结膜松弛症

结膜松弛症为老年人常见眼病,是由于球结膜过度松弛和(或)下睑缘张力增高,造成松弛的球结膜堆积在眼球与下睑缘以及内、外眦部之间形成皱褶,引起眼表泪液学异常,并伴有眼部干涩、异物感、溢泪不适等症状的疾病.     

《结膜松弛症》一书出版

张兴儒著、陈家祺审的《结膜松弛症》一书已由上海科技出版社出版。结膜松弛症是常见病，主诉眼部干涩、异物感、泪溢，是由于球结膜过度松弛和（或）下睑缘张力高，造成松弛结膜堆积在眼球与下睑缘、内眦部、外眦部之间引起眼表泪液学异常，并伴有眼部不适等症状的疾病。     

结膜松弛症手术治疗临床观察

结膜松弛症可由于球结膜过度松弛和／或下睑缘张力高，导致松弛的球结膜堆积在眼球与下睑缘、内外眦部之间而引起眼表泪液学异常。我科采用手术治疗结膜松弛症效果良好，报告如下。     

《结膜松弛症》一书出版

张兴儒著、陈家祺审的《结膜松弛症》一书已由上海科技出版社出版。结膜松弛症是常见病,主诉眼部干涩、异物感、泪溢,是由于球结膜过度松弛或下睑缘张力高,造成松弛结膜堆积在眼球与下睑缘、内眦部、外眦部之间引起眼表泪液学异常,并伴有眼     

《结膜松弛症》一书出版

张兴儒著、陈家祺审的《结膜松弛症》一书已由上海科技出版社出版。结膜松弛症是常见病,主诉眼部干涩、异物感、泪溢,是由于球结膜过度松弛和(或)下睑缘张力高,造成松弛结膜堆积在眼球与下睑缘、内眦部、外眦部之间引起眼表泪液学异常,并伴有眼部不适等症状的疾病。本书总结了国内外有关结膜松弛症研究成果,从结膜松弛症的病因、发病机理、临床表     

《结膜松弛症》一书出版

由张兴儒编著、陈家祺审阅的《结膜松弛症》一书已由上海科技出版社出版。结膜松弛症是常见病,主诉眼部干涩、异物感、泪溢,是由于球结膜过度松弛或下睑缘张力升高,造成松弛结膜堆积在眼球与下睑缘、内眦部、外眦部之间引起眼表泪液     

《结膜松弛症》一书出版

张兴儒著、陈家祺审的《结膜松弛症》一书已由上海科技出版社出版。结膜松弛症是常见病,主诉眼部干涩、异物感、泪溢,是由于球结膜过度松弛和(或)下睑缘张力高,造成松弛结膜堆积在眼球与下睑缘、内眦部、外眦部之间引起眼表泪液学异     

《结膜松弛症》一书出版

张兴儒著、陈家祺审的《结膜松弛症》一书已由上海科技出版社出版。结膜松弛症是常见病,主诉眼部干涩、异物感、泪溢,是由于球结膜过度松弛或下睑缘张力高,造成松弛结膜堆积在眼球与下睑缘、内眦部、外眦部之间引起眼表泪液学异常,并伴有眼部不适等症状的疾病。本书总结了国内外有关结膜松弛症研究成果,从结膜松弛症的病因、发病机理、临床表现、诊断标准、治疗     

《结膜松弛症》一书出版

张兴儒著、陈家祺审的《结膜松弛症》一书已由上海科技出版社出版。结膜松弛症是常见病，主诉眼部干涩、异物感、泪溢，是由于球结膜松弛和（或）下睑缘张力高，造成松弛结膜堆积在眼球与下睑缘、内眦部、外眦部之间引起眼表泪液学异常，并伴有眼部不适等症状的疾病。     

结膜松弛症泪液功能改变的观察

结膜松弛症(conjunctivochalasis)是由于球结膜过度松弛和(或)下睑张力高,造成松弛球结膜堆积在眼球与下睑缘,内、外眦部之间形成皱褶引起眼表泪液学异常,并伴有眼部不适(如流泪、干涩、异物感等)症状的疾病[1].有学者发现结膜松弛症可引起泪液动力学异常型干眼[2-5],泪液功能的改变在结膜松弛症的发生与发展中可能起一定的作用,但机制尚不明.因此,本研究对结膜松弛症的泪液功能改变进行检测,以探讨结膜松弛症的发病机制.     

结膜松弛症治疗进展

结膜松弛症是由于球结膜过度松弛和/或下睑缘张力高,造成松弛球结膜堆积在眼球与下睑缘,在内外眦部之间形成皱褶,引起眼表泪液学异常,并伴有眼部干涩、异物感、泪溢等眼部不适症状的疾病。近年来,国内眼科医生逐渐对这一疾病提高了认识,其治疗手段亦得到越来越多的重视和应用。结膜松弛症的严重程度决定了其不同的治疗方法。症状不明显的结膜松弛症不需治疗;眼部刺激症状严重者,可以给予药物治疗;而保守治疗无效,或是对于Ⅲ～Ⅳ级结膜松弛严重的患者,则选择手术治疗。结膜松弛症的手术方法多种多样,但要达到最好的治疗效果,应该权衡各种方法的利弊,掌握其适应证。我们对结膜松弛症的这些治疗方法及其优缺点、适应证,以及近年来的研究进展进行综述。     

结膜松弛症泪液学及治疗研究进展

结膜松弛症是与年龄相关的常见眼表疾病.松弛结膜堆积在睑缘内外眦部之间,引起泪液分泌、排泄、成分的改变,导致泪液学异常,泪河残缺、泪膜不稳定,出现眼干涩、视物模糊等症状,降低眼视觉质量和生活质量.目前的治疗包括局部眼液对症治疗、中药保守治疗以及手术.常用的手术方式有结膜新月形切除术、结膜缝线固定术、双极电凝治疗术、下睑缘张力减弱术等,均可以不同程度改善患者的泪液学症状和体征.     

结膜松弛症的发病机理研究

结膜松弛症的发病机理是出现了球结膜、泪液和睑缘三者平衡失调,眼表自动反馈调节系统失灵。球结膜组织发生以弹力纤维减少为主要的组织病理改变,泪液中出现蛋白质及酶的异常表达,在瞬目或闭眼时下睑缘张力增高向上推压已经过度变薄、弹性下降、张力降低、与其下方组织结合疏松的球结膜,松弛结膜就会明显堆积在下睑缘上、内、外眦部之间,形成皱褶,突出于眼表曲面,影响泪液的流动、分布、排泄,在松弛结膜上不能形成正常泪膜,而发生干燥、充血、水肿、上皮角化、泪河变窄或残缺不全,泪液不能正常流动到泪湖区,泪湖不能聚泪,泪液不能进入泪点,使泪液排泄出现障碍,泪液清除延缓又可导致大量降解酶的堆积,可能使胶原纤维溶解,弹力纤维变性,引起眼表泪液学异常的病理循环,而发生结膜松弛症。     

Conjunctivochalasis: a systematic review

Conjunctivochalasis (CCH) is a conjunctival condition characterized by loose, redundant conjunctival folds, most typically in the inferior bulbar conjunctiva of both eyes. Although CCH is a common cause of ocular irritation and discomfort, especially in the elderly, it is often overlooked in clinical practice. CCH may be associated with various ocular and nonocular conditions; however, the most important risk factor is aging. Although often asymptomatic, CCH may cause symptoms related to tear film instability and/or delayed tear clearance. Pathogenesis of CCH remains largely unknown but may involve different elements such as aged conjunctiva, unstable tear film, mechanical friction, ocular surface inflammation, and delayed tear clearance. Contradictory results have been reported on histopathologic changes in CCH, with some studies showing a normal microscopic structure. For symptomatic CCH, medical treatment may include lubrication and anti-inflammatory medications. For symptomatic patients who fail to respond to medical treatment, a surgical procedure may be considered. Although various surgical procedures have been used for CCH, more often, it consists of conjunctival cauterization or excision of the redundant conjunctiva, with or without amniotic membrane transplantation.     

Conjunctivochalasis. A cause of tearing and its management

Conjunctivochalasis is an isolated bilateral condition in which redundant conjunctival tissue overlies the lower eyelid margin or covers the lower punctum. It causes tearing by mechanically disrupting the normal flow of tears. Unlike the boggy conjunctiva seen in an allergic reaction, the extent of this redundant tissue is small, well-localized, and unresponsive to antihistamine drops. During the 40-month period from May 1981 through September 1984, 15 patients complaining of epiphora were found to have this problem. Simple local surgical excision relieved their symptoms. Follow-up period ranged from 10 to 40 months, with an average of 27 months. Conjunctivochalasis can be recognized by a thorough ocular examination and managed by simple excision of the redundant tissue. Consequently, before extensive surgery such as dacryocystorhinostomy, eyelid surgery, or silicone intubation of the lacrimal system is contemplated, conjunctivochalasis should be ruled out and corrected.     

Conjunctival cytology features of giant papillary conjunctivitis associated with ocular prostheses

PURPOSE: In this study, the conjunctival cytology features of giant papillary conjunctivitis (GPC) associated with ocular prosthesis wear was examined. METHODS: In a prospective study, 12 consecutive patients diagnosed with GPC associated with ocular prosthesis wear were examined. Impression cytology specimens were taken from the upper eyelid tarsal conjunctiva, the bulbar conjunctiva, and the lower eyelid tarsal conjunctiva of each socket, with the contralateral eye serving as a matched control. RESULTS: The randomized impression cytology specimens showed no significant change in goblet cell density or epithelial cell morphology when comparing the GPC and control specimens. The GPC specimens did have a statistically significant increase in conjunctival inflammation and mucous strands on all three sample areas. In addition, the GPC specimens from the upper and lower tarsal conjunctiva had a honeycomb pattern consistent with giant papillae. CONCLUSIONS: This is the first report to describe the honeycomb pattern created by giant papillae on impression cytology and the changes of GPC on the lower tarsal conjunctiva.     

Hughes technique, amniotic membrane allograft, and topical chemotherapy in conjunctival melanoma with eyelid involvement

A 59-year-old woman presented with a pigmented mass in the inferior tarsal conjunctiva of the left eye with an associated diffuse, multifocal pigmentation involving largely the inferior half of the bulbar conjunctiva, fornix, and eyelid skin. Histopathologic examination of map biopsies disclosed conjunctival melanoma from primary acquired melanosis. Surgical excision of the inferior bulbar conjunctiva, fornix, and lower eyelid with histopathologic free margins was performed. Adjuvant cryotherapy was applied. The bulbar conjunctiva and lower fornix were reconstructed with an amniotic membrane allograft. Lower eyelid reconstruction was accomplished by use of the Hughes technique. Topical mitomycin C (0.04%) was applied after surgery. After 2 years of follow-up, no tumor recurrence has been detected and the eyelid and conjunctival defect have been satisfactorily corrected. This combined surgical procedure using amniotic membrane allograft and a composite tarsoconjunctival flap is shown to be useful in the treatment of an advanced conjunctival neoplasia with extensive eyelid involvement.     

Unilateral eyelid lag and retraction as sequelae of trachoma

A 42-year-old woman had a large right palpebral fissure 13 mm high with 0.5 mm of scleral show both superiorly and inferiorly due to upper and lower eyelid retraction. The upper eyelid showed eyelid lag behind the globe only during the initial ocular movement. Superior tarsal height measured 7.5 mm with palpebral conjunctival cicatrization and Arlt's line. Severe cases of trachoma may lead to contracture of the conjunctiva and deeper tissues including Müller muscle and the tarsal plate, which supports the insertion of the levator aponeurosis. Shortening of the posterior lamella and fornix contracture would explain eyelid retraction and failure of the upper eyelid to smoothly follow the globe on downgaze.     

结膜松弛症研究新进展

结膜松弛症是年龄相关性老年性常见眼病,随着人口老龄化加快,患者日趋增多。下睑缘张力高、睑板腺功能障碍及结膜淋巴流动阻塞可能是结膜松弛症诱发因子之一。自身免疫性甲状腺疾病患者结膜松弛症发病率高。结膜松弛症患者球结膜杯状细胞减少,并有形态及超微结构异常表现。结膜松弛症泪液分泌减少,泪膜稳定性下降,泪液中黏蛋白减少,出现调节凋亡相关蛋白质和防御素。细胞凋亡和炎症可能是结膜松弛症发病的原因。结膜松弛症发病机制认为是泪液中IL-1β,IL-6,肿瘤坏死因子-α等炎性因子增加,使结膜成纤维细胞中MMP-1,3,9过度表达,使得MMPs与TIMPs之间失去平衡,可能使胶原纤维融解,弹力纤维变性减少,导致球结膜基质和Tenon囊的过度降解,引起眼表泪液异常的病理循环,而发生结膜松弛症。纤维蛋白胶应用于结膜松弛症手术中,电凝治疗结膜松弛症及开展上方结膜松弛症手术治疗。     

Ocular adnexal lymphoma: Five case reports and a literature review

This article reports the clinical course and treatment of ocular adnexal lymphoma based on a retrospective review of five cases with a histologically approved ocular adnexal lymphoma at Kaohsiung Veterans General Hospital over 10 years. Extranodal B-cell lymphoma in the orbit, lacrimal gland, eyelid, or conjunctiva was found in these patients. Four of them were female, and they were aged 45–64 years. All patients were also consulted with hematologists for possible systemic involvement and therapeutic plan. The patient with retrobulbar and orbital apex involvement received systemic chemotherapy. The patient with lacrimal gland involvement experienced tumor recurrence after local excision, and therefore received adjuvant radiotherapy. The remaining three patients had localized lymphoma on the eyelid or bulbar conjunctiva, and they all showed no recurrence after surgical excision. The incidence of ocular adnexal lymphoma has risen worldwide over the last few decades. Although most cases are confined to ocular adnexal, some may also be associated with disseminated lymphoma. Accurate diagnosis and staging is mandatory for appropriate treatment. Generally speaking, localized and low-grade ocular adnexal lymphoma involved eyelid or conjunctiva seem to have good outcome after surgical excision only. Systemic chemotherapy should be considered in patients with advanced disease or systemic manifestations, and radiotherapy also offers a good choice for lacrimal gland lymphoma.