结膜松弛与泪溢关系的临床研究

目的：观察球结膜松弛与泪溢的关系。探索手术治疗的结果。方法：选择24例46只眼球结膜松弛并有泪溢患者系统观察,由于球结膜松弛阻碍了泪液的流向,或直接堵塞下泪小点开口处,引起泪溢,故手术切除松弛的球结膜以解除泪溢,随访2-8周。结果：切除松弛结膜术后4周;78.2%患者自觉泪溢得到改善;60.8%患者室内观察泪溢消失;78.2%患者裂隙灯检查结膜松弛完全消除,结论：结膜松弛症是泪溢的主要原因之一,手术切除松弛结膜治疗泪溢有效。     

手术治疗结膜松弛症16例临床疗效观察

目的 观察结膜松弛症手术治疗的效果。方法 按照诊断标准筛选16例结膜松弛症患者，手术切除松弛结膜解除泪溢症状，术后随访时间为第2周、第4周、第8周。结果 切除松弛结膜术后8周，75．0％患者自觉泪溢得到改善，68.75％患者室内观察泪溢消失，78．13％患者裂隙灯检查松弛结膜消失。结论 手术切除松弛结膜治疗泪溢有明显疗效。     

老年性结膜松弛性溢泪的手术治疗

目的探讨老年性结膜松弛性溢泪的手术治疗方法。方法13例（18眼）老年性结膜松弛引起的溢泪进行结膜及泪阜部分切除术治疗。随访观察1～6月。结果手术获得良好效果。3眼溢泪减轻而未完全治愈;另1眼因膜状物覆盖泪点开口仍溢泪,经去除膜状物后,流泪消失。治愈率83．33％。术后无后遗症。结论采用结膜及泪阜部分切除术治疗结膜松弛性溢泪手术安全、疗效可靠。     

放射核素动态显像评估结膜松弛对泪液排出的影响

目的 :评估结膜松弛症对泪液排泄系统的影响。方法 :结膜松弛症与对照组各 8例 (16只眼 ) ,在SPECT下 ,用99mmTcO-4 动态显像 ,比较结膜松弛症组与对照组T1/2值和结膜松弛症组手术前后的T1/2值。结果 :结膜松弛症组T1/2值(2 92± 198)明显大于对照组 (110± 38) ,差异有显著性意义 (t=3 5 8,P <0 0 1)。结膜松弛症组手术后T1/2值 (2 45± 115 )较手术前明显缩短 (35 6± 189) ,差异具有显著性意义 (t=3 18,P <0 0 1)。手术切除松弛结膜后解除了对泪液排泄系统的影响 ,患者的溢泪症状改善。结论 :结膜松弛症中泪液排泄系统功能不全 ,泪液排泄延缓     

结膜松弛综合征的临床研究

目的观察球结膜松弛的临床症状,探索保守治疗和手术治疗的效果。方法选择30例(58只眼) 球结膜松弛并有泪溢或干眼等症状的患者系统观察,进行症状评估、泪河观察、BUT测定、眼表荧光素染色,并观察手术后球结膜及下睑缘变化。32只眼由于轻度球结膜松弛及干眼症状,局部给予0．1％爱丽滴眼液缓解症状; 26只眼中重度球结膜松弛引起泪溢,经手术解除泪溢。随访2-4月。结果32只眼给予0．1％爱丽滴眼液干眼症状改善者26只眼(81．25％);BUT≥10秒者29只眼(90．63％);眼表荧光素染色正常者24只眼(75．00％)。26 只眼手术后泪溢症状改善者22只眼(84．62％),BUT≥10秒者18只眼(69．23％);眼表荧光素染色正常者19只眼 (73．08％);裂隙灯显微镜检查眼球与下睑缘、内、外眦部之间无松弛结膜皱褶者20只眼(76．92％);下睑缘位置正常者23只眼(88．46％);泪河恢复正常者21只眼(80．77％)。结论选择适宜治疗方式治疗结膜松弛症是安全、有效的。     

手术治疗结膜松弛症临床疗效观察

目的:探讨结膜新月形切除术、结膜缝线固定术治疗结膜松弛症的疗效。方法:对27例48眼结膜松弛症患者随机分组,分别应用结膜新月形切除、结膜缝线固定术进行治疗,术后随访观察疗效。从术后患者自觉症状、裂隙灯显微镜观察结膜松弛改善情况及泪河和泪膜破裂时间(BUT)的变化进行观察分析。结果:术后1wk,结膜新月形切除术组有效率为92%,结膜缝线固定术组有效率为88%。术后1mo,结膜新月形切除术组有效率为92%,结膜缝线固定术组有效率为83%。结论:两种手术方法治疗结膜松弛症方法简单,疗效明确。     

结膜松弛症定量定位切除术的临床疗效观察

目的:为了寻求安全、简便、经济、有效切除结膜松弛症的手术方法,评价结膜松弛症定量定位切除术和新月形切除术的临床疗效。方法:采用前瞻性随机分组对照研究方法,将2008-01/2009-05在上海中医药大学附属普陀医院眼科按照结膜松弛症诊断标准入选手术治疗患者30例30眼按患者入选编号末位数的奇偶数随机分为两组。奇数组行结膜定量定位切除术15例15眼;偶数组行结膜新月形切除术手术15例15眼。手术后第2,4,8wk分别随访患者症状改善程度,裂隙灯观察结膜松弛症变化情况,测量泪河、BUT,氯霉素眼液尝味试验。结果:结膜松弛症定量定位切除仪和结膜新月形切除术组术后4wk,两组症状改善有效率均为87%,无差异。结膜定量定位切除术松弛结膜完全消除,占87%;结膜新月形切除术组松弛结膜完全消除,占73%,差异无统计学意义(χ2=0.833,P=0.361)。结膜定量定位切除术后4wk泪河恢复正常者,占87%,BUT≥10s者,占73%,氯霉素眼液尝味试验阳性者,占53%。结膜新月形切除术后4wk泪河恢复正常者,占73%(χ2=0.833,P=0.361),BUT≥10s者,占67%(χ2=0.159,P=0.690),氯霉素眼液尝味试验阳性者,占60%(χ2=0.136,P=0.713),差异均无统计学意义。结论:结膜松弛症定量定位切除术安全、简便、准确、有效,更适合手术经验不足的医师开展。     

手术治疗结膜松弛症21例临床观察

目的观察结膜切除联合结膜巩膜固定术治疗结膜松弛症的手术疗效。方法按照诊断标准筛选结膜松弛症21例（42眼）行结膜切除联合结膜巩膜固定术,对手术效果进行评估。结果术后临床治愈36眼（85．71％）,自觉症状治愈或改善者39眼（92．86％）,随访6～24月无一例复发,也无一例出现并发症。结论结膜切除联合结膜巩膜固定术治疗结膜松弛症,疗效较好,未见明显并发症。     

眼结膜松弛的临床分级探讨

结膜松弛症是指结膜过度松弛堆积在眼球与下睑缘、内、外眦部之间 ,引起眼表异常的一组病变。 1996年 3月至2 0 0 1年 9月我们收集了 80例 (147只眼 )结膜松弛的病例 ,进行了系统的观察 ,并对 31例 5 2只眼结膜松弛性泪溢症患者手术治疗。结膜松弛症有轻重之分 ,合理的分级对指导临床诊治有着重要意义。现试提出结膜松弛的临床分级标准。1　结膜松弛临床分级标准Ⅰ级 :患者无结膜松弛引起的泪溢、异物感、干涩等相关症状。裂隙灯显微镜检查 ,在眼球与下睑缘、内、外眦部之间 ,球结膜松弛成细小的皱褶 ,在原位眼时不明显 ,眼球下转时加重 ,上…     

结膜切除联合结膜巩膜固定术治疗结膜松弛症的临床观察

我科采用结膜切除联合结膜巩膜固定术治疗结膜松弛症24例（47眼）,效果良好,现报告如下。 材料与方法 一、资料：2000年3月至2004年10月手术治疗结膜松弛症24例（47眼）,男11例,女13例;年龄48～73岁,平均64．3岁。结膜松弛临床分级：Ⅱ级8眼,占17．02％;Ⅲ级24眼,占51．06％;Ⅳ级15眼,占31．9％。泪溢时间2～8年,平均5．6年。     

189例主诉流泪患者的病因分析

目的 分析以流泪为主诉患者的病因。设计 回顾性病例系列。研究对象 2013年1月～2014年12月以流泪为主诉就诊于大连大学附属中山医院的成年患者189例（321眼）。方法 所有患者完成问卷调查,外眼、裂隙灯显微镜、鼻腔检查及泪道冲洗。有眼干涩或异物感等症状或泪河高度偏低者行泪液分泌试验及泪膜破裂时间（BUT）检查。主要指标 病因构成比。结果 321眼中各种原因泪道狭窄或阻塞174眼（54.21%）,干眼症27眼（8.41%）,结膜松弛8眼（2.49%）,泪阜肥大2眼（0.62%）,眼睑松弛2眼（0.62%）,鼻腔疾病2眼（0.62%）,结膜炎8眼（2.49%）,鳄鱼泪2眼（0.62%）,视疲劳20眼（6.23%）。2种以上原因76眼（23.68%）,其中泪道狭窄或阻塞合并干眼症43眼（13.40%）,泪道狭窄或阻塞并干眼症与结膜松弛6眼（1.87%）,泪道狭窄并干眼症与结膜炎2眼（0.62%）,干眼症及结膜松弛6眼（1.87%）,泪道狭窄或阻塞合并结膜松弛9眼（2.80%）,结膜松弛及泪阜肥大5眼（1.56%）,泪道狭窄或阻塞合并结膜松弛及眼睑松弛3眼（0.94%）,泪道阻塞合并泪阜肥大1眼（0.31%）,泪道阻塞合并倒睫1眼（0.31%）。结论 泪道狭窄或阻塞是主诉流泪者的主要原因,多因素原因中干眼症合并泪道狭窄或阻塞比例较大。（眼科,2016, 25：343-346）     

New approach for conjunctivochalasis with argon laser photocoagulation

ObjectiveTo report a novel approach for conjunctivochalasis using argon laser photocoagulation.DesignNoncomparative clinical interventional study.ParticipantsWe studied 5 eyes of 5 patients with epiphora due to conjunctivochalasis.MethodsThe patients underwent argon laser photocoagulation between April 2011 and July 2011 at Myongji Hospital. The preoperative and postoperative tear break-up time, tear meniscus height, conjunctivochalasis grading, and improvement of symptoms were evaluated.ResultsMost patients showed improvement of epiphora symptoms. No significant complications were observed during the follow-up period of more than 3 months.ConclusionsArgon laser photocoagulation is a simple and effective procedure for treating epiphora caused by conjunctivochalasis.     

泪道激光联合改良结膜松弛矫正术治疗溢泪

目的探讨泪道阻塞合并结膜松弛引起的溢泪,行泪道激光联合改良结膜松弛矫正术的临床效果。方法2011年10月至2012年10月在天津爱尔眼科医院行泪道激光联合改良结膜松弛矫正术28例（42眼）。分析其治疗溢泪的临床效果、并发症及其手术要点,并与分期手术进行对比。结果42眼中治愈6眼,明显好转25眼,好转10眼,无效1眼,总有效率为97．6％。并发症包括泪道阻塞复发15眼,但其中14眼溢泪症状亦明显改善;治愈病例中有2眼出现轻度干眼。手术效果与分期手术者无明显差异。结论泪道激光联合改良结膜松弛矫正术治疗溢泪有效,术后并发症少。改良结膜松弛矫正术的手术要点是处理眼球筋膜囊,并将其与浅层巩膜固定。     

Etiology of Epiphora

PurposeThis study aimed to analyze the common causes of epiphora in Korean patients and their response to subsequent management.MethodsWe retrospectively analyzed the medical records of 180 patients who visited Kim’s Eye Hospital for epiphora between December 2017 and January 2019. This study included 320 eyes of 180 patients.ResultsIn the 320 eyes of 180 patients, the most common etiology of epiphora was reflex tearing due to dry eye syndrome, which occurred in 167 eyes (52.19%). The other etiologies of epiphora included anatomical abnormality (68 eyes, 21.25%), multifactorial (60 eyes, 18.75%), functional epiphora (14 eyes, 4.38%), ocular surface disease (seven eyes, 2.19%), and eyelid abnormality (four eyes, 1.25%).ConclusionsThe most common etiology of epiphora in Korean patients was reflex tearing due to dry eye syndrome, followed by lacrimal passage abnormality, multifactorial, functional epiphora, anterior segment disease, and eyelid malposition. Most patients with reflex tearing reported improvement in their symptoms after lubrication.     

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.     

部分结膜切除术治疗结膜松弛症性溢泪的疗效

目的：评价球结膜部分切除术治疗球结膜松弛症患者溢泪的安全性和有效性。方法：回顾性病例系列研究。对2015年6月到2017年12月在陆军军医大学附属西南医院眼科确诊为结膜松弛症并伴有溢泪症状,接受部分结膜切除手术治疗的患者31例（31眼）,完成随访的27例（27眼）进行统计分析。所有患者的结膜松弛症均为Ⅲ级或以上,接受球结膜部分切除术后,检查患者自觉症状及结膜脱垂体征变化。采用配对t检验比较术前及术后1、6、12个月泪膜破裂时间变化以及术前和术后6个月的下泪河高度变化。结果：术后患者的溢泪症状均消失。拆除结膜缝线后未见切口处的结膜裂开。至术后平均15个月的随访期间,裂隙灯显微镜检查未见结膜松弛症复发。术后随访各时间点泪膜破裂时间均显著提高（P<0.001）,术后12个月下泪河高度较术前提高（t=-14.642,P<0.001）。结论：切除松弛脱垂的球结膜,间断缝合球结膜切口,并固定于浅层巩膜上,可有效避免手术中结膜撕裂和术后结膜切口裂开等手术并发症,能够改善患者的溢泪,一定程度上稳定泪膜,且安全、有效。     

Amniotic membrane transplantation for symptomatic conjunctivochalasis refractory to medical treatments

PURPOSE. To determine whether preserved human amniotic membrane can restore the large conjunctival defect created during surgical removal of conjunctivochalasis. METHODS: Amniotic membrane transplantation was performed at two facilities in 40 consecutive patients (47 eyes) with symptomatic conjunctivochalasis refractory to conventional treatments. RESULTS: The majority of patients were elderly (73.1 +/- 9.7 years) and women (75%). Over a follow-up period of 6.9 +/- 4.3 months, 46 (97.8%) eyes recovered smooth, quiet, and stable conjunctival surfaces. Epithelial defects healed in 16.5 +/- 7.3 days. Episodic epiphora was resolved in 24 of 30 (83.3%) eyes and improved in five other eyes. Notable relief was also noted for such symptoms as fullness or heaviness (19/19, 100%), sharp pain (6/6, 100%), redness (14/17, 88.2%), tiredness (17/20, 80.9%), itching (11/13, 78.6%), blurry or decreased vision (6/8, 75%), burning (8/13, 61.5%), foreign body sensation (8/13, 61.5%), and crust formation (1/2, 50%). Complications included focal inflammation of the host conjunctiva adjacent to the graft (six eyes), scar formation (five eyes), and suture-induced granuloma (one eye). CONCLUSION: Amniotic membrane transplantation can be considered as an effective means for conjunctival surface reconstruction during removal of conjunctivochalasis.     

Epiphora caused by conjunctivochalasis: treatment with transplantation of preserved human amniotic membrane

PURPOSE: To present our experience with the use of preserved human amniotic membrane on patients with epiphora caused by conjunctivochalasis. METHODS: Twelve patients, seven women and five men, ages ranging from 56 to 72 years (mean, 61 years) were referred to our Cornea Service with chronic epiphora. In all patients, no punctal ectropion was present, the lacrimal pathway was patent, and the dye disappearance test was abnormal. All patients had already undergone various therapies including multiple irrigations of the lacrimal system, antibiotic drops, steroid drops, and artificial tear drops. In all patients, conjunctivochalasis, which was not previously diagnosed, was evident on slit-lamp examination. After surgical removal of the excess conjunctiva, preserved human amniotic membrane was placed over and sutured with 10-0 nylon continuous suture to the free conjunctival edges. During the postoperative period, artificial tear drops and steroid/antibiotic drops were applied. RESULTS: Improvement of the epiphora was evident from the first postoperative day. After removal of the suture 10 to 15 days (mean, 12 days) after surgery, no patient complained of epiphora. The dye disappearance test was normal. During the follow-up period, which ranged from 6 to 11 months (mean, 8 months), no patient complained of epiphora and no conjunctivochalasis was detected in the area in which human amniotic membrane was transplanted. CONCLUSION: In our experience, transplantation of preserved human amniotic membrane greatly improved symptoms of epiphora caused by conjunctivochalasis. Continued education of the general ophthalmologists concerning this condition is required.