Abstract
Patients undergoing intensity-modulated radiotherapy (IMRT) for head and neck cancer may have increased incidence of dry eye disease and the exact mechanism is unclear. The present study aims to assess tear film and meibomian gland (MG) features in patients who received IMRT for head and neck cancer not involving the orbital area. Twenty-seven patients (64.7 ± 9.8 years) and 30 age-matched controls (61.4 ± 11.0 years) underwent a comprehensive dry eye work-up. Compared to the control group, the patients had more lid margin abnormalities, and worse meibum quality. The MG loss, calculated as (tarsal area-MG area)/tarsal area, was higher in the patient group in both the upper (53.0 ± 12.0% vs. 35.1 ± 10.3%, p < 0.001) and lower lids (69.5 ± 12.6% vs. 48.5 ± 12.5%, p < 0.001). In the patient group, more MG loss in the lower lids correlated with worse meibum quality (r = 0.445, p = 0.029). In contrast, there was no significant difference in aqueous tear production level, measured with Schirmer test. Patients treated with IMRT for head and neck cancer seemed to have comparable lacrimal gland function to the controls despite more dry eye symptoms. However, the patients had MG functional and morphological changes, which may present a higher risk for developing dry eye disease.
Highlights
Patients undergoing intensity-modulated radiotherapy (IMRT) for head and neck cancer may have increased incidence of dry eye disease and the exact mechanism is unclear
The lipid layer is formed by meibomian gland (MG) secretion, the mucin layer is secreted by the goblet cells and the ocular surface epithelium, and the aqueous component is secreted from the lacrimal glands
The present study shows that around 26% of the patients treated with IMRT for head and neck cancer (HNC) had positive dry eye related complaints
Summary
Patients undergoing intensity-modulated radiotherapy (IMRT) for head and neck cancer may have increased incidence of dry eye disease and the exact mechanism is unclear. Patients treated with IMRT for head and neck cancer seemed to have comparable lacrimal gland function to the controls despite more dry eye symptoms. Intensity-modulated radiotherapy (IMRT) is an advanced RT planning technique that uses non-uniform radiation beam intensities to maximize the delivery to the target volume while minimizing the RT dose to the surrounding normal tissues. This allows the prospect of increasing the probability of locoregional disease control while decreasing the complication rate[15]. Sex Male Female Original disease locations Oropharyngeal cancer Oral cancer Parotid gland cancer Nasopharyngeal cancer Unknown primary, malignant lymph node of the neck
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