泪道结石致下泪小管扩张性炎症1例

0引言泪道阻塞性疾病(lacrimal duct obstruction diseases,LDOD)是眼科常见病和多发病,常导致溢泪、溢脓,给患者造成身体上和心理上的不适,其发生原因有多种,如:急慢性泪囊炎、泪道肿瘤、结石或异物等。其中泪道结石在临床上极少见,现将我院收治1例泪道结石伴发下泪小管炎报告如下。     

泪道阻塞性疾病的诊断与治疗

泪道阻塞性疾病指各种原因引起的以泪道阻塞为病理特征、溢泪为主要临床表现的一组疾病,是眼科常见病和多发病,这种疾病易发展为急慢性泪囊炎,影响患者日常生活。而泪囊炎作为眼部的感染灶可向眼球及眶内蔓延,造成不良后果,且常作为内眼手术的禁忌证。     

改良鼻内窥镜下泪囊鼻腔造口术

目的 探讨改良鼻内窥镜下泪囊鼻腔造口术治疗慢性泪囊炎的临床效果。方法 采用泪囊鼻腔造口C形置管术治疗慢性泪囊炎42例(42眼)。对伴上泪道阻塞者用自制的头端略呈锥形泪道探针，按泪道探通方向突破阻塞部位11眼。结果 42眼术后全部治愈，拔管后溢泪、溢脓症状消失，泪道冲洗通畅。结论 改良鼻内窥镜下泪囊鼻腔造口术能较好地解决伴上泪道阻塞的慢性泪囊炎；C形置管使手术效果更为可靠。     

泪道阻塞性疾患的导管留置治疗

泪道阻塞所致之泪溢,是眼科的多发病,虽不直接影响视力,但常给患者的工作和生活带来诸多不便,治疗方法,种类较多,但效果不其理想。我们将过去的泪道插管方法作了一些改进,并使导管长期留置,经临床应用,尚称满意,曾先后用于泪小管阻塞、鼻泪管阻塞、泪道损伤、慢性泪囊炎、泪囊摘除术后,泪囊鼻腔吻     

鼻泪管阻塞研究现状

鼻泪管阻塞导致溢泪，并可发展为急慢性泪囊炎，常给患者造成身体和心理上的不适。本文就近年来鼻泪管阻塞的病因研究作简要的描述。诊断方面介绍几种常用泪道影像学方法、微返流试验、泪道冲洗和荧光素试验的特点。治疗方面讨论了鼻内泪囊鼻腔吻合术的方法，与外路方法的比较，置管和应用丝裂霉素的作用，介绍了颇具争议的鼻泪管支架管植入和泪道成形术。并讨论泪道内窥镜下的诊断治疗。     

高频电灼术加留置硅胶管术治疗泪道阻塞

0引言 泪道阻塞是眼科常见病,主要原因有炎症后瘢痕形成、息肉、异物阻塞,先天畸形、外伤等;常导致溢泪,溢泪本身可影响患者工作学习和生活;由于泪道阻塞,泪液潴留,细菌在泪囊内繁殖,易形成急慢性泪囊炎.是眼科手术的禁忌症,因为当角膜外伤或内眼手术时易发生角膜溃疡或眼内炎而导致失明的危险.我科自2005-04/2007-04,采用WZC-Ⅲ型高频泪道治疗仪,对50例56眼各种泪道阻塞患者进行内高频电灼术加硅胶管植入,经过临床观察疗效满意,现报告如下.     

SC-LY新型硅胶泪道探通引流管治疗泪道疾病的临床观察

泪道疾病是我国常见眼病．慢性泪囊炎多发于农村．以女性多见．致长期流脓、溢泪且易造成眼部感染；泪小管断裂及泪道阻寒、狭窄也是令眼科医师倍感棘手的眼病，以往的治疗方法较复杂且疗效不确切，手术痛苦大、费用高．有瘢痕体质者其面部常留下永久性瘢痕．我们采用自行设计的新型泪道探通引流装置，对慢性泪囊炎、泪小管断裂、泪遭阻塞和泪道狭窄患者进行治疗，效果满意，报告如下。     

新型泪道探通引流装置的临床应用探讨

目的 观察新型泪道探通引流装置治疗泪囊炎和泪小管断裂的临床效果。方法 新型泪道探通引流装置是由两端金属探子及中间软性硅胶管组成,利用该装置对30例泪囊炎,15例泪小管断裂患者进行治疗。结果 25例泪囊炎患者均在植管后1周内症状消失。5例泪囊炎患者在留管期间明显好转,拔管后复发。15例泪小管断裂者术后溢泪症状立即消失。拔管后观察6月,冲洗泪道通畅。结论 新型泪道探通引流装置治疗由泪管狭窄、阻塞及断裂所致的溢泪、流脓组织创伤小,临床疗效肯定,具有推广应用价值。     

Nd:YAG激光治疗泪道阻塞

我们自 1999年 10月至 2 0 0 0年 6月应用Ｎｄ :ＹＡＧ激光治疗泪道阻塞及慢性泪囊炎 ,获得良好疗效 ,报告如下 :一般资料 :6 5例 (74眼 ) ,男 7例 ,女 5 8例 ,年龄 11～ 6 8岁 ,平均 40 2 7岁。泪道阻塞 2 5眼 ,慢性泪囊炎 49眼。溢泪 2 0天～ 2 0年 ,平均 5 1 32月 ,泪囊炎溢脓 10天～ 2 0年 ,平均 2 5 5 4月。治疗前泪道挂线 4眼 ,插管 2眼 ,泪囊脓肿切开 2次 1眼 ,泪囊鼻腔吻合 1次及 2次各 1眼 ,泪道探通 2 6眼 ,次数 1～ 11次 ,平均 3 92次。适应证与禁忌症 :(1)适应证 :泪小管、泪总管阻塞 ;鼻泪管阻塞及慢性泪囊炎 ;泪囊鼻腔吻合…     

泪囊鼻腔吻合联合下泪小管插管扩张术的探讨

慢性泪囊炎由于炎症刺激，反复泪道冲洗，常并发下泪小管狭窄或阻塞，单纯行泪囊鼻腔吻合术常不能解决这类病人的溢泪。另外，泪囊鼻腔吻合术后发生吻合道阻塞也是一个较常见且棘手的问题。对此，我科自1993年～1997年对20例因慢性泪囊炎合并下泪小管狭窄或阻塞的患者进行了泪囊鼻腔吻合联合下泪小管插管扩张术，解除了患者溢脓、溢泪的症状，获得了满意的效果。临床资料：20例20眼，男3例，女17例，年龄23～60岁，均为慢性泪囊炎伴下泪小管不同程度狭窄或阻塞。材料与方法：一、材料：除泪囊鼻腔吻合术的器械外尚需准备以下物品：1．塑料管…     

Endonasal dacryocystorhinostomy in the primary treatment of acute dacryocystitis with abscess formation

PURPOSE: To determine whether endonasal dacryocystorhinostomy may constitute effective primary treatment of acute dacryocystitis with lacrimal sac abscess formation. METHODS: This was a retrospective review of a series of 24 patients with acute dacryocystitis and lacrimal sac abscess who underwent endonasal dacryocystorhinostomy as a primary procedure. Outcome measures included resolution of signs and symptoms of acute dacryocystitis as well as intranasal ostium patency as assessed by lacrimal irrigation. RESULTS: Pain was relieved in all patients within 3 days of surgery, and swelling resolved in all patients by 9 days after surgery. Ostium patency, as defined by the absence of epiphora, and free lacrimal irrigation was achieved in 20 (83%) of 24 patients, with follow-up of 27 to 59 months (mean, 40 months). Recurrent epiphora developed in four patients; recurrent dacryocystitis developed in none. CONCLUSIONS: Endonasal dacryocystorhinostomy may be a useful option in the treatment of acute dacryocystitis with abscess formation.     

泪道阻塞性疾病的诊断研究进展

泪道阻塞性疾病(lacrimal duct obstruction diseases,LDOD)是眼科常见病和多发病。近年来,随着人们对健康要求的提高和医学科学技术的发展,在LDOD的诊断方面取得了较大进展。本文综述了泪道阻塞的病因、检查、诊断和鉴别诊断方面的研究进展。     

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.     

慢性泪囊炎的鼻内窥镜下手术治疗

目的 评估慢性泪囊炎在鼻内窥镜下行鼻腔泪囊造口术的手术方法和疗效。方法 在局麻下由鼻内径路在鼻内窥镜下施行鼻腔泪囊造孔术．治疗慢性泪囊炎共39例（42眼）。结果 经过6-12个月的随访发现．流脓溢泪症状消失。泪道冲洗通畅．达到治愈标准41眼，流脓溢泪症状减轻．泪道冲洗通而不畅．达到好转标准1眼。结论 本术式操作简便．损伤小，恢复快，并发症少．无面部疤痕．疗效较显著。     

鼻内镜下泪囊鼻内造口术治疗慢性泪囊炎的临床探讨

目的:探讨鼻内镜下泪囊鼻内造口术治疗24例慢性泪囊炎患者的临床术式与疗效。方法:针对24例26眼慢性泪囊炎,行鼻内窥镜下泪囊鼻内造口术,其中对于14眼(8眼Ⅰ型和6眼Ⅱ型)行单纯泪囊鼻腔造口术,12眼(6眼Ⅱ型和6眼Ⅲ型)行泪囊-筛窦-鼻腔造口术。结果:19眼治愈,6眼好转,1眼无效,无效者为合并有慢性鼻窦炎行上颌窦根治术。结论:鼻内镜下泪囊鼻内造口术治疗慢性泪囊炎具有良好疗效,但对于不同类型的泪囊窝,需依据术前泪囊CT造影实施不同的术式。     

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.     

自制软管式冲洗探通针在婴幼儿泪囊炎中的应用

目的探讨自制软管式冲洗泪道探通针在婴幼儿泪囊炎中的应用。方法在95例婴幼儿泪囊炎用软管式冲洗探通针进行泪道冲洗和探通治疗,观察其疗效。结果94例患儿溢泪、溢脓现象消失,泪道通畅而治愈,1例因鼻中隔弯曲而无效。无其他并发症发生。结论用自制软管式泪道冲洗探通针治疗婴幼儿泪囊炎是一种安全、有效、方便的方法。     

泪道阻塞部位的分布特点及相关因素的初步研究

目的:研究泪道阻塞性疾病患者中泪道阻塞部位的分布特点,并探讨泪道阻塞发病的相关因素。方法:选取2005-01/2008-03我院眼科门诊就诊患者634例(634眼),取单眼(双眼患者随机选取1眼)作为研究对象,在获得知情同意后进行泪道阻塞性疾病问卷调查、泪道探查冲洗及鼻内窥镜检查,对其中泪道探查冲洗不通畅患者进行泪道造影、泪道CT三维重建等检查,明确诊断以及阻塞部位,对确诊的泪道阻塞患者进行阻塞部位分布特点进行研究,分析其相关因素。结果:泪道阻塞患者共315例,男女之比为1∶2.2,年龄7～83(平均49.5)岁。41～60岁患者所占比例最大,各职业中工人所占比例最大。泪道阻塞各部位所占比例不同,由高到低依次为鼻泪管上段、鼻泪管下段、下泪小管、泪总管、下泪小点、上泪小管、上泪小点阻塞。泪道阻塞的发生受多种因素影响,有眼部炎症、邻近组织疾病、家族泪道病史者泪道阻塞患者的发生率高于无以上因素患者,差异有统计学意义(χ2检验,P<0.05),其中有结膜炎、睑缘炎病史者发生泪道阻塞部位中上下泪小管、上下泪小点所占比例较大,有鼻炎、鼻窦炎病史者发生泪道阻塞部位中鼻泪管上、下段所占比例较大。结论:泪道阻塞各部位所占比例不同。泪道阻塞的发生受多种因素影响,其中有结膜炎、睑缘炎病史者发生泪道阻塞部位中上下泪小管、上下泪小点所占比例较大,有鼻炎、鼻窦炎病史者发生泪道阻塞部位中鼻泪管上、下段所占比例较大。     

改良小切口外路泪囊鼻腔吻合术36例临床观察

目的观察改良小切口外路泪囊鼻腔吻合术治疗慢性泪囊炎的临床效果。方法回顾性分析小切口手术治疗的慢性泪囊炎36例（36眼）的临床资料。男7例,女29例。年龄15～66岁。病程,3月～4年。所有患者术前明确诊断为慢性泪囊炎,冲洗鼻泪管不通并有脓液溢出。其中7例曾行泪道激光,6例曾反复冲洗过。手术采用改良小切口外路泪囊鼻腔吻合术,皮肤切口10mm,以小型眼睑拉勾或缝线牵开暴露术野,钝性分离皮下组织,不切断内眦韧带,蚊式钳轻压造成骨孔,咬骨钳制做超过10mm的骨孔,骨窗尽可能较大且较低,充分止血,“H”字形切开泪囊及鼻黏膜,6-0可吸收线分别吻合前后瓣,不植管,前瓣悬吊于皮下组织。结果术后随访1—4年。1例因骨孔内肉芽组织增生,于术后3个月泪道堵塞,患者拒绝进一步处理而继续出现溢泪症状。一例泪道冲洗通畅,但患者仍出现溢泪而无溢脓,未行特殊处理。其余34例效果良好,无明显溢泪或流脓症状,手术成功率为94．4％。所有患者皮肤愈合良好,无明显瘢痕形成。结论改良小切口外路泪囊鼻腔吻合术,掌握手术技巧,术中精心操作,可显著提高手术成功率并减少并发症的发生。     

Mycotic dacryocystitis related to naso-lacrimal stent. Case report

CASE REPORT: A nasolacrimal stent was placed in a diabetic woman with a ten-year history of epiphora. Three months later the non-functional stent was removed and taken for histological study. A presumed diagnosis of fungical dacryocystitis was then established. An external dacryocystorhinostomy was performed and the obtained cultures confirmed Candida albicans as the infective agent. DISCUSSION: Only 1.2% of all dacryocystitis are due to fungal agents. This possibility must be considered when evaluating a routine chronic dacryocystitis. Cultures should be obtained when removing a nasolacrimal stent in order to rule out different causes of nasolacrymal obstruction.