RAI, DRY EYES, TEARING EYES

[Guest guest]

Dear All,

While salivary gland problems seem to get more attention,

tearing eyes after RAI ablation is not an uncommon complaint,

and occurs for the same reason - RAI is in bodily fluids, including

tears as well as saliva.

The tearing eye problem seems to be most often caused by

blocked lachrymal ducts (the ducts that drain the tears from

the eyes), occurring as a direct result of RAI, in much the

same fashion as blocked salivary glands.

OTOH, some members have mentioned having this problem

before their RAI treatment, and I found one abstract suggesting

that it is the hypothyroid state causing the blocked glands and not the

RAI.

Of course, there are always other explanations for blocked

lachrymal and salivary gland blockage, some of which are

unrelated to thyca in any way.

Some people find relief with eye drops and finds the problem disappears

with time, some find it diminishes but never really goes away, while

an unfortunate few find the problem remains and either learn to live

with it or else seek surgical treatment.

I have included some quotes below.

-

NYC

(TT 2/99 dx pap/foll; RAI 100 mCi 3/99 & 4/00;

current TSH ~.06 on .225 levothyroxine)

NOTE: the links included below will probably become separated

onto 2 lines, in which case the second line will need to be copied

and pasted into the URL.

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TREATMENTS:

Not too many successful treatments have been reported; eye drops or

artificial

tears are the first line of defense, and often relieve the problem until it

solves

itself. If the situation becomes chronic and severe, surgery is an

option, to

unblock (or create new) ducts. This is very specialized surgery, requiring

a

duct surgery specialist.

As far as I know, only one list member had a surgical procedure. Her

tearing

began several months after after her RAI treatment, and after 6 months, she

had a procedure to " unblock the tear ducts but that has not helped " .

I'm not sure what the procedure was, nor if it was done by a duct

specialist.

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" My husband has the same problem as you have with the tearing eyes

but he doesn't have any problem with thyroid that he's aware of.

He's been using salt water to put in his eye and he claims it seems

to be better so you might want to try that. He uses an eye cup to apply it.

Sprinkle salt in a small glass of water. "

and this follow-up ....

" A while ago ... I stated that my husband has tearing eyes. He had an appt.

with an eye doctor recently. He said it is caused by dry eyes. He gave him

a sample of Bausch & Lomb Moisture Eyes lubricant eye drops. My husband

said it is working. He used to have tears running down his face all day. "

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" I found the best treatment [for tearing eyes] is an over the counter

ointment

called Refresh PM, it's a " lubricant eye ointment " , and it's for nighttime

use, but

I use it during the day too. My eyes are blurry for a few minutes when I

put it in,

but it easily lasts longer than regular eye drops. "

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" I received 150 mCi [two days ago]. Since that time my eyes have been

increasingly

goopy and look glassy when I look at them in the mirror. They are full of

dry gunk

after a night of sleep. .... "

[2 days later ....]

" My doc prescribed some gentamicin and my eyes are feeling better already! "

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.... from an online radiology text ...

http://www.auntminnie.com/MD2/nucmed/Endocrine/Thyroid/I-131%20for%\

20cancer/I-131%20for%20thyroid%20cancer.html#rhTSH

" Acute Complications of I-131 Thyroid Ablation Therapy:

" 14- Chronic or recurrent conjunctivitis, keratoconjunctivitis,

decreased lachrymal function.

" About one-quarter of patients treated will have subjective

complaints of xerophthalmia [1,26], and about 18% will have

objective evidence of decreased lacrimal function after one year [26].

Objective evidence for persistent keratoconjuctivitis sicca can be found

in up to 7.6% of patients three years following treatment [26].

Therefore, although decreased lacrimal function is common after therapy,

it is generally a transient side effect [26]. "

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http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uid\

s=11337569 & dopt=Abstract

J Nucl Med 2001 May;42(5):738-43

" ..... CONCLUSION: Salivary and lacrimal gland dysfunction (sicca syndrome)

is relatively

frequent after radioiodine therapy. In most cases this is a transient side

effect, but in

some patients it may persist for a long period or appear late. "

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http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uid\

s=9708527 & dopt=Abstract

J Nucl Med 1998 Aug;39(8):1452-4

" .....CONCLUSION: An appreciable amount of ingested radioiodine could

be secreted in tears. The potential damage of the lacrimal gland after

high doses of 131I treatment deserves further study. "

--------------------------------

http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uid\

s=8469542 & dopt=Abstract

Oral Surg Oral Med Oral Pathol 1993 Mar;75(3):318-22

" Salivary and lacrimal gland involvement in a patient who had undergone

a thyroidectomy and was treated with radioiodine for thyroid cancer. ....

" It is suggested that the hormonal and metabolic derangements are

responsible for the glandular dysfunction, rather than a direct effect

of iodine on the glands. "

(NOTE: this abstract was based on observation of one patient - K.)

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http://www.goodhope.org.uk/Departments/eyedept/watery.htm

Good Hope Hospital Eye Department - " Watery Eyes "

(mentions lots of causes, none being RAI, but includes a possible

explanation for hypo tearing ...)

" ... if your eyes are ëdryí you may notice watery eyes:

the tears may not spread, and dry patches develop

on the surface of the eyes ... "

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