5-FU in cicatricial conjunctivitis
Reviewed by James Hsuan

This is a retrospective review of 56 patients with cicatricial conjunctivitis, including 25 eyes that received sub-conjunctival injections of 25-50mg of 5-fluorouracil (5-FU) as part of their treatment. Thirty-seven patients had ocular cicatricial pemphigoid (OCP) and 19 had Stevens-Johnson syndrome / toxic epidermal necrolysis (SJS/TEN). Injections were given when there was shortening of the fornices, symblepharon, cicatricial entropion or corneal pannus with conjunctival hyperaemia. Sixteen eyes received one to four injections and nine received five or more. Thirty-two patients in the OCP group received systemic immune suppression, including seven who were also treated with 5-FU injections. One of the OCP and five of the SJS/TEN group were treated with 5-FU injections without systemic therapy. Median follow-up was 18 months. The authors claim that treatment with 5-FU was associated with less corneal scarring and decreased surgery in both groups, better acuity in the OCP group and less trichiasis in the SJS/TEN group. The data is difficult to interpret, especially given the non-randomised retrospective nature of the study, but this is the first report suggesting 5-FU may be beneficial in auto-immune cicatricial conjunctivitis.

Direct injection of 5-fluorouracil improves outcomes in cicatrizing conjunctival disorders secondary to systemic disease.
Jovanovic N, Russell WW, Heisel CJ, et al.
OPHTHALMIC PLASTIC AND RECONSTRUCTIVE SURGERY
2021;37:145-53.