鼻内镜下泪道磷酸钾钛激光在复发性泪囊炎中的应用

目的 探讨鼻内镜引导下泪道磷酸钾钛（KTP）激光在治疗复发性泪囊炎的应用效果.方法 复发性泪囊炎35例（35眼）采用鼻内镜直视下泪道KTP激光成形术,术中植入泪囊型支架,合并泪管阻塞者植入泪道引流管,3个月后取出支架及引流管,术后随访半年至1年.结果 35例（35眼）,治愈32例（32眼）,好转1例,无效2例,有效率,94.29％.出现炎症反应1例,占2.86％.结论 鼻内镜引导下泪道KTP激光治疗复发性泪囊炎可提高手术成功率,创伤更小.但也出现了再次阻塞的病例.     

Lacrimal sac diverticula associated with a patent lacrimal system

PURPOSE: To describe the clinical features of lacrimal sac diverticula. METHODS: Orbital masses were evaluated in 3 patients. One patient had a large tumor extending from the medial orbit associated with upward globe displacement, one had a mass inferior to the medial canthus, and one had an inflamed mass in the right lower lid. Two of the patients had no history of chronic epiphora, sinus disease, or nasal trauma. In all patients, irrigation demonstrated lacrimal drainage system patency. RESULTS: Surgical exploration confirmed the diagnosis of lacrimal sac diverticulum in all patients. Two diverticula were associated with a dacryolith. Each patient was successfully managed with excision of the diverticulum and dacryocystorhinostomy. CONCLUSIONS: Lacrimal sac diverticula should be considered in the diagnosis of medial orbital tumors, and computed tomography is useful in the diagnosis of lacrimal sac diverticula.     

新生儿急性泪囊炎治疗方法与时机探讨

目的 探讨新生儿急性泪囊炎发病原因及有效的治疗方法.方法 对门诊就诊的42例(42只眼)新生儿急性泪囊炎全身抗感染治疗后采用泪道治疗三步法(泪道引流脓液、抗生素冲洗、探通)后观察疗效.结果 42例通过治疗,41例治愈.治愈率97.62%.结论 经全身抗感染治疗后行泪道治疗三步法是治疗新生儿急性泪囊炎简单有效方法.

Abstract：

Objective To explore the cause and the treatment method for infant acute dacryocystitis.Methods Forty-two cases(42 eyes)with infant acute dacryocystitis were treated with systemic anti-infective treatment and lacrimal duct three-step method(lacrimal drainage of pus,irrigation,probing).The effectiveness of treatment was observed.Results All 41 patients(42 eyes)were cured after irrigation and probing of lacrimal passage.The cure rate was 97.62%.Conclusions The three-step treatment method of neonatal lacrimal duct followed by the systemic anti-infective treatment is simple and effective method to treat infant acute dacryocystitis     

Recurrent Dacryocystitis and Lacrimocutaneous Fistula Caused by a Retained Griffiths’ Collar Button Stent

Abstract

A 42-year-old man presented with a white plastic-like material exposed in the left medial canthal area, with a fistula and purulent discharge. He had undergone endonasal dacryocystorhinostomy 7 years earlier for left eye epiphora; he had persistent postoperative epiphora and recurrent dacryocystitis despite multiple drainage attempts and antibiotics elsewhere. Computed tomography showed bilateral enlarged cystic lacrimal sacs, with a well-defined contoured tunnel-like hole at the center of the left sac. Treatment included excision of the foreign body, which was a Griffiths’ collar button nasolacrimal stent, excision of the fistula tract, and revision dacryocystorhinostomy with implantation of bicanalicular silicone stent. He recovered with no further symptoms or complications. This case highlights the importance of follow-up for removal of an implanted Griffiths’ stent after dacryocystorhinostomy. Patients with recurrent dacryocystitis may benefit from a detailed history of previous surgery, careful examination, and imaging to evaluate for endogenous and exogenous foreign bodies such as lacrimal sac calculi, and retained lacrimal sac stents.     

内窥镜下鼻腔内引流联合一期泪道重建治疗急性泪囊炎

目的:探讨急性泪囊炎的鼻腔内引流术联合一期泪道重建的可行性、安全性及手术时机的选择,明确手术治疗的效果、手术并发症情况为急性泪囊炎患者寻找一种可在急性期快速控制感染,同期重建泪道的方法。方法:回顾我集团医院两年半来收治的急性泪囊炎156例,经内窥镜下行鼻腔内引流联合一期泪道重建手术,术前、术后常规全身使用抗生素控制感染。结果:患者156例经鼻内窥镜下鼻内引流术后,1～2d可控制炎症,随诊6～18mo,失访9例,进入观察病例147例,治愈145例,2例无效,成功率98.6%,无1例手术后发生败血症、骨髓炎、感染扩散等并发症,所有患者出院时血常规均恢复正常。结论:鼻内窥镜下鼻腔内引流术是治疗急性泪囊炎的一种很好的手术方式,可有效的、快速的控制泪囊及周围的炎症,同期行泪道重建后,成功率高、创伤小、恢复快、面部无瘢痕、实用于各年龄段的患者、可同期处理鼻腔疾患,可广泛推广应用。     

泪囊鼻腔吻合术后复发的原因分析和再次手术探讨

目的分析泪囊鼻腔吻合术术后复发的原因并探讨再次手术的可行性。方法对11例泪囊鼻腔吻合术术后复发的患者予以再手术治疗,随访半年至一年。结果复发原因：泪囊未完全切开2例,骨孔过小或位置错误4例,吻合腔或骨孔内肉芽组织增生堵塞5例;10例术后流泪消失,泪道冲洗通畅,占90.91%,1例流泪减轻,泪道冲洗基本畅通,占9.09%。结论泪囊鼻腔吻合术术后复发患者可以通过再次手术重建泪道,是治疗泪囊鼻腔吻合术术后复发的有效方法之一。     

Oral and topical antibiotic therapy of complete, primary acquired nasolacrimal duct obstruction in adults.

PURPOSE: To determine whether patients with complete, acquired nasolacrimal duct obstruction may be treated with broad spectrum oral antibiotics and office lacrimal irrigation. METHODS: In a retrospective review, patients with complete, primary acquired nasolacrimal duct obstruction (NLDO) were divided by predominant symptoms and signs into two main groups: (a) those with tearing and/or mucous discharge and (b) those with previous acute dacryocystitis and/or lacrimal sac mucocele. All patients received a therapeutic trial of oral and topical antibiotics followed by lacrimal irrigation. RESULTS: Five of 55 patients with tearing and/or mucous discharge showed significant improvement after treatment with a mean follow-up of 16.5 months. A sixth patient with mucous and tearing had resolution of the mucous discharge but persistent tearing and blockage of the nasolacrimal system to irrigation. Two of 20 patients with lacrimal sac mucocele or history of acute dacryocystitis avoided surgery while 18 opted for early lacrimal surgical intervention. CONCLUSIONS: Conservative management of complete acquired NLDO consisting of oral and topical antibiotics and appropriately timed office lacrimal drainage system irrigation may be considered in selected patients.     

Congenital lacrimal fistula

PURPOSE: Congenital lacrimal fistula is a rare abnormality of the lacrimal system. The patients may be asymptomatic but treatment of those with symptoms such as epiphora and dacryocystitis is still controversial. METHODS: The clinical findings, methods of surgical treatment and results were evaluated in seven patients (four male, three female) with congenital lacrimal fistula. Three were asymptomatic, types of surgical treatment were fistula excision with dacryocystorhinostomy (DCR) (two cases), fistula excision with conjunctival DCR (one case) and closed fistula excision alone (one case). RESULTS: Three of the four patients who underwent surgery had relief of symptoms. The fistula recurred in the case that had undergone fistula excision alone. CONCLUSIONS: It is difficult to design controlled studies to detect which method is superior for the treatment of lacrimal fistula, considering the small number of cases in the literature. We recommend treating each case according to its own characteristics.     

Acute Dacryocystitis Causing Orbital Cellulitis and Abscess

Purpose: Acute dacryocystitis commonly presents as preseptal cellulitis as lacrimal sac lies anterior to the orbital septum and hence infection localizes in the preseptal space. The purpose of this study is to describe presentation and management of cases of acute dacryocystitis presenting as orbital cellilitis and abscess secondary to acute dacryocystitis. Method: This retrospective, non-comparative, interventional case series included 6 patients presenting with orbital cellulitis and abscess secondary to acute dacryocystitis. All patients underwent drainage of abscess under general anesthesia. External dcaryocystorhinostomy was advised as the definitive treatment for all pateints. Result: Abscess was localized in the extraconal space in 4 patients and in the intraconal space in 2 patients. Patients with intraconal abscess had visual loss on presentation while vision could be preserved in patients with abscess in extraconal space. Both patients with intraconal abscess had history of acute dacryocystitis. Conclusion: Acute dacryocystitis is an ophthalmic emergency that can cause orbital cellulitis with abscess formation, and even vision loss, if left untreated.     

Acquired capillary hemangioma in the lacrimal sac region

PURPOSE: To describe two cases of acquired capillary hemangiomas in adults, in the lacrimal sac region. DESIGN: Interventional case reports. METHODS: Review of the history, clinical examination, and pathologic findings. RESULTS: Two patients, an 80-year-old woman and a 50-year-old man, presented with a history of tearing and a slowly growing nodular mass in the lacrimal sac area. Probing and irrigation showed a patent drainage system in both cases. Both lesions were biopsied. Histopathologic examination of the specimens showed capillary hemangiomas. CONCLUSIONS: Capillary hemangiomas in the lacrimal sac area may present with clinical features of more common lesions such as dacryocystitis or mucocele, or rarer lacrimal sac malignancies. They should therefore be considered in the differential diagnosis of any nodular lesion in this area in adults, even at a very late age.     

Lacrimal drainage obstruction from lacrimal sac infiltration by lymphocytic neoplasia

In two patients, a 52-year-old woman with chronic lymphocytic leukemia and a 71-year-old woman with malignant lymphoma, lymphocytic neoplasia infiltrated the lacrimal sac, obstructed the lacrimal drainage system, and resulted in acute or chronic dacryocystitis. The prognosis of lymphocytic neoplasia is sufficiently good that definitive treatment is usually warranted. Both patients benefitted from dacryocystorhinostomy with placement of silicone tubing in concert with management of the neoplasia and hemoglobin level.     

Acute dacryocystitis associated with epstein-barr virus infection

Acute dacryocystitis is a rare complication of infectious mononucleosis with only three previous reports in the English literature. We present two further children with acute dacryocystitis and clinical and laboratory features of Epstein-Barr Virus related infectious mononucleosis. Both were treated with systemic antibiotics and one child additionally required surgical drainage of a lacrimal sac abscess. Both children made a complete recovery without any lacrimal symptoms. Acute dacryocystitis is uncommon in children without a history of congenital nasolacrimal duct obstruction, and an underlying systemic condition such as infectious mononucleosis should be suspected. In such patients, dacryocystitis can be expected to resolve without symptoms of nasolacrimal duct obstruction and dacryocystorhinostomy is seldom required.     

Acute Dacryocystitis Associated with Epstein-Barr Virus Infection

Acute dacryocystitis is a rare complication of infectious mononucleosis with only three previous reports in the English literature. We present two further children with acute dacryocystitis and clinical and laboratory features of Epstein-Barr Virus related infectious mononucleosis. Both were treated with systemic antibiotics and one child additionally required surgical drainage of a lacrimal sac abscess. Both children made a complete recovery without any lacrimal symptoms. Acute dacryocystitis is uncommon in children without a history of congenital nasolacrimal duct obstruction, and an underlying systemic condition such as infectious mononucleosis should be suspected. In such patients, dacryocystitis can be expected to resolve without symptoms of nasolacrimal duct obstruction and dacryocystorhinostomy is seldom required.     

The treatment of acute dacryocystitis using laser assisted endonasal dacryocystorhinostomy

AIMS: To determine whether acute dacryocystitis complicated by abscess formation can be successfully treated using laser assisted endonasal dacryocystorhinostomy. METHODS: A protocol was adopted for the management of acute dacryocystitis presenting to an ophthalmology department. All patients were assessed jointly by an ophthalmologist and otolaryngologist for their suitability for primary internal drainage via a nasal endoscopic approach. All suitable patients during the study period August 1999 to November 2000 were managed by intravenous antibiotics and holmium:YAG laser dacryocystorhinostomy. RESULTS: Nine patients were studied (mean age 72 years (range 38-82 years), three men, six women). A history of chronic epiphora was found in 78% of patients, and recurrent nasolacrimal infections in the same 78%. Resolution of symptoms and signs of acute dacryocystitis occurred in all nine patients. No recurrence of acute dacryocystitis occurred during the median follow up period of 11 months (range 6-31 months). Ostium patency defined as the absence of epiphora and the observation of irrigated lacrimal fluorescein at the ostium was achieved in 67% of patients. Epiphora recurred in 33% of cases. CONCLUSION: Laser assisted endonasal dacryocystorhinostomy is an effective primary treatment in cases of acute dacryocystitis complicated by abscess formation. In addition, pre-existing symptoms of epiphora and recurrent nasolacrimal infections are relieved in the majority of patients.     

Lesions of the lacrimal drainage system: a clinicopathological study of 643 biopsy specimens of the lacrimal drainage system in Denmark 1910-1999

PURPOSE: To determine the frequency of histologically verified lesions of the lacrimal drainage system in Denmark between the years 1910 and 1999. Furthermore, to correlate the clinical diagnosis with the pathology diagnosis. METHODS: Retrospective review of all pathology reports from 1910 to 1999 in the files of the Eye Pathology Institute, University of Copenhagen, describing a lesion of the lacrimal drainage system. In addition, a retrospective review of all reports describing a lesion of the lacrimal drainage system from the Danish Pathology Database. All specimens were re-evaluated, except in cases with a primary diagnosis of dacryocystitis. In these cases a sample of 25% was re-evaluated. RESULTS: A total of 643 lesions were collected. Dacryocystitis was the most frequent lesion, constituting 508 cases (79%). The remaining cases were diagnosed as dacryolithiasis (62 cases; 7.9%), tumour (29 cases; 4.5%), trauma (19 cases; 3.0%), congenital malformation (nine cases; 1.4%), canaliculitis (eight cases; 1.2%) and granulomatous inflammation (eight cases; 1.2%). Seventeen tumours were malignant, of which B-cell lymphoma was the most common (six cases). In 0.6% of cases with a clinical diagnosis of dacryocystitis/lithiasis a non-suspected malignant tumour was diagnosed. Micro-organisms were uncommon in dacryocystitis (9%) but frequent in cases of dacryolithiasis (87%). CONCLUSION: Dacryocystitis was by far the most frequent lesion of the lacrimal drainage system referred for histopathological evaluation. Dacryolithiasis was often associated with micro-organisms, especially Gram positive rods. Histopathology is necessary to confirm suspected tumours, more than half of which were inflammatory lesions, and to detect tumours that sometimes masquerade as inflammation.     

泪囊瘘管切除联合泪道双硅胶管植入治疗慢性泪囊炎合并泪囊瘘管的疗效

目的：：探讨泪囊瘘管切除联合泪道双硅胶管植入治疗慢性泪囊炎合并泪囊瘘管的疗效。方法：回顾性分析25例25眼慢性泪囊炎合并泪囊瘘管患者,分为两组：双硅胶管组13例13眼行泪囊瘘管切除联合泪道双硅胶管植入术,传统组12例12眼行传统外路鼻腔泪囊吻合术,分析两组疗效。结果：双硅胶管组：治愈12例12眼,好转1例1眼,治愈率92.3%,有效率100%。传统吻合组：治愈11例11眼,有效1例1眼,治愈率91.7%,有效率100%,两组患者比较差异无统计学意义(P>0.05)。结论：泪囊瘘管切除联合泪道双硅胶管植入治疗慢性泪囊炎并泪囊瘘管效果与传统外路鼻腔泪囊吻合术相当,但更微创、无面部瘢痕,可减少患者痛苦,满足患者美容的需求。     

Possibilities and limits of minimal invasive lacrimal surgery

Endoscopy of the lacrimal drainage system with miniaturized endoscopes has been possible since 1990 and permits the direct evaluation of the lacrimal drainage system. Additionally, attached instruments permit recanalization in cases of stenosis of the lacrimal drainage system. Both an Erbium-Yag Laser and a miniaturized drill are available, with which a stenosis of the lacrimal drainage system can be opened under endoscopic control. Favorable findings for endoscopic recanalization are stenoses in the area of the canaliculi or the lacrimal sac, for which the success rate of recanalization is approximately 75%. Unfavorable prognostic factors are submucous scar formations due to a dacryocystitis in the patient's history. Endoscopic findings have also improved the understanding of diseases of the lacrimal drainage system. Punctal stenoses causing epiphora often show intact mucous membranes before and behind the stenosis and it is possible to cure these patients without extensive surgical procedures. Micro-surgical procedures and dacryocystorhinostomy complete the spectrum of the endoscopic surgical possibilities in the lacrimal drainage system.     

Possibilities and limits of minimal invasive lacrimal surgery

Endoscopy of the lacrimal drainage system with miniaturized endoscopes has been possible since 1990 and permits the direct evaluation of the lacrimal drainage system. Additionally, attached instruments permit recanalization in cases of stenosis of the lacrimal drainage system. Both an Erbium-Yag Laser and a miniaturized drill are available, with which a stenosis of the lacrimal drainage system can be opened under endoscopic control. Favorable findings for endoscopic recanalization are stenoses in the area of the canaliculi or the lacrimal sac, for which the success rate of recanalization is approximately 75%. Unfavorable prognostic factors are submucous scar formations due to a dacryocystitis in the patient's history. Endoscopic findings have also improved the understanding of diseases of the lacrimal drainage system. Punctal stenoses causing epiphora often show intact mucous membranes before and behind the stenosis and it is possible to cure these patients without extensive surgical procedures. Micro-surgical procedures and dacryocystorhinostomy complete the spectrum of the endoscopic surgical possibilities in the lacrimal drainage system.     

Dacryocystorhinostomy for dacryocystitis caused by methicillin- resistant Staphylococcus aureus: report of four cases

BACKGROUND: To evaluate the outcome of dacryocystorhinostomy (DCR) for dacryocystitis caused by methicillin-resistant Staphylococcus aureus (MRSA). CASES: Four otherwise healthy patients with dacryocystitis caused by MRSA were studied (3 with chronic dacryocystitis; 1, acute dacryocystitis). Ophthalmic symptoms were epiphora with purulent discharge in 2 cases, with blepharoconjunctivitis in 1 case, and with lacrimal fistula in 1 case. Culture of the purulent discharge from the affected conjunctival sacs revealed MRSA infection. Initial treatment, which was unsuccessful, included intravenously administered common antibiotics, the use of topical antibiotics and povidone-iodine in the conjunctival sac and mupirocin ointment in the nasal cavity. Subsequently, standard DCR was performed with a bicanalicular silicone tube inserted under local anesthesia, accompanied by the administration of common antibiotics. OBSERVATION: Cultures from all patients were negative for MRSA as soon as 4 days after DCR. None of the patients had epiphora with pus, and the lacrimal passage became patent postoperatively. CONCLUSION: Dacryocystitis due to MRSA was resistant to conservative therapy. DCR subsequent to the conservative therapy resulted in almost immediate resolution of the lacrimal fistula and nasolacrimal obstruction, rapid control of dacryocystitis, and a decrease in the period of MRSA infection in the conjunctiva and the nasal cavity.     

新型泪道探通引流装置治疗泪小管断裂及泪囊炎的临床研究

目的 设计，临床应用新型泪道探通引流装置治疗小不止管断裂及鼻泪管阻塞所致泪囊炎。方法 新型泪道探通引流装置由两端金属探子及中间软性硅胶管组成。共42例患者（27例泪囊炎，15例泪小管断裂，女23例，男19例），首先收敛鼻粘膜，在表面麻醉下，探通泪道，自上下泪小点插入泪道探通引流装置，末端引至鼻腔鼻泪管开口处，内窥镜下取出探子，硅胶管留置在鼻腔内，术后第1周冲洗2次，术后1月每周冲洗1次，术后3个月取出引流管。结果 21例泪囊炎患者均在植管后1周内症状消失，6例泪囊炎患者明显好转，15例泪小管断裂者术后流泪症状立即消失，拔管后观察3个月，6例泪囊炎患者复发，冲洗泪道不通，其余患者痊愈。结论 应用新型泪道探通引流装置治疗由泪小管断裂所致溢泪，泪道狭窄，鼻泪管阻塞所致长期溢泪，流脓具有良好的临床效果。组织创伤小，疗效显著。具有广泛的临床应用价值。