From the Guidelines
For eye discharge during radiation therapy of basal cell carcinoma of the eyelid skin, the recommended local treatment is gentle cleansing with sterile saline solution or mild, preservative-free artificial tears, followed by the application of antibiotic ophthalmic ointments such as erythromycin or bacitracin. This approach is based on general principles of managing ocular surface inflammation and preventing secondary bacterial infections that can occur during radiation therapy, as radiation can damage the meibomian glands and lacrimal apparatus, reducing tear production and disrupting the protective tear film 1. Key points to consider in the management include:
- Cleaning the affected eye 2-3 times daily by wiping from the inner to outer corner with a clean, damp cloth.
- For moderate to severe discharge, tobramycin 0.3% or ciprofloxacin 0.3% ophthalmic drops may be prescribed, typically 1-2 drops 3-4 times daily for 7-10 days.
- Preservative-free lubricating eye drops can also help manage dryness and irritation, applied 4-6 times daily as needed. Patients should avoid rubbing the eyes and should report worsening symptoms, vision changes, or severe pain immediately as these may indicate more serious complications requiring additional intervention. While the provided evidence primarily focuses on the management of basal cell carcinoma and radiation dermatitis, the principles of gentle cleansing, use of antibiotic ointments, and lubricating eye drops are broadly applicable to managing eye discharge during radiation therapy, prioritizing the prevention of infection and the maintenance of ocular surface health 1.
From the FDA Drug Label
One drop instilled into the affected eye(s) four times daily. Ocular adverse reactions occurring in 5-15% of patients treated with loteprednol etabonate ophthalmic suspension (0.2-0. 5%) in clinical studies included ... discharge
The local treatment for eye discharge during radiation therapy of basal cell carcinoma of the eyelid skin is loteprednol etabonate ophthalmic suspension, with a dosage of one drop instilled into the affected eye(s) four times daily 2.
- Key points:
- Dosage: one drop four times daily
- Medication: loteprednol etabonate ophthalmic suspension
- Reference: 2
From the Research
Local Treatment for Eye Discharge during RT of BCC of the Eyelid Skin
- The local treatment for eye discharge during radiation therapy (RT) of basal cell carcinoma (BCC) of the eyelid skin is not explicitly mentioned in the provided studies 3, 4, 5, 6, 7.
- However, the studies suggest that radiation therapy is a safe and effective treatment for BCC of the eyelid skin, with good tumor control and minimal side effects 3, 5.
- Electrochemotherapy (ECT) has also been shown to be effective in the treatment of locally advanced or recurrent BCC of the eyelid-periocular skin region, with excellent tumor control and good functional and cosmetic results 4.
- Immunotherapy, including topical therapies such as imiquimod, has been used in the management of BCC, but its efficacy in the treatment of eye discharge during RT is not established 6.
- The optimal therapy for BCC of the eyelid and periocular skin is controversial, and treatment strategy is formulated on an individual basis, taking into account tumor size, anatomic location, and growth pattern 7.
Management of Side Effects
- Radiation-induced cataracts and lower eyelid ectropion are potential side effects of RT and ECT, respectively 3, 4.
- The management of these side effects is crucial to minimize their impact on the patient's quality of life.
- Further research is needed to establish the most effective local treatment for eye discharge during RT of BCC of the eyelid skin.