泪功能检查

泪功能异常常表现多泪或少泪。多泪包括泌泪亢进(流泪)、排泪障碍(泪溢)和假泪溢症;少泪为泌泪障碍,常表现干眼,临床上常见。流泪尤多见,但常为眼病症状之一,将随原发病痊愈而消失。就泪器病而言,泪溢较流泪约多见2.5倍。泪功能异常,尤其轻度干眼症诊断困难,检查方法虽多,但结果可靠者少。因分泌及排泪功能互相影响,反射性分泌功能随排泪障碍而减退;所有检查都难免影响泪功能,许多排泪功能检查法会影响排泪功能;基础泪和保留泪取样困     

泪囊粘液性囊肿的联合手术治疗观察

泪囊粘液性囊肿是泪囊长期的慢性炎症，在鼻泪管阻塞的基础上，又导致上下泪小管或泪总管阻塞，泪囊粘膜不断分泌液体，从而导致泪囊的不断膨大扩张所引起。对于泪囊粘液性囊肿既往都采用囊肿摘除的方法，术后导致终身的溢泪。作者根据泪囊粘液性囊肿的形成是在鼻泪管阻塞的基础上，又导致上下泪小管或泪总管阻塞的原因，对临床上遇到的12例泪囊粘液性囊肿采用上下泪小管或泪总管激光再通联合泪囊囊肿鼻腔吻合术的方法，获得良好的效果。     

泪总管-泪囊区黏膜皱褶的解剖学观察

目的观察泪总管-泪囊区黏膜皱褶在Honer’s不同状态下的解剖学变化。方法临床解剖实验研究。对2013年1月至2014年1月在温州医科大学眼视光医院经尸头标本（由温州医科大学解剖教研室提供）,采用标准泪囊摘除法完整摘除泪囊,沿泪囊内侧纵向切开泪囊。通过沿Homer’s肌方向牵拉与放松肌肉,显微镜下观察泪总管一泪囊区结构的变化。并进一步组织学检查泪总管-泪囊区显微结构。结果完整摘除泪囊22例,所有标本上下泪小管汇聚成泪总管后进入泪囊,所有标本在泪总管-泪囊区均发现黏膜皱褶样结构。在Horner’s肌拉紧时出现泪总管-泪囊区开口关闭,放松时开放。组织学显示黏膜皱褶样结构含有丰富的血管以及淋巴组织。结论泪总管-泪囊区瓣膜皱褶在不同的Horner’s状态下可出现泪总管开口的启闭。     

CT泪囊造影及其临床应用

目的探讨CT泪囊造影在泪囊手术中的临床应用价值.方法对23例(26眼)慢性泪囊炎患者进行CT泪囊造影,并以X-线平片泪囊造影做对照.结果23例(26眼)中大泪囊11眼,中泪囊13眼,小泪囊2眼.CT泪囊造影片能清晰显示泪囊大小以及与周围结构的关系.结论CT泪囊造影对鼻内镜下鼻腔泪囊造口术有指导意义.     

Jones泪小管插管及结膜泪囊鼻腔吻合联合手术

泪囊鼻腔吻合术是消除由鼻泪管阻寒所致泪溢的首选方法,但对于泪道虹吸功能不良者亦能招致失败。对于上、下泪小管或泪总管阻塞引起的泪溢可做弹性硅胶管暂时插入泪小管的泪囊鼻腔吻合术。然而常常由于泪管重新狭窄,泪溢复发。Jones管-泪小管插管和结膜泪囊鼻腔吻合联合手术适用于因泪道虹吸功能不良、泪小管或泪总管完全阻塞者,作者手术6例病人获得成功。     

碘油泪管注入在小泪囊鼻腔吻合术中的应用

泪囊鼻腔吻合术是治疗慢性泪囊炎的行之有效的方法,正常大小的泪囊行泪囊鼻腔吻合术并不困难,而且效果也满意,小泪囊行泪囊鼻腔吻合既增加手术中的难度也影响术后的效果。我院眼科近来在行小泪囊鼻腔吻合术中从泪管注入碘油治疗小泪囊型泪囊炎     

瘘管切除联合泪囊鼻腔吻合术治疗泪囊瘘临床观察

目的探讨慢性泪囊炎合并泪囊瘘行泪囊瘘管切除联合泪囊鼻腔吻合术的临床疗效。方法对13例（13只眼）慢性泪囊炎合并泪囊瘘行瘘管切除联合低位泪囊鼻腔吻合术,切除瘘管后,泪囊侧切口采用内翻缝合,观察疗效。结果13例患者均无溢泪、溢脓,瘘管无复发,瘘管切除处皮肤愈合良好,皮肤瘢痕不明显,随访l～3年,无复发。结论泪囊瘘管切除联合泪囊鼻腔吻合术是治疗慢性泪囊炎合并泪囊瘘的有效方法。     

鼻内窥镜下经鼻腔治疗泪囊瘘

泪囊瘘由急慢性泪囊炎、泪囊囊肿或外伤感染等引起的泪囊皮肤瘘.传统大多采用泪囊及瘘道摘除或泪囊鼻腔吻合术,前者遗有溢泪,后者适应征及成功率不多.     

泪小管置管联合泪囊鼻腔吻合术治疗慢性泪囊炎103例

目的 探讨泪小管置管联合泪囊鼻腔吻合术治疗伴泪小管阻塞的慢性泪囊炎的临床效果。方法 对2007年7月至2009年12月103例慢性泪囊炎患者进行了泪囊鼻腔吻合术联合泪小管置管,术后随访6个月至18个月,观察疗效。结果 术后103例泪囊鼻腔吻合术联合泪小管置管术中,治愈97例,有效5例,无效1例,无效者在泪道内窥镜下进一步处理后治愈。结论 泪囊鼻腔吻合术联合泪小管置管术成功率高,是目前治疗慢性泪囊炎尤其是泪囊囊肿的较好手术方法。     

小泪囊慢性泪囊炎泪囊鼻腔吻合术疗效观察

目的观察泪囊鼻腔吻合术对小泪囊慢性泪囊炎的治疗效果。方法对术前经泪道冲洗和造影检查证实泪囊体积小的慢性泪囊炎患者47例53眼施行泪囊鼻腔吻合手术,观察术后疗效。结果47例53眼术后泪道畅通,治愈率100%。结论泪囊鼻腔吻合术是治疗小泪囊慢性泪囊炎的理想术式,小泪囊是泪囊鼻腔吻合术的适应症。     

Tear dynamics model

PURPOSE: Quantitative understanding of tear dynamics may help in developing better ophthalmic drug delivery vehicles and dry eye treatments. This paper attempts to develop a comprehensive model that can predict the effect of physiological parameters on various issues related to tear dynamics. METHODS: The model is based on mass balances of water and solutes such as glucose, sodium, potassium, and chloride. The mass balances require models for the drainage of fluid through the canaliculi and the transport of tears and solutes through the conjunctiva. The model parameters are obtained by simulating Ussing-chamber experiments. The differential equations for the unsteady balances are solved numerically. RESULTS: The model predicts that under normal conditions, the tear volume, tear osmolarity and potential are 7.1 microl, 297.6 mM, and -15.1 mV, respectively. The model also predicts that the conjunctiva is secretory and contributes about 25% of the total tear production. We also predict the effect of evaporation on tear physiology and show that an increase in evaporation increases osmolarity, reduces tear volume, and increases conjuctival secretion. Additionally, the new tear dynamics model helps assess the effect of osmolarity of the instilled drops, insertion of punctum plugs and use of moisture chamber as treatments for dry eyes. Furthermore, the model is used to predict the effect of modulation of specific transport pathways, which is proposed as a potential remedy for dry eyes, on conjuctival secretion and total tear volume. CONCLUSIONS: Most of the predicted results agree with the reported experimental results, at least qualitatively. However, some predictions disagree with experiments suggesting that further improvements in the model are needed. The model developed in this paper can improve our understanding of tear dynamics and also serve as a tool to evaluate the efficacy of various modalities at treating dry eyes.