特发性睑皮检驰伴泪腺脱垂的诊断和手术治疗

目的 通过２６例睑皮松驰伴泪腺脱垂的病例分析，探讨此疾病的部分成因，以及合理的手术方法。方法 用手术的方法使脱垂的泪腺复们至泪腺窝，同时对眶隔进行加固来减轻眶隔的松驰造成的眼睑膨隆，并对上睑松驰的皮肤进行充分的切除和正确缝合，来彻底改善病人的外观，结果 ２６例５２只眼术后睑皮肤松驰得到矫正，皮肤弹性得到一定恢复，外观有很大的改善。４８只眼的眼睑膨隆得到改善，４只眼于上睑颞侧穹隆部可见重又脱垂的泪腺     

泪腺脱垂复位并重睑成形治疗泪腺脱垂

目的 探讨泪腺脱垂复位并重睑成形治疗泪腺脱垂的临床效果.方法 对18例(36眼)泪腺脱垂按照重睑成形术设计手术切口,根据上睑皮肤松弛和眼睑饱满程度决定皮肤及脂肪的去除量,用4-0线褥式缝合泪腺前缘及泪腺筋膜将脱垂的眶部或睑部泪腺分别固定于眶上缘内及眶外侧壁的骨膜上,并将切开的眶隔拉紧加固间断缝合,上睑皮肤以重睑成形方式缝合,外侧皮肤间断缝合.术后随访6个月～3年.结果 17例34眼(94.44％)术后泪腺复位良好,无复发.1例2眼(5.56％)在术后2年轻度复发,但症状较术前明显改善.18例36眼全部双眼睑裂对称,重睑形态良好自然.结论 泪腺脱垂复位、眶隔加固并重睑成形术治疗泪腺脱垂效果良好,实现了功能治愈与美容效果的双重目的.     

眼睑松弛症的手术治疗分析

目的:探讨眼睑松弛症的手术治疗方法及效果。方法:对15例26眼眼睑松弛症患者均在停止发作并静止6mo以上手术。对于上睑皮肤松弛、上睑下垂、泪腺脱垂和睑裂横径缩短均采用重睑切口,上睑下垂视提上睑肌腱膜有无断裂采取提上睑肌腱膜修复或折叠术。泪腺脱垂全层缝合泪腺组织固定于眶泪腺窝处的骨膜上。睑裂横径缩短将外眦韧带缝合固定于外侧眶缘骨膜,下睑内翻做平行于睑缘的皮肤切口,去除多余皮肤及部分眼轮匝肌。结果:15例患者皮肤松弛得到明显改善,其中上睑下垂、睑裂横径缩短和下睑内翻,也均得到满意矫正,泪腺脱垂1例明显改善,余复位良好。随访6mo～2a,无复发。结论:手术治疗安全,效果确切。     

上睑成形术治疗泪腺脱垂并眼睑松弛症

目的 探讨泪腺脱垂并眼睑松弛症的手术矫正方法及效果。方法 28例（56眼），年龄17－43岁。采用上睑成形术治疗泪腺脱垂并眼睑松弛症：距睑缘6－8mm画出满意弧度的重睑线，切除多余皮肤，切除眶隔处脱出的眶脂肪，通过眶隔缩短加固使脱垂泪腺复于原位。结果 56眼术后均泪腺复位，重睑线美观，睑松弛症消失，随访6月至3年无复发。结论 此法操作简单，疗效满意。     

泪腺脱垂并眼睑松驰症的手术治疗（附21例报告）

泪腺脱垂并眼睑松驰症的手术治疗（附２１例报告）中国医科大学第一临床学院眼科张士瑞，张广舒是由于眶隔发育不良，松驰所造成泪腺脱垂眼部表现为双眼对称性上睑皮肤松驰、肿胀，下垂以睑颞侧中外下垂更明显。有的人可以轻度充血。病程长者常有皮肤粗躁、褐色色素沉着。...     

泪腺脱垂复位与切除术

泪腺脱垂患者多为青年女性,双眼同时或先后发病。轻症双眼上睑外上眶缘部呈膨隆状态,皮下可触到柔软的脱垂泪腺;重症因眼睑反复充血而松弛,甚至形成皱襞;如合并眶内脂肪脱套,眶内上缘皮肤亦呈膨隆状态。药物治疗无效。泪腺脱垂轻的可切开睑     

泪腺脱垂67例分析

泪腺脱垂是一种较常见的眼病,但常被忽略。多见于青年女性,均为双眼。最初上睑皮肤轻度充血,浮肿,晨起时较重。经2～3日自行消退,数日后再发,逐渐加重。上外眶缘下方之皮肤稍呈膨隆状态,在眶缘下触到脱垂的泪腺,继续发展眶隔明显驰缓,泪腺脱垂加重,皮肤松驰变薄成皱摺状,出现退行改变,个别病例可伴有毛细血管新生。过度松驰的皮肤常向下遮盖睑缘,形成皮肤性或脂肪性睑下垂。后期皮肤充血浮肿等症状逐渐减轻甚至消失。现将著者经治的87例分析如下。     

眼睑松弛症伴泪腺脱垂的手术治疗

目的 探讨眼睑松弛症合并泪腺脱垂的手术疗效.方法 采用双重睑切口的皮肤松弛矫正术联合泪腺复位固定术,对12例(24只眼)眼睑松弛症合伴泪腺脱垂患者进行手术治疗.结果 随访6月至6年,12例患者术后眼睑皮肤松弛均得到明显改善,泪腺脱垂,上睑下垂均得到满意矫正.结论 眼睑松弛症合并脱垂泪腺,采用双重睑切口的皮肤松弛矫正术联合泪腺复位固定术可有效改善其症状,实现患者美观与功能的双重疗效.     

眼睑皮肤松弛症及其伴发畸形的手术整复

目的 评价眼睑皮肤松弛症及其伴发畸形的手术整复效果.设计 回顾性病例系列.研究对象 35例(52眼)眼睑皮肤松弛症稳定期患者.方法 所有患者实施上睑畸形矫正术,做上睑重睑切口,切除多余松弛皮肤及眶脂肪,18例(36眼)联合行泪腺脱垂复位术;10例(16眼)联合上睑下垂矫正术.4例(6眼)行下睑缩矫正术.7例(14眼)行外眦畸形矫正术,联合或二期行眼睑皮肤松弛矫正或上睑下垂矫正术.主要指标 双眼重睑形态,眼睑位置,眼睑运动功能,泪腺的位置,有无泪液分泌异常.结果 随访6～60个月,所有患者双眼上睑重睑基本对称,双上睑形态良好,眦角位置接近正常,无溢泪及干眼症状.2例(3眼)患者于术后29及36个月复诊时发现泪腺脱垂复发,再次行泪腺脱垂复位术,术后分别随访18、24个月,未发现泪腺再脱垂.结论 采用眼部整复手术矫正眼睑皮肤松弛症及伴发畸形安全有效,术后复发率较低.     

进行性睑皮肤松弛症伴泪腺脱垂的手术治疗

目的 探讨眼睑皮肤松弛合并泪腺脱垂症手术治疗效果.方法 采用切开法重睑成形术设计手术切口.按拟定的重睑高度嘶出第一条切口线,再于第一条重睑线处用平镊夹起松弛皮肤,以睫毛微翘无睑裂闭合不全为度,画出第二条切口线与第一条线相连,两线间的距离即为拟切除的皮肤量.术中去除部分松弛皮肤、部分眼轮匝肌及疝出之眶隔脂肪,同时将脱垂的泪腺一并固定于泪腺窝内.皮肤缝合同美容性重睑术.结果 9例患者术后眼睑重新塑造,泪腺复位,随访6～12个月,眼睑形态良好,泪腺脱垂无复发,外观显著改善.结论 经双重睑切口联合脱垂泪腺复位手术效果良好,实现患者美观与功能的双重恢复.     

泪腺脱垂手术治疗的探讨

目的:复原脱垂的泪腺,并矫正其带来的"肿眼泡"。方法:确定脱垂泪腺后,局部前设计皮肤切口,标记出切除的部分皮肤,术中切除其内部组织,稳固脱垂泪腺,完好重睑缝线。结果:泪腺脱垂33例66眼中,10例部分切除泪腺,而Schirmer试验术前正常,术后稍减少。10例单纯泪腺切除,未作其他处理,术后"肿眼泡"外观矫正不满意;有2例轻症者,只作结膜、泪腺、骨膜、眼睑"U"形线圈褥式悬吊术;余下11例均做皮肤切口,切除多余的皮肤、皮下组织,复位脱垂的泪腺,眶膈缩短,外型满意。结论:泪腺脱垂手术恢复泪腺解剖位置,复原功能改善"肿眼泡"的外型效果显著。     

泪腺窝眶缘骨孔固定泪腺治疗泪腺脱垂临床观察

目的:探讨泪腺窝眶缘骨孔固定泪腺治疗泪腺脱垂临床效果。方法:对21例42眼泪腺脱垂患者采用重睑切口,泪腺窝眶缘制作骨孔,缝线穿孔固定泪腺手术。术后随访3～36mo。结果:全组21例42眼,显效19例38眼,显效率90.5%,有效2例4眼,有效率9.5%,无效0例,总有效率100%。结论:泪腺窝眶缘骨孔固定泪腺能有效治疗泪腺脱垂,实现患者外观与功能的双重恢复。     

泪腺脱垂手术治疗探讨

目的 探讨治疗泪腺脱垂的有效方法.方法 分别对8例(16只眼)双眼泪腺脱垂患者行眶壁打孔、缝线固定脱垂的泪腺来治疗泪腺脱垂,术后观察和总结患者的视力情况、外观改善情况、可靠性和持久性.结果 术后患者的外观均得到了改善,泪腺不再触及,无一例复发.结论 只要具有熟练的手术技巧,精细的眼眶解剖知识,选择最佳的手术方式,手术治疗泪腺脱垂可取得良好效果.     

Lacrimal gland prolapse in two cases of blepharochalasis syndrome and its treatment

Blepharochalasis is a rare disorder characterized by recurrent non-painful eyelid edema, which leads to atrophy and stretching of the supporting connective tissue around the eye. As a consequence, prolapse of the lacrimal gland can occur which results in fullness in the temporal third of the upper eyelids and may cause visual field restriction or cosmetic blemish for patients. Thus, correct diagnosis is important to plan appropriate surgery and obtain a successful postoperative result. We present two young patients with lacrimal gland prolapse associated with blepharochalasis and report on their treatment.     

Blepharochalasis syndrome

Patients with chronic forms of blepharochalasis often develop eyelid deformities characterized by blepharoptosis and prolapse of the orbital fat and lacrimal gland. Some individuals have an acquired form of blepharophimosis, secondary to the dehiscence of the canthal tendons. In this late stage of the condition, the tendons still adhere to the periosteum of the orbital rims and loss of fixation occurs at the distal attachment between the tendons and the eyelid tissues. This results in a horizontally shortened palpebral fissure and a rounded deformity of the lateral canthal angle. Surgery remains the primary treatment.     

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.     

Herniation of the lacrimal glands

Herniation of the lacrimal gland is an unusual condition which has a predilection for blacks and is associated with blepharochalasis. It is benign and tends to become progressive. Either or both lobes of the lacrimal gland can herniate and must be differentiated from dermolipoma and orbital fat. A surgical treatment is described, and three cases are presented.     

The Treatment of Lacrimal Gland Prolapse in Blepharoplasty by Repositioning the Glands

Abstract

Prolapse of the lacrimal gland is an unusual condition. An appearance of bilateral dermatochalasis was observed in the medical examination of a 30-year-old female patient with bilateral upper eyelid edema.The patient underwent bilateral blepharopylasty. During the surgery, it was noticed that in the temporal portions of the eyelids, there was a prolabed tissue-like lacrimal gland. We did incisional biopsy from the prolabed tissue that was thought to be orbital lobe of the lacrimal gland and carried out reposition of the orbital rim with 5-0 polyester suture and closed the orbital septum. Lacrimal gland reposition is a procedure which entails the separation of such anatomic structures as orbital septum, adipose tissue, and levator complex. However, failure to recognize a prolapsed lacrimal gland may mistreat by simple excision, and will lead to important alterations in ocular lubrication. In our case, repositioning of the glands was successfully performed during upper-lid blepharoplasty.     

眼睑皮肤松弛综合征临床研究进展

眼睑皮肤松弛综合征是一种较少见的眼睑疾病,表现为青少年时期特发性局限性眼睑皮肤反复间断性无痛性血管神经性水肿,反复水肿破坏眼睑组织结构导致眼睑皮肤松弛变薄,毛细血管增多迂曲扩张以及后期上睑下垂、眶脂肪脱垂、泪腺脱垂等多种并发症。眼睑皮肤松弛综合征的发病机制尚不明确,可能存在遗传等因素的参与;组织病理学研究发现IgA沉积和基质金属蛋白酶活性表达增强,提示免疫反应参与弹性纤维的降解,后者进一步引起局部淋巴系统结构功能的改变;这些因素共同参与了本病的发生发展。眼睑皮肤松弛综合征的治疗分为急性水肿期和稳定期的治疗。     

上睑下垂术后常见并发症的治疗

目的:探讨上睑下垂常见并发症的处理方法。方法:总结近5a来矫正上睑下垂的临床体会,对常见的并发症如矫正不足、矫正过度、暴露性角膜炎、结膜或者泪腺脱垂分别采取相应对策,尽量早期发现纠正,可以获得满意临床效果。结果:所选150例180眼上睑下垂患者中,127例患者术后上睑下垂矫正满意,双侧基本对称,无明显并发症。12例患者14眼欠矫,4例患者4眼轻度过矫,3例患者3眼结膜脱垂,1例患者1眼泪腺脱垂,3例3眼轻度睑球分离,早期予以调整后形态满意,未出现感染、血肿病例。结论:对于上睑下垂患者采用提上睑肌缩短法或者额肌瓣悬吊矫正,术中尽量准确判断,术后精心护理,严密观察,出现并发症可以早期处理以获得好的效果。