EVALUATION OF DRY EYE DISEASE IN PATIENTS TREATED WITH RADIOTHERAPY FOR HEAD AND NECK TUMORS

Abstract

NEED FOR THE STUDY: Head and neck tumors account for 30% of all cancers in males and 11% in females according to national cancer registry program (ICMR) consolidated report of population based cancer registries. External beam radiation therapy is used to treat patients with head and neck tumors. EBRT delivers variable amounts of radiation doses to the eye, including the adnexa, lacrimal glands, lacrimal canaliculi, lacrimal sac, nasolacrimal duct, cornea, conjunctiva, eyelids, and meibomian glands. As the prevalence of head and neck tumors are high and the patients receiving radiotherapy for the same might have ocular surface complications, this study aims to detect dry eye disease in such patients at our tertiary care hospital and recommend for early treatment, thereby reducing late ocular surface complications. OBJECTIVES 1) To document the frequency of occurrence of dry eye disease in patients on radiotherapy for head and neck tumors 2) To grade the severity of dry eye disease using Dry eye severity grading scheme. Methods and Materials: The present observational study included 72 patients treated for primary extracranial head-and-neck tumors between December 2019 and August 2020. Each patient underwent four examinations, One at the start of radiotherapy (Day1), second on 15th day after the start of radiotherapy (Day 15), Third after completion of radiotherapy (Last Day), Fourth after 15 days after completion of radiotherapy. (Follow UP). The ophthalmic examination and tear film examinations were done. Results: Of 144 eyes of the 72 patients, 44 eyes developed some form of dry eye after xiii radiotherapy accounting for 30.55%. Among the patients who had dry eye, 68.18% had dry eye severity of grade 1, 22.72% had grade2 and 9.09% had grade3 according to DEWS I criteria classification. Conclusion: This study analyzed the acute effects of radiation in the causation of dry eye disease. Dry eye disease in patients on radiotherapy was significantly associated with the age, dose/ fraction and total dose received in our study population. Moderate and severe forms of dry eye was seen more commonly in older patients more than 60 years of age receiving radiotherapy and in those patients who had received higher dose/ fraction and total dose of radiation. Early detection of dry eye disease during the course of radiotherapy and treating it, can help in reduction of late ocular surface and corneal complications in patients receiving radiotherapy for head and neck tumors.