Effect of intubation in patients with functional epiphora after endoscopic dacryocystorhinostomy

AIM:To investigate the effect of bicanalicular silicone tube intubation(BSTI)in the treatment of functional epiphora after endoscopic dacryocystorhinostomy(En-DCR).METHODS:Clinical data of 84 patients(95 eyes)with functional epiphora after En-DCR were retrospectively analyzed.Functional epiphora was confirmed as persistent or recurrent epiphora by fluorescein dye disappearance test(FDDT),lacrimal irrigation test,as well as endoscopic examination.Secondary BSTIs were recommended for patients with functional epiphora.These tubes were removed 1mo after surgery.Functional success and associated complications were assessed after 2y of follow-up.RESULTS:Seven patients(9 eyes)refused intervention,5 patients(6 eyes)did not complete postoperative followup,and 1 patient(1 eye)developed tube prolapse within 1mo after surgery.Seventy-one patients(79 eyes)were included at last.Functional success ratios at six months,one year,as well as two years post-operation were 94.9%(75/79),92.4%(73/79),and 91.1%(72/79),respectively.Three eyes presented with punctal slitting(2 eyes without epiphora),1 eye with proximal canaliculus slitting,1 eye with canaliculus stenosis and 4 eyes with still present functional epiphora without detectable abnormal at the last follow-up.CONCLUSION:Secondary intubation is an effective procedure with low recurrence probability for functional epiphora after En-DCR.Punctal and canaliculus injury are the main tube-associated complications after secondary intubation.

Etiology,diagnosis, management and outcomes of epiphora referrals to an oculoplastic practice

AIM： To investigate the etiology, diagnosis, management and outcome of epiphora referrals to an oculoplastic practice.METHODS： Retrospective chart review of patients referred for epiphora to an oculoplastic clinic between 2005 and 2009. Patient demographics, past history, ophthalmic examination, treatment and outcome were analyzed.RESULTS： There were 237 subjects with a primary complaint of epiphora. They included 130 （55%） females and 107 （45%） males with an average age of 55.9±25.9y. The most common cause of epiphora was lacrimal obstruction （46%）; followed by multifactorial epiphora （22%）, reflex tearing （22%） and eyelid malposition （11%）. Differences in prevalence of etiology were noted in terms of age and gender distribution. Of the 182 （77%） patients who returned for follow up, 41 （23%） reported a complete resolution and 102 （56%） reported a significant improvement in their symptoms.CONCLUSION： Epiphora is a common condition with many causes. A thorough history and examination are required to provide the appropriate treatment tailored to the underlying cause.

Use of the Crawford tube for symptomatic epiphora without nasolacrimal obstruction

AIM： To evaluate the effectiveness of the Crawford tube in treating symptomatic epiphora without nasolacrimal obstruction. METHODS： A protocol was adopted for the management of symptomatic epiphora without nasolacrimal obstruction. Patients who suffered symptomatic epiphora without nasolacrimal obstruction in both eyes were included in the study. One eye was treated with Crawford tube intubation and the other eye was treated with medication therapy. Degree of watering, patient satisfaction, and symptomatic improvement were carefully evaluated by one of the authors at the end of the follow-up period, after Crawford tube removal, to ascertain functional results. RESULTS： Thirty-seven adult patients （37 eyes） underwent Crawford tube intubation for functional epiphora. The mean follow-up time after removal of the tube was 14.8 ~4.8mo. The procedure was an overall success in 28 eyes （75.7%）, with symptoms improving significantly. Two eyes （5.4%） were relieved of indoor epiphora, two （5.4%） had minimal epiphora outdoors, but only with wind or cold, and five （13.5%） continued to experience tearing both indoors and outdoors. Thirty of the patients （81%） expressed satisfaction with the procedure. CONCLUSION： Crawford tube insertion is an effective, safe, simple, and relatively noninvasive treatment strategy for functional lacrimal system obstruction.

Risk factors for persistent epiphora following successful canalicular laceration repair

AIM:To identify the risk factors of epiphora in patients with anatomical patency after surgical repair of canalicular laceration.METHODS:This retrospective case series included 178 cases of canalicular laceration repair from 2005 to 2012.Demographic data collected from each patient included age,sex,type of injury,distance from the distal lacerated end of the canaliculus to the punctum,the severity score for the structural abnormity of the medial canthus,the duration of stent placement,and the timing of surgery.The risk factors for epiphora were evaluated using Logistic regression models.RESULTS:Among the 178 cases,45(25.3%)with lacrimal patency after irrigation had symptomatic epiphora at the final follow-up.Patients'sex,age,type of injury,duration of stent placement,timing of surgery,and concurrent trauma were not found to be significantly associated with symptomatic epiphora after surgical repair of the lacerated canaliculus(P>0.05).A distance of more than 5 mm from the distal cut end to the punctum was closely and significantly associated with symptomatic epiphora after surgical repair of the lacerated canaliculus(P<0.01).Symptomatic epiphora was significantly more frequent in patients with higher severity scores for structural abnormities of the medial canthus(P<0.01).CONCLUSION:Our results indicate that the risk factors for postoperative symptomatic epiphora include a further distance between the distal cut end and the lacrimal punctum and a higher severity score for structural abnormities of the medial canthus.These findings could be used to prognosticate postoperative symptomatic epiphora.

Diagnostic value of orbicularis oculi muscle electromyography in functional epiphora

BACKGROUND Functional epiphora is a clinical condition which is not due to an anatomic defect.Most studies agree that it involves the action of the orbicularis oculi muscle,particularly its deeper segment(Horner’s muscle),but the exact mechanism is not clear.AIM To evaluate the orbicularis oculi muscle in functional epiphora patients using electromyography(EMG).METHODS A total of 8 Chinese patients(16 eyes)with functional epiphora were enrolled in this study,and ten volunteers(10 eyes)were included as normal controls.Five epiphora patients(five eyes)with facial palsy served as positive controls.Quantitative EMG was performed in the deeper segment of orbicularis oculi muscle.The average duration of each EMG waveform was measured.RESULTS The average duration of EMG waveforms in the normal control group,the functional epiphora group,and the facial palsy group were 6.39±0.73 ms,9.39±1.32 ms and 11.2±1.42 ms,respectively.The duration of EMG waveforms was significantly longer in the functional epiphora group than in the normal control group(P<0.05),and shorter than that in the facial palsy group(P<0.05).CONCLUSION These data indicate the presence of neurogenic orbicularis oculi muscle damage in epiphora patients,which may be the cause of functional epiphora.The etiology of neurogenic damage in the orbicularis oculi muscle requires further investigation.

Caruncle excision to treat epiphora caused by caruncle swelling in patients with active Graves' ophthalmopathy:case series

Dear Editor,Iam Yoon Jin Kong from the Department of Ophthalmology,Soonchunhyang University Bucheon Hospital,Bucheon,Korea.Herein,we describe a series of three patients with active Graves＇ophthalmopathy（GO）who presented with epiphora caused by swollen caruncles whose symptoms improved after surgical excision of the caruncles.

Topical Cyclosporine-A for Management of Epiphora in Eyes with Acquired Punctal Stenosis

Background: Cyclosporine A (CsA) is an inhibitor of calcineurin that prevents T-cell production of inflammatory cytokines and disrupts the immune-mediated inflammatory response that plays a crucial mechanism in punctal stenosis. Purpose: To evaluate the clinical outcomes and tolerances of CsA in treating epiphora in eyes with punctal stenosis. Study Design: Prospective study. Methods: The study included patients who presented with symptomatic epiphora associated with lower punctal stenosis during the period between July 2019 and December 2020. Patients were treated with topical 0.05% CsA on twice daily dose with topical preservative-free artificial tears Q.I. D. Patients were followed up monthly for at least 3 months by Munk epiphora grading, Fluorescein dye disappearance test (FDT) and evaluation of the patient satisfaction. Results: A total of 26 patients with 47 eyes were included in the study with a mean age of 55.1 ± 10.24 years. All the eyes had grade 0 lower punctal stenosis with grade 4 on Munk grading and grade 3 in FDT. There was a statistically significant difference in the Munk grading and FDT along the follow-up period compared to the baseline values (p Conclusion: CsA can control the inflammation of the conjunctival sac and restore the integrity of the ocular surface with subsequent symptomatic relief of the epiphora in eyes with punctal stenosis.

年龄因素对先天性鼻泪管阻塞泪道探通术治疗效果的影响

目的探讨年龄因素对先天性鼻泪管阻塞(CNLDO)泪道探通术治疗效果的影响。方法本研究为单中心回顾性病例研究,采用阶梯式治疗方案对保守治疗无效的患儿适时行泪道探通术,根据患儿年龄分为0~<6月、6~<12月、12~<24月和24~60月龄4组,对比分析各组的手术成功率及其与患儿年龄的相关性。结果共纳入269例患儿314只眼,4个年龄组一次泪道探通成功率分别为86.8%、91.7%、73.6%和37.8%,所有患儿泪道探通总成功率为84.7%(266/314)。12月龄以后探通总成功率下降与年龄增加呈显著相关(P=0.000),与患儿性别和眼别无显著相关性(P=0.255和0.708)。结论阶梯式方案治疗CNLDO安全有效,泪道探通术的成功率与年龄呈负相关,可作为2岁以下患儿保守治疗无效的首选手术方法。

单纯吻合前瓣的改良式泪囊鼻腔吻合术对慢性泪囊炎患者溢泪情况的影响

目的探讨单纯吻合前瓣的改良式泪囊鼻腔吻合术对慢性泪囊炎患者溢泪情况的影响。方法选取2019年1月至2022年1月我院收治的52例慢性泪囊炎患者,根据手术方式的差异将其分为对照组和观察组,各26例。对照组采用常规泪囊鼻腔吻合术治疗,观察组采用单纯吻合前瓣的改良式泪囊鼻腔吻合术治疗。比较两组的治疗效果。结果术后1、3、6个月,观察组的吻合口肉芽组织形成率低于对照组(P<0.05);术后1个月,观察组的鼻黏膜上皮化率高于对照组(P<0.05)。术后1个月,观察组的溢泪程度评分低于对照组(P<0.05);术后6个月,观察组的泪道通畅率高于对照组(P<0.05)。术后1个月,观察组的C反应蛋白(CRP)、白细胞介素-6(IL-6)水平低于对照组(P<0.05)。观察组的手术并发症总发生率低于对照组(P<0.05)。术后6个月,观察组的心理维度、社会维度评分高于对照组(P<0.05)。结论单纯吻合前瓣的改良式泪囊鼻腔吻合术治疗慢性泪囊炎患者可防止周围肉芽组织形成,促进鼻腔黏膜上皮化,改善溢泪情况,也能减轻炎症反应,降低手术并发症发生率,提高患者生活质量,值得推广。

Preliminary study on the efficacy of lacrimal duct reconstruction with pedicled conjunctival flap in the treatment of severe lacrimal canalicular obstruction with conjunctivochalasis

AIM:To determine the efficacy and safety of pedicled conjunctival lacrimal duct reconstruction in the treatment of severe obstruction of superior and inferior lacrimal canaliculi with conjunctivochalasis.METHODS:This study was per formed as a retrospective analysis of patients who received conjunctival dacryocystorhinostomy with pedicled conjunctival flap reconstruction combined with tube intubation due to severe superior and inferior lacrimal canalicular obstruction with conjunctivochalasis from January 2019 to October 2019.The clinical data included the degree of preoperative epiphora and postoperative relief,preoperative examination of lacrimal duct computed tomography and ultrasound biomicroscopy,postoperative evaluation of lacrimal duct function by chloramphenicol taste and fluorescein dye disappearance test,etc.Syringing was carried out to determine the reconstruction and patency of the lacrimal duct.RESULTS:All 9 patients(9 eyes)had severe canalicular obstruction with conjunctivochalasis.The patients included 4 males and 5 females aged between 47–65y with an average age of 52.2±6.7y.At 3mo follow-up,the tube was removed and the patients were followed for a further 3mo.After tube removal,6 patients showed no epiphora.These patients also had positive chloramphenicol tastes and normal fluorescein dye disappearance test results.Two patientshad epiphora.Also,syringing showed partial patency of the reconstructed lacrimal duct.One patient had no improvement in epiphora with negative chloramphenicol taste and fluorescein dye disappearance test results and obstruction of the reconstructed lacrimal duct.The total effective rate of the operation was 8/9,with no serious complications.CONCLUSION:Pedicled conjunctival lacrimal duct reconstruction conjunctival dacryocystorhinostomy is safe and effective for superior and inferior canalicular obstruction with conjunctivochalasis.

显微手术切除泪阜部囊肿的疗效观察

目的:观察通过显微手术切除泪阜部囊肿的临床疗效。方法:对笔者医院2019年6月-2022年8月收治的28例(28眼)泪阜部囊肿患者治疗结果进行分析研究,通过显微手术方式切除其泪阜部囊肿,观察患者临床疗效、瘢痕增生情况及囊肿复发情况。结果:所有患者术后切口愈合良好,切口均一期愈合,眼部外观明显改善,内眦部结膜半月皱襞弧度正常自然,双侧泪阜基本对称。术后随访1~6个月,泪阜部结膜无瘢痕增生,无囊肿复发。结论:本研究应用泪阜囊肿切除术,在显微手术过程中不切除泪阜组织,不损伤结膜,保留完整的泪阜及结膜组织,恢复泪阜的正常功能及形态。泪阜囊肿切除术治疗泪阜部囊肿,操作简单、安全有效,具有良好的眼部美学效果,值得临床推广。

人工鼻泪管植入术治疗慢性泪囊炎的有效性和安全性评价

目的评价人工鼻泪管植入术治疗慢性泪囊炎的有效性及安全性。方法选择2008年7月至2010年12月在我院行逆行性人工鼻泪管植入术治疗慢性泪囊炎的患者163例191眼,年龄26～73岁,平均57岁。所有患者术后随访2a,观察术后溢泪情况及泪道的通畅性。结果人工鼻泪管植入术后155例(182眼)患者溢泪症状完全缓解。随访期间,138例(166眼)患者人工鼻泪管保持通畅,25例(15眼)发生阻塞;随访过程中人工鼻泪管植入有效率为86.91%。术中有17例(17眼)患者出现疼痛,5例(5眼)出现眼睑水肿,所有患者均有少量鼻出血,均经对症处理后缓解。结论人工鼻泪管植入术是治疗慢性泪囊炎简单有效安全的方法,不愿意接受或不能耐受常规鼻腔泪囊吻合术的患者也能进行人工鼻泪管植入。

双泪小管鼻泪管插硅胶管联合泪小管断裂吻合术的疗效观察

目的观察双泪小管-鼻泪管插硅胶管联合泪小管断裂吻合术的疗效,寻求治疗泪小管断裂更合理的方法。方法收集26例(26眼)外伤性泪小管断裂患者,其中下泪小管断裂22例,上下泪小管同时断裂4例,所有患者采用双泪小管-鼻泪管插硅胶管术,以硅胶管作支撑,进行泪小管断端显微吻合。术后常规抗炎治疗,术后7d拆线,2个月时拔管。结果26例患者中,有2例术后出现吻合口哆开,再次吻合后创面愈合良好。术后2个月拔管时,无溢泪、泪小点裂伤、眼睑畸形、硅胶管脱落发生。随访5～18个月,全部患者泪小点复位良好,泪道冲洗通畅,23例患者无溢泪,治愈率为88.5%;3例患者有溢泪,好转率为11.5%。结论双泪小管-鼻泪管插硅胶管联合泪小管断裂吻合术,手术成功率高,并发症少,是治疗外伤性泪小管断裂的理想方法。

CT泪囊造影术及三维重建在鼻腔结构异常伴功能性溢泪诊治中的应用

目的探讨CT泪囊造影术(computed tomographic dacryocystography,CT-DCG)和泪道系统的CT三维重建(CTthree-dimensional reconstruction)在诊治鼻腔结构异常伴功能性溢泪中的应用价值。方法鼻腔结构异常并伴功能性溢泪及鼻阻塞患者18例,均有下鼻甲肥大,其中12例同时伴有鼻中隔偏曲。术前均排除由眼部疾病引起的溢泪。所有患者均采用CT-DCG和三维重建检查,行鼻内镜下鼻甲低温等离子射频消融术,12例伴鼻中隔偏曲者同时行鼻中隔偏曲矫正术,观察疗效。术后随访12个月。结果 CT-DCG和CT三维重建术能清晰显示泪道引流系统的解剖形态及其与周围组织的关系,术前影像显示鼻泪管口通而不畅,术后影像显示泪道系统通畅,造影剂可顺利经下鼻道流出。18例患者术后鼻中隔均居中,下鼻甲明显缩小。其中鼻阻塞痊愈14例(77.8%),好转4例(22.2%);13例(72.2%)溢泪症状消失,5例(27.8%)溢泪症状好转。结论 CT-DCG和泪道系统的三维重建技术对鼻腔结构异常伴功能性溢泪的诊治具有较大的临床应用价值。

功能性泪溢患者泪道泵功能及泪液蛋白成分的初步研究

目的:分析功能性泪溢患者泪道泵功能及泪液蛋白成分与正常泪液的异同。方法:功能性泪溢患者100例200眼,正常对照20例40眼。观察指标包括SchirmerⅠ试验、按压泪囊部时SchirmerⅠ试验、泪膜破裂时间,同时采用ELISA测定功能性泪溢患者泪液主要蛋白含量,并与正常人的泪液对比。结果:正常受试者按压泪囊部时与开放泪囊部时的SchirmerⅠ测试值比较,差异有显著意义(t=-4.008,P<0.05),而功能性泪溢患者在不同时间点的SchirmerⅠ试验测试值比较,差异无显著意义(t=-0.811,P>0.05)。功能性泪溢患者泪膜破裂时间缩短(t=-5.382,P<0.01),功能性泪溢组与对照组泪液蛋白含量比较,溶菌酶、白蛋白浓度降低(P<0.05),乳铁蛋白、分泌型免疫球蛋白A含量无明显差异(P>0.05)。结论:泪道泵功能破坏在功能性泪溢中存在重要影响,功能性溢泪患者泪液蛋白质发生变化。

泪道支架植入术治疗慢性化脓性泪囊炎

目的探讨泪道支架植入术治疗慢性化脓性泪囊炎的临床疗效。方法对37例（42眼）慢性化脓性泪囊炎患者行泪道支架植入术，术后随访3～6个月。结果支架植入成功率100％。2眼于术后3～5d发生支架阻塞，及时行泪道冲洗后恢复通畅。另1眼发生于术后5个半月，泪道冲洗不通后拔除支架。支架留置期间，41眼泪道冲洗通畅，其中溢泪、溢脓症状完全消除35眼，另外6眼仍有轻度溢泪。取出支架后复发11眼占26．2％，治愈27眼，好转4眼，总有效率73.8％。结论应用泪道支架植入术治疗慢性化脓性泪囊炎手术时间短，出血少，安全性高，具有肯定的临床效果。

功能性溢泪的研究现状

近年来,随着眼表疾病和溢泪相关疾病的研究进展,功能性溢泪开始受到人们的重视,我们综述了功能性溢泪的病因学和发病机制、治疗和预后及目前存在的尚待解决问题。

半月皱襞松驰致泪溢手术疗效观察

目的:观察半月皱襞松弛性泪溢的手术疗效。方法:2007-06/2009-06对13例18眼半月皱襞松弛手术切除,手术后观察:症状评估,裂隙灯结膜观察,氯霉素眼液尝味试验。结果:手术后4wk18眼中症状消失和改善者15眼(83%);术后12wk随访到9例13眼中症状消失和改善11眼(85%)。手术后4wk18眼中裂隙灯检查半月皱襞松弛完全消除、下泪小点堵塞解除者16眼(89%);术后12wk随访到9例13眼中12眼半月皱襞松弛完全消除、下泪小点堵塞完全解除(92%)。术后4wk18眼中氯霉素眼液尝味试验恢复正常者14眼(78%);术后12wk随访到9例13眼氯霉素眼液尝味试验正常10眼(77%)。结论:半月皱襞松弛切除术简单、安全、有效。

Microbiologic spectrum of acute and chronic dacryocystitis

AIM:To report the microbiological spectrum of acute and chronic dacrocystitis.METHODS:Retrospective study on 100 patients who presented to the ophthalmic plastic clinic of a tertiary eye care center from May 2011 and April 2013 with acute and chronic dacryocystitis was reviewed for demographic and microbiological profile. The culture results and organisms isolated were recorded.RESULTS:Sixty patients had acute onset and the remaining 40 patients had chronic onset dacryocystitis.The female to male ratio was 1.78. The mean age of patients was 44 y. Gram-positive organisms were the most commonly isolated accounting for 54%, and the commonest species isolated was S. aureus in 26%.Percentage of gram positive cultures was higher in chronic dacryocystitis than acute ones(82% vs 48% of positive cultures; P =0.003). Also in culture positive acute dacryocystitis, gram negative species were found in 52%of eyes but only in 18% of chronic dacryocystitis.CONCLUSION:Gram negative bacteria, culture negative samples, unusual and more virulent organisms are more common in acute dacryocystitis than chronic ones. The results of this study have significant bearing on the treatment of patients with dacrocystitis.

泪道阻塞的数字减影泪道造影评价

目的 :探讨数字减影泪道造影(DSDCG)对泪道阻塞的诊断价值。材料和方法 :选择189例患者253只眼 ,临床表现为溢泪4～5级。采用数字减影机进行数字减影泪道造影 ,根据数字减影泪道造影的表现 ,将泪道阻塞分为泪小管阻塞、泪总管阻塞、泪囊颈部以上的泪囊阻塞及泪囊颈部以下的鼻泪管阻塞 ,并结合泪囊扩大情况及阻塞的程度进行分析。结果 :253例患眼的DSDCG检查均获成功 ,成功率100 %。其中泪小管阻塞12只眼(4.7 %) ,泪总管阻塞22只眼(8.7 %) ,泪囊颈部以上阻塞24只眼(9.5 %) ,泪囊颈部以下阻塞195只眼(77.1 %) ,其中泪囊明显扩大67只眼(26.5 %) ,泪囊颈部以下不完全性阻塞39只眼(15.4 %)。结论 :数字减影泪道造影可清晰地动态显示泪道全程 。