95例泪道阻塞患者阻塞部位分布及相关因素的初步分析

Analysis of obstructed portions distribution and risk factors in 95 cases of lacrimal duct obstruction

目的研究95例泪道阻塞性疾病患者中泪道阻塞部位的分布特点,并做出相关临床分析。方法选取2010年1月至2011年10月我院眼科门诊就诊的有流泪症状的患者420例(840只眼),取单眼作为研究对象,在获得患者知情同意后进行泪道探查冲洗检查,对泪道冲洗不通畅者进行泪道阻塞性疾病的问卷调查、眼科常规检查、鼻内窥镜检查及泪道造影检查,明确诊断以及阻塞部位,并选择同期在相同眼科就诊的无流泪症状、泪道冲洗通畅,且年龄、性别、职业等因素均相似的患者为对照,对确诊的泪道阻塞患者阻塞部位分布特点进行临床分析。结果泪道阻塞患者共95例,男女之比为1∶2.1,年龄6～71岁(平均50.2岁)。40～61岁患者中所占比例最大,各职业中工人所占比例最大,泪道阻塞部位所占比例不同,鼻泪管上段阻塞占32.6%(31/95),鼻泪管下段阻塞占22.1%(21/95),下泪小管阻塞15.8%(15/95),下泪点阻塞9.5%(9/95),泪总管阻塞8.4%(8/95),上泪点阻塞6.3%(6/95),上泪小管阻塞5.3%(5/95)。泪道阻塞的发生受多种因素影响,泪道阻塞患者中有邻近组织疾病及眼部炎症病史者的比例高于对照组,差异有统计学意义(卡方检验,P<0.05)。结论泪道阻塞各部位所占比例不同,由高到低依次为鼻泪管上段、鼻泪管下段、下泪小管、下泪点、泪总管、上泪点、上泪小管,有邻近组织疾病及眼部炎症病史者泪道阻塞的机率较大。

OBJECTIVE To study the distribution characters of obstructed portions in 95 cases of lacrimal duct obstruction, and analyse the risk factors of these cases. METHODS A total of 420 patients （840 eyes） with lacrimation symptom were screened for lacrimal duct obstruction diseases （LDOD） from January 2010 to October 2011. After informed consent was obtained from patients, probing and irrigating of lacrimal passage were performed. Subjects who were diagnosed as obstruction of lacrimal duct accepted a questionnaire, slip lamp examination, nasal endoscopy, X-ray Dacryocystography with iodin oil to confirm diagnosis and find obstructed portions. Patients with- out tear, whose lacrimal duct irrigated as unobstructed, and diagnosed in the same ophthalmology department during the same time were included in this study as control group. Analysis on the distribution characters of obstructed por- tions and risk factors of LDOD were conducted to LDOD patients. RESULTS Ninety-five LDOD patients were screened, male： female were 1：2.1, age from 6 to 71 years, average 50.2 years. The major composition was from 41- 60 years. Of all occupation, factory workers were the maximum. Composition of obstructed position was superior na- solacrimal duct （32.6%, 31/95 ）, inferior nasolacrimal duct （22.1%, 21/95）, inferior canalicula（ 15.8%, 15/95 ）, in- ferior puncture （9.5%, 9/95）, common canalicula （8.4%, 8/95）, superior punctum （6.3%, 6/95）, and superior canalicula （5.3%, 5/95） by turns. The ratio of a history of nasal disease, or a history of ocular inflammation in pa- tients of lacrimal duct obstruction was higher than that in control group. There was statistical difference between two groups. CONCLUSIONS It had significant diversity in different position of lacrimal passage, including upper and lower portion of nasolacrimal duct, inferior canaliculus, inferior punctum, common canaliculus, superior punctum,superior canaliculus, in the sequence of descending. A history of nasal disease, and ocular inflammation was associated with LODD.