先天性泪道疾病的诊疗进展

先天性泪道疾病是由于鼻泪系统的先天发育不良所导致,通常可涉及骨性、黏膜或膜性结构,可分为上泪道系统及下泪道系统或其二者均存在的不良发育,其临床表现多为溢泪,或可合并有溢脓。近年来,越来越多的研究致力于先天性泪道疾病的诊疗,且各方所持观点截然不同。因此,本文对先天性泪道疾病的最新诊疗进展作一综述,以便更好地服务临床。     

The surgical management of congenital lacrimal fistulae.

Congenital lacrimal fistulae are developmental anomalies of the lacrimal apparatus that are usually symptomatic, frequently causing epiphora and occasionally causing fistulitis or dacryocystitis. They may be associated with other abnormalities of the lacrimal system or with systemic anomalies. Complete excision alone, or in combination with nasolacrimal intubation and/or dacryocystorhinostomy is recommended for treatment.     

The surgical management of congenital lacrimal fistulae

Congenital lacrimal fistulae are developmental anomalies of the lacrimal apparatus that are usually symptomatic, frequently causing epiphora and occasionally causing fistulitis or dacryocystitis. They may be associated with other abnormalities of the lacrimal system or with systemic anomalies. Complete excision alone, or in combination with nasolacrimal intubation and/or dacryocystorhinostomy is recommended for treatment.     

Pyogenic granuloma of the lacrimal sac

BACKGROUND: Pyogenic granulomata belong to the group of inflammatory pseudotumours. They consist of granulation tissue usually following inflammatory processes or trauma. PATIENT: We report on a 86-year old female suffering from chronic dacryocystitis. In the course of the treatment exstirpation of the lacrimal sac was performed. The removed tissue was analysed histologically. RESULTS: Histological examination revealed a dense lymphoplasmacellular infiltration underlying the epithelium of the lacrimal sac. A mushroom-like tumour rising into the lumen of the lacrimal sac could be observed. This tumour consisted of capillaries and a dense inflammatory infiltrate. The findings were consistent with a pyogenic granuloma of the lacrimal sac. CONCLUSION: Pyogenic granulomata usually arise in the conjunctiva as a sequel of chronic lipogranulomatous inflammation. They are very rare in other areas such as the lacrimal drainage system.     

阻塞性泪道疾病的临床治疗进展

泪道阻塞为眼科常见病,根据病因分为先天性泪道阻塞和后天性泪道阻塞两大类,按部位分为上泪道阻塞（泪小点、泪小管和泪总管）和下泪道阻塞（泪囊和鼻泪管）。近年来,随着激光、内窥镜、各种生物材料的不断发展和完善,泪道阻塞的治疗也趋于多样化。传统治疗多采用保守治疗、泪道探通、鼻腔泪囊吻合术等。近来新型泪道支架和泪道内窥镜得以越来越多地用于泪道阻塞疾病的治疗。总之,各种方法都有着各自的优缺点和适应范围,需要术者针对患者具体情况进行最佳的选择。     

泪道支架术后再次梗阻280眼原因探析

目的:探讨泪道支架术后再次梗阻原因.方法:对泪道支架患者523例523眼,术前检查眼部鼻腔相关情况,观察泪道阻塞与相关疾病关系,泪道支架术后平均随访2 a.其中280眼再次梗阻,观察分析再次梗阻原因.结果:泪道阻塞往往继发于结膜或鼻腔黏膜的炎症蔓延.高位阻塞与慢性结膜炎关系密切,低位阻塞与下鼻甲肥大关系更密切.两种支架拔除后再次阻塞都是其失败的首要原因.环形支架术后发生低位梗阻为其再次梗阻的第二位因素.而球头型支架再梗阻第二位因素为术后继发高位泪道阻塞.结论:泪道支架手术安全、简单,门诊治疗方便,但随植入支架时间延长疗效逐年减低.应根据泪道阻塞患者的可能病因、泪道阻塞部位、年龄、治疗情况,制定个性的综合治疗方案.     

Pleomorphic adenoma of the lacrimal gland in a nine-year-old child

A case of a 9-year-old child with pleomorphic adenoma of the lacrimal gland is described. This tumour is usually found in adults; cases younger than 10 years of age have proved to be extremely rare. Because of its age distribution, pleomorphic adenoma of the lacrimal gland is usually overlooked as a possible cause of unilateral proptosis in children. Also, the history of disease provided by the family may be incorrect, possibly leading to misdiagnosis by the ophthalmologist.     

Congenital lacrimal fistula: A major review

The purpose of this article is to review and summarize the etiopathogenesis, symptomatology, systemic associations, management, complications and clinical outcomes of congenital lacrimal fistulae. The authors performed an electronic database (PubMed, MEDLINE, EMBASE and Cochrane Library) search of all articles published in English on congenital lacrimal fistulae. Congenital subsets of patients from series of mixed lacrimal fistulae were included in the review. These articles were reviewed along with their relevant cross-references. Data reviewed included demographics, presentations, investigations, management, complications and outcomes. The prevalence of congenital lacrimal fistulae is reported to be around 1 in 2000 live births. They are frequently unilateral, although familial cases tend to be bilateral. Lacrimal and systemic anomalies have been associated with lacrimal fistulae. Exact etiopathogenesis is unknown but mostly believed to be an accessory out budding from the lacrimal drainage system during embryogenesis. Treatment is indicated when significant epiphora or discharge is present and is mostly achieved by various fistulectomy techniques with or without a dacryocystorhinostomy. Congenital lacrimal fistulae are a distinct clinical entity with unique features. Surgical management can be challenging and successful outcomes are usually achieved with widely accepted protocols.     

Primary lacrimal sac B-cell immunoblastic lymphoma simulating an acute dacryocystitis

The case of a 72-year-old woman with diffuse large B-cell lymphoma of the lacrimal sac is reported. The patient was evaluated for the first time in our department for tearing of the right eye. One month later, a slightly aching mass appeared over the right lacrimal sac. An acute infectious etiology was suspected and antibiotic therapy was given. When she finally presented with a rapidly growing lesion, she underwent echography and computed tomography followed by incisional biopsy. Results of histopathologic and immunohistochemical evaluation showed a primary, diffuse, large B-cell non-Hodgkin lymphoma of the lacrimal sac. This case demonstrates how difficult the clinical diagnosis of tumors of the lacrimal sac may be in the early stages. The clinical signs, usually aspecific, may be misleading and the diagnosis delayed.     

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.     

Orbital abscess secondary to acute dacryocystitis: case report

Acute dacryocystitis usually induces preseptal infection. In rare instances the infection that is confined to the lacrimal sac can extend to the orbital contents resulting in orbital cellulitis. We present a case of intraconal abscess secondary to acute dacryocystitis and review the literature of orbital cellulitis resulting from acute lacrimal sac infection.     

Conjunctival cicatrizing disease presenting with lacrimal obstruction

Patients with conjunctival cicatrizing disease may develop lacrimal obstruction. Little is published on lacrimal obstruction as the presenting feature of otherwise asymptomatic cicatrizing conjunctival disease. The records of all patients presenting between 1994 and 2015 with lacrimal obstruction found to have cicatrizing conjunctival disease were reviewed. Demographic details, clinical findings, disease progression and treatment were analyzed. Thirty-five patients (25 female), aged 43–91 years (median 74, mean 71.3 years) had epiphora and a mild conjunctival cicatrizing process. Nine patients had onset of epiphora after cataract surgery. All except one patient had obstruction of the proximal lacrimal system (punctum and/or canaliculus). In 14 cases, the obstruction was unilateral (both puncta or canaliculi), with one progressing to bilateral obstruction after 11 years. In 19, all 4 puncta or canaliculi were obstructed. Two patients had unilateral nasolacrimal duct obstruction; one developed contralateral canalicular obstruction 2 years later. Conjunctival biopsies were obtained in 19 of 35 cases (54%), and OCP immunohistochemistry was positive in 7/19 (37%). All other biopsies showed chronic inflammation. Two patients had lichen planus. In follow-up (range 0.1–11 years, mean 3.2 years), 2 patients’ conjunctival disease progressed mildly, and 3 progressed moderately, with 2 of these 5 having positive OCP immunohistochemistry, and 1 having lichen planus. Patients with conjunctival cicatrization may present with lacrimal obstruction, usually punctal or canalicular. Conjunctival disease is usually mild and non-progressive, but patients should be monitored for disease progression.     

Computed tomography of the lacrimal drainage system: retrospective study of 107 cases of dacryostenosis.

PURPOSE: To evaluate the role of computed tomography in patients with dacryostenosis. METHODS: One hundred seven cases of dacryostenosis (94 patients) were assessed by thorough clinical and lacrimal history and examination, and lacrimal region computerized tomography (CT). The lacrimal drainage system examination included the state and position of the puncta; Jones testing; lacrimal syringing; and, in the latter half of the study, telescopic nasal endoscopy. The patients were drawn from the hospital outpatients and private office of the operating lacrimal surgeon in this series (I.C.F.). Of the 107 cases, 79 either underwent dacryocystorhinostomy surgery or had this planned. RESULTS: In 14 of the 107 cases (12 patients), preoperative CT led to an alteration of patient management, usually referral to an otolaryngologist for further evaluation or treatment. In addition to the detection of two tumors extrinsic to the sac, conditions such as ethmoiditis, lacrimal sac mucoceles, soft tissue opacity in the nasolacrimal duct, gross nasal polyposis, fungal sinusitis, and a dacryolith were observed by CT. CONCLUSION: Similar to the role of functional endoscopic sinus surgery in otolaryngology, CT imaging will become increasingly important in the assessment of many patients with symptoms of lacrimal drainage obstruction.     

Intra-Lacrimal Gland Cavernous Hemangioma

Orbital cavernous hemangioma usually has a typical clinical and imagery pattern. We present a patient with an enlarged lacrimal gland due to an intra-gland cavernous hemangioma.     

Intra-lacrimal gland cavernous hemangioma

Orbital cavernous hemangioma usually has a typical clinical and imagery pattern. We present a patient with an enlarged lacrimal gland due to an intra-gland cavernous hemangioma.     

白内障患者手术后干眼不应忽视

白内障患者手术后发生干眼的问题已经引起了国内外学者的注意.白内障患者术后干眼可分为早期(可逆性)干眼和慢性(不可逆性)干眼,前者术前泪液分泌功能多为正常,由于手术及术后用药等因素的影响,术后泪液分泌暂时性减少,随着相关因素的去除,其功能可以恢复正常;后者术前已患有干眼,或泪液分泌功能处于"边界状态",手术及术后相关因素加剧了泪液分泌的异常,甚至造成眼表组织的异常.及时发现和正确处理术后干眼,对维持眼表稳定性和更好地恢复视力均有重要的临床意义.     

泪腺区占位性病变65例临床分析

目的探讨近10年来住院治疗的泪腺区占位性病变的类型、临床特点和治疗方法。方法对65例（74眼）泪腺区占位性病变进行回顾分析。结果65例（74眼）中男29例（32眼）,女36例（42眼）。年龄13～76岁,平均39岁。右眼31例,左眼25例,双眼9例。所有患眼泪腺区均可触及占位性病变,均经CT或B超检查证实。除2例（4眼）双眼泪腺炎型炎性假瘤患者接受药物治疗治疗外,余均经手术治疗。其中泪腺炎型炎性假瘤28例（30眼）,泪腺多形性腺瘤27例（27眼）（其中包括1例（1眼）复发病例）,泪腺腺样囊性癌3例（3眼）,泪腺腺癌2例（2眼）,泪腺恶性多形性腺瘤2例（2眼）,泪腺导管囊肿1例（1眼）。经眉弓外侧切口手术60例（62眼）,结膜切口1例（1眼）,眶内容摘除2例（2眼）。所有手术患眼术后均经病理检查结果证实诊断。结论因泪腺区占位性病变入院治疗者以泪腺炎型炎性假瘤及泪腺多形性腺瘤多见。泪腺区占位性病变绝大多数手术切口选取经眉弓外侧切口。     

Subconjunctival Prolapse of the Palpebral Lobe of the Lacrimal Gland Occurring in Association with Occult Orbital Fat Herniation

Introduction: Sub-conjunctival prolapse of the palpebral lobe of the lacrimal gland can be a disfiguring and sometimes uncomfortable problem, usually caused by lacrimal gland enlargement or associated orbital lobe displacement. However, we present two novel cases associated with occult orbital fat herniation.

Method: Retrospective interventional case series of two middle-aged/elderly male patients presenting with unilateral prolapse of the palpebral lobe of the lacrimal gland and no clinically apparent orbital fat prolapse. Neither patient had proptosis, globe displacement or diplopia, but both were aware of a subconjunctival mass in the lateral fornix causing a cosmetic concern.

Results: Imaging in both cases revealed a normal sized lacrimal gland with a prominent orbital fat pocket behind this. This fat was excised through an upper-eyelid skin crease approach with temporary detachment of the levator muscle in one case, and through a trans-conjunctival incision in the other. In both cases fat excision resulted in retroplacement of the palpebral lobe of the lacrimal gland such that it was no longer visible. Neither patient experienced any additional dry eye post-operatively.

Conclusion: Sub-conjunctival prolapse of the palpebral lobe of the lacrimal gland can be associated with occult orbital fat herniation, revealed on imaging. Localised orbital fat excision is an effective means of treating this condition.     

Pleomorphic adenoma of the lacrimal gland: A review with updates on malignant transformation and molecular genetics

Pleomorphic adenoma (benign mixed tumor) is the most common epithelial neoplasm of the lacrimal gland. It is usually a slow growing, well-circumscribed, mass that is identical to its salivary gland counterpart. Patients generally have an excellent prognosis for vision and long-term survival after complete surgical excision. There is a tendency to reoccur, especially if there is an incomplete excision, and rarely, malignant transformation to carcinoma ex pleomorphic adenoma can occur, which has a much poorer prognosis. The molecular genetics of lacrimal gland pleomorphic adenomas have only recently been studies, but appear to display similar genetic aberration found in the salivary gland counterparts.     

MALT (mucosa-associated lymphoid tissue) lymphoma of the lacrimal gland

MALT lymphoma of the lacrimal gland is rare. Orbital involvement is usually located on the anterior orbit. We report the case of a 65-year-old man consulting for an eyelid tumor located on the right upper and lateral lid, which clinically recalled lacrimal gland involvement. The gland biopsy and the immunohistochemical analysis concluded in the diagnosis of B and MALT lymphoma. The assessment of the ganglion and extra-ganglion enlargement of these lymphomas is of capital importance in treatment. A multidisciplinary analysis, especially oncological, is important so that the best therapeutic plan can be adopted.