Radiation Effects on the Eye
Chalupecky (1897) first described the effects of ion-izing radiation on the eye. Subsequent studies by Birch-Hirschpeld (1908) identified the first case of radiation cataract. Definitive investigations on the effects of ionizing radiation on the eye began
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CONTENTS 11.1 11.2 11.3
11.3.1 11.3.2 11.3.3 11.3.4 11.3.5 11.3.6 11.3.7 11.3.8 11.3.9 11.3.10
11.3.11 11.3.12 11.3.13
11.4
Introduction 95 Acute Lesions 95 Ocular Tissues and Their Response to Ionizing Radiation 96 Lid Skin 96 Tarsus 97 Lid Margin 97 Lacrimal Ducts 97 Lacrimal Gland 98 Conjunctiva 98 Cornea 98 Sclera 99 Iris 99 Lens 100 Retina 100 Optic ~erve 100 Orbit 101 Conclusion 101 References 10 1
11.1 Introduction CHALUPECKY (1897) first described the effects of ionizing radiation on the eye. Subsequent studies by BIRCH-HIRSCHFELD (1908) identified the first case of radiation cataract. Definitive investigations on the effects of ionizing radiation on the eye began with ROHRSCHNEIDER (1929). This author described a gradient in radiosensitivity of the ocular structures extending from the lens (the most sensitive tissue) through the conjunctiva, cornea, uvea, and the retina to the least sensitive tissue - the sclera. POPPE (1942) further elucidated the work of Rohrschneider. L.W. BRADY, MD Hylda Hohn! American Cancer Society Professor of Clinical Oncology and Professor, Department of Radiation Oncology, Hahnemann University Hospital, Broad and Vine Streets, Mail Stop 200, Philadelphia, PA 19102, USA T.E. YAEGER, MD Department of Radiation Oncology, Halifax Medical Center, Daytona Beach, FL 32115, USA
W. E. Alberti et al. (eds.), Age-Related Macular Degeneration © Springer-Verlag Berlin Heidelberg 2001
This paper is directed toward summarizing the current available clinical and experimental data on the effects of radiation on the eye and ocular adnexa and to suggesting guidelines for radiation tolerance of normal ocular tissues. Even though many clinicians have an almost morbid fear of the harmful effects of irradiating the eye and orbit, modern innovative radiation therapy technologies allow appropriate treatment programs to be administered with minimal complications. Table 11.1 illustrates the potential magnitude of the problem and Table 11.2 demonstrates the techniques and dosages generally used in radiation therapy of eye lesions (BIRCH-HIRSCHFELD 1908). The presence of complications, whether functional or cosmetic, will vary depending upon a number of factors: 1. The cellular composition of the injured tissue (in the eye there is a broad diversity of types of cellular composition) 2. That tissue's functional reserve to withstand evolution of a clinically apparent complication 3. Other factors such as the vascular-nutritional integrity of the organ These factors underlie a general scheme that can be applied to the eye and the orbital contents. Table 11.1. Malignant tumors in or near the orbit in the USA Site
Number of patients
Head and neck Central nervous system Eye Skin Other rhabdomyosarcoma, lymphoma, etc. Metastases
29800 14700 1900 100000 3 000 80 000
11.2 Acute Lesions Acute lesions represent primary functional cell necroses affecting rapidly proliferating cells. Acute radiation-induced lesions may be defined as effects which
L.w. Brady and T.E. Yaeger
96 Table 11.2. Usual radiation dos
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