrimal gland dysfunction (sicca syndrome) after radioiodine therapy. J Nucl Med. 2001;42(5):738-743.
  6. Alexander C., Bader J.B., Schaefer A., Finke C., Kirsch C.M. Intermediate and long-term side effects of high-dose radioiodine therapy for thyroid carcinoma. J Nucl Med. 1998;39(9):1551-1554.
  7. Garreis F., Gottschalt M., Paulsen F.P. Antimicrobial peptides as a major part of the innate immune defense at the ocular surface. Dev Ophthalmol. 2010;45:16-22. doi: 10.1159/000315016.
  8. Leder O. The significance of extrathyroidal radioactive iodine accumulation and secretion in clinical pathology. Histochemistry. 1982;74(4):585-588.
  9. Morgenstern K.E., Vadysirisack D.D., Zhang Z., Cahill K.V., Foster J.A., Burns J.A., Kloos R.T., Jhiang S.M. Expression of sodium iodide symporter in the lacrimal drainage system: implication for the mechanism underlying nasolacrimal duct obstruction in I(131)-treated patients. Ophthal Plast Reconstr Surg. 2005;21(5):337-344.
  10. Sakahara H., Yamashita S., Suzuki K., Imai M., Kosugi T. Visualization of nasolacrimal drainage system after radioiodine therapy in patients with thyroid cancer. Ann Nucl Med. 2007;21(9):525-527. doi: 10.1007/s12149-007-0056-5.
  11. Yuoness S., Rachinsky I., Driedger A.A., Belhocine T.Z. Differentiated thyroid cancer with epiphora: detection of nasolacrimal duct obstruction on I-131 SPECT/CT. Clin Nucl Med. 2011;36(12):1149-1152. doi: 10.1097/RLU.0b013e3182336016.
  12. Ali M.J., Vyakaranam A.R., Rao J.E., Prasad G., Reddy P.V. Iodine-131 Therapy and Lacrimal Drainage System Toxicity: Nasal Localization Studies Using Whole Body Nuclear Scintigraphy and SPECT-CT. Ophthal Plast Reconstr Surg. 2017;33(1):13-16. doi: 10.1097/IOP.0000000000000603.
  13. Kloos R.T., Duvuuri V., Jhiang S.M., Cahill K.V., Foster J.A., Burns J.A. Nasolacrimal drainage system obstruction from radioactive iodine therapy for thyroid carcinoma. J Clin Endocrinol Metab. 2002;87(12):5817-5820. doi: 10.1210/jc.2002-020210.
  14. Shepler T.R., Sherman S.I., Faustina M.M., Busaidy N.L., Ahmadi M.A., Esmaeli B. Nasolacrimal duct obstruction associated with radioactive iodine therapy for thyroid carcinoma. Ophthal Plast Reconstr Surg. 2003;19(6):479-481. doi: 10.1097/01.IOP.0000092802.75899.F8.
  15. Al-Qahtani K.H., Al Asiri M., Tunio M.A., Aljohani N.J., Bayoumi Y., Munir I., AlAyoubi A. Nasolacrimal duct obstruction following radioactive iodine 131 therapy in differentiated thyroid cancers: review of 19 cases. Clin Ophthalmol. 2014;8:2479-2484. doi: 10.2147/OPTH.S71708.
  16. Brockmann H., Wilhelm K., Joe A., Palmedo H., Biersack H.J. Nasolacrimal drainage obstruction after radioiodine therapy: case report and a review of the literature. Clin Nucl Med. 2005;30(8):543-545.
  17. Burns J.A., Morgenstern K.E., Cahill K.V., Foster J.A., Jhiang S.M., Kloos R.T. Nasolacrimal obstruction secondary to I(131) therapy. Ophthal Plast Reconstr Surg. 2004;20(2):126-129.
  18. Fonseca F.L., Lunardelli P., Matayoshi S. [Lacrimal drainage system obstruction associated to radioactive iodine therapy for thyroid carcinoma]. Arq Bras Oftalmol. 2012;75(2):97-100.
  19. Sun G.E., Hatipoglu B. Epiphora after radioactive iodine ablation for thyroid cancer. Thyroid. 2013;23(2):243-245. doi: 10.1089/thy.2011.0186.
  20. Ali M.J. Iodine-131 Therapy and Nasolacrimal Duct Obstructions: What We Know and What We Need to Know. Ophthal Plast Reconstr Surg. 2016;32(4):243-248. doi: 10.1097/IOP.0000000000000647.
  21. Fard-Esfahani A., Farzanefar S., Fallahi B., Beiki D., Saghari M., Emami-Ardekani A., Majdi M., Eftekhari M. Nasolacrimal duct obstruction as a complication of iodine-131 therapy in patients with thyroid cancer. Nucl Med Commun. 2012;33(10):1077-1080. doi: 10.1097/MNM.0b013e3283570fb8.
  22. Sagili S., Selva D., Malhotra R. Lacrimal scintigraphy: "interpretation more art than science". Orbit. 2012;31(2):77-85. doi: 10.3109/01676830.2011.648797.
  23. da Fonseca F.L., Yamanaka P.K., Kato J.M., Matayoshi S. Lacrimal System Obstruction After Radioiodine Therapy in Differentiated Thyroid Carcinomas: A Prospective Comparative Study. Thyroid. 2016;26(12):1761-1767. doi: 10.1089/thy.2015.0657.
  24. Song H., Jeong J., Ju Koh M. Epiphora after radioactive iodine therapy in a low-risk patient. Clin Nucl Med. 2015;40(6):536-537. doi: 10.1097/RLU.0000000000000717.
  25. Sweeney A.R., Davis G.E., Chang S.H., Amadi A.J. Outcomes of Endoscopic Dacryocystorhinostomy in Secondary Acquired Nasolacrimal Duct Obstruction: A Case-Control Study. Ophthal Plast Reconstr Surg. 2018;34(1):20-25. doi: 10.1097/IOP.0000000000000841.
  26. Juniat V.A.R., Rajak S. The use of prophylactic Nunchaku stents to reduce the risk of nasolacrimal duct obstruction in patients with midfacial tumours undergoing radiotherapy. Orbit. 2017;36(5):298-300. doi: 10.1080/01676830.2017.1337182.

Supplementary files

There are no supplementary files to display.



Abstract: 23


Copyright (c) Yartsev V.D., Atkova E.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies