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。     

泪腺窝微骨孔固定泪腺治疗泪腺脱垂临床探讨

目的 探讨采用眶骨造孔法将泪腺经泪腺窝微骨孔原位固定治疗泪腺脱垂的临床疗效.方法 回顾性分析24例48只眼泪腺脱垂患者,经重睑皮肤切口,采用颞上方眶骨缘造孔法,将泪腺组织经微骨孔固定于泪腺窝,分析影像学及眼部外观改变,评价泪腺的复位情况,分析术前术后泪液分泌试验、泪膜破裂时间,观察泪腺功能的改变.术后随访6～24个月(平均12个月).结果 术后影像学显示所有24例48只眼的泪腺解剖复位率100％,随访期间均无泪腺脱垂复发,上睑外侧臃肿消失,重睑形成良好,眼部外观满意.术前术后Schirmer试验、泪膜破裂时间(BUT)差异无统计学意义(P＞0.05),所有24例48只眼均无干眼症状.结论 经重睑皮肤切口行泪腺窝眶骨造孔固定泪腺治疗泪腺脱垂,泪腺解剖复位良好,不易复发,重睑形成自然,对泪腺功能损伤小,值得临床推广.     

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.     

眼睑松弛症伴泪腺脱垂的手术治疗

目的探讨眼睑松弛症伴泪腺脱垂的手术矫正方法及效果，方法按照切开法重睑成形术设计手术切口，将脱垂的泪腺复位于眶外上方的泪腺窝内，然后去除上睑松弛的皮肤及疝出的脂肪，形成弧度自然、流畅的重睑。结果28例（56眼）上睑皮肤松弛得到充分矫正，恢复皮肤弹性，3例（4眼）术后6个月时在颞上方触到泪腺，目前仍处于观察中。结论治疗眼睑松弛症的重点是通过手术将汨腺复位下泪腺窝内，可达到美容与功能治疗的目的，手术效果稳定易于掌握。     

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     

特发性睑皮松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位至泪腺窝,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的缝合,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。结论　通过对这些病例的分析和手术矫治,使我们对此种疾病的病因、诊断及手术关键有了很好的认识     

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.     

泪腺脱垂内固定手术探讨

泪腺脱垂在临床上并非罕见，手术是泪腺脱垂唯一有效的方法[1,2]。作者自1987－1994年共收治23例泪腺脱垂，采用泪腺内固定、眶隔加固联合双重睑成形术，术后经半年至7年随访观察，取得满意效果。临床资料：本文23例男9例，女14例，男：女为1：1．6；年龄15-47岁，其中35岁以下者20例占86．96％。23例均为双眼，既往健康，血尿常规和胸透检查均正常。8例作了血沉、igG和lgE检查无异常。手术方法：（1）眶深部及睑皮下浸润麻醉。（2）按术前双重睑设计高度与睑缘平行切开皮肤和眼轮匝肌。（3）用拉钩向上牵拉切口上唇，钝性分离肌层下组织达…     

泪腺复位术治疗外伤性泪腺脱垂的临床观察

临床上外伤性泪腺脱垂并不常见，但外伤性泪腺脱垂较泪腺穿孔伤、泪腺破裂伤多见，外伤性泪腺脱垂常见于严重的眶睑部外伤，泪腺分眶部泪腺和睑部泪腺，外伤性泪腺脱垂常见于睑部泪腺的脱垂，临床表现为泪腺脱垂于上睑外侧部，上睑外侧部可见明显隆起。笔者在临床上曾遇见50例，均给予手术治疗，效果较为满意，现报告如下。     

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。     

Intraocular lacrimal gland choristoma

There have been nine previously reported cases of intraocular lacrimal gland choristoma. This case report is of an infant with an intraocular lacrimal gland choristoma which was managed conservatively for a 19-month period until the onset of glaucoma. Tumour biopsy was initially performed because until this time the tumour's behaviour suggested it was not malignant. The latter was confirmed on biopsy, however hypotony resulted following the surgical intervention.     

Amyloidosis of lacrimal gland

Primary localized amyloidosis of lacrimal gland is a rare occurrence. This report describes a female patient with isolated amyloidosis of the lacrimal gland. A 45-year-old Indian woman presented with a swelling over the left lacrimal gland region. Computed tomography showed uniform enlargement of the lacrimal gland. A lacrimal gland biopsy revealed amyloidosis. No systemic involvement was detected on further investigation. To our knowledge, this is the first report of lacrimal gland amyloidosis from India and our report also highlights the importance of lacrimal gland biopsy in diagnosing lacrimal gland masses.     

Carcinoid tumour in the lacrimal gland

A case of carcinoid tumour in the lacrimal gland is described, thought to be a metastasis from a known primary lesion in the mediastinum. The results of light and transmission electron microscopic examination are presented, and the possibility of the lesion representing a second primary tumour discussed.     

泪腺病变的CT分析

目的探讨不同泪腺病变的CT表现,提高泪腺病变的诊断水平。方法20例23眼泪腺病变患者,比较分析其CT表现特点。结果10例11眼泪腺炎性假瘤表现为泪腺增大,与周围结构如眼环分界不清,部分边缘锐利,其中1例伴有外直肌及上直肌增厚。1例1眼泪腺淋巴细胞反应性增生表现为右侧泪腺体积增大,边界清楚。5例5眼泪腺混合瘤,主要表现为泪腺区类圆形软组织肿块,密度均匀。2例4眼良性淋巴上皮性病变表现为对称性双侧泪腺弥漫性肿大,与周围组织分界清楚。2例2眼泪腺癌表现为眼眶外上方软组织肿块影,侵犯邻近组织结构并破坏眶壁骨质。结论根据CT表现特点,多数泪腺病变可明确诊断。     

The role of biopsy in lacrimal gland inflammation: A clinicopathologic study

Purpose: To determine the causes of lacrimal gland inflammation based on histopathology and systemic evaluation.

Methods: This is a retrospective case series study. From the University of British Columbia Orbit Clinic between January 1976 and December 2008, we reviewed the medical records of 60 patients who presented with inflammatory features of the lacrimal gland (i.e., erythema, edema, or tenderness) in which the diagnoses were not possible clinically and on imaging alone. As was our routine practice, all these patients underwent lacrimal gland biopsy before starting any treatment.

Results: The histopathologic findings of the 60 patients showed that 37 (61.7%) had identifiable types of lacrimal inflammation including 10 with Sjogren’s syndrome, seven with sarcoidal reaction, six with feature of granulomatosis with polyangiitis (formerly known as Wegener’s granulomatosis), five with lymphoma, two with sclerosing inflammation, two with IgG4-related dacryoadenitis, and one patient each with infectious dacryoadenitis, myoepithelial carcinoma, xanthogranuloma, eosinophilic angiocentric fibrosis, and eosinophilic allergic granulomatous nodule. The histopathologic findings of the remaining 23 (38.3%) patients showed nonspecific inflammation of the lacrimal gland. 23 patients (38.3%) had associated systemic diseases. 48 patients (80%) were treated successfully and 10 (16.7%) had recurrence of inflammation.

Conclusions: We recommend that in patients presenting with lacrimal gland inflammation (i.e., erythema, edema, tenderness) in which the specific diagnosis cannot be made clinically and on imaging, biopsy is warranted for accurate diagnosis and appropriate treatment. We found that the majority of these patients (61.7%) had specific histopathology, and 38% had systemic diseases.     

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。     

Unusual presentations of pleomorphic adenoma and adenoid cystic carcinoma of the lacrimal gland

Purpose: To report two atypical cases of pleomorphic adenoma and adenoid cystic tumours of the lacrimal gland. Methods: Two case reports are presented. The first is of a 65-year-old female with a long history of right hypoglobus with sudden recent worsening. Computed tomography (CT) showed a round, well-defined lesion in the fossa for the lacrimal gland with an anterior hypodense exten- sion suggestive of possible malignancy in a pleomorphic adenoma. The tumour in the second case, a 35-year-old male, was diagnosed after presentation following a relatively minor periorbital injury. The smooth rounded mass on CT scan was suggestive of a benign lacrimal gland tumour. Results: The lesion in case 1 was excised with a diagnosis of haemorrhage within a pleomorphic adenoma. The lesion in case 2 was excised with a diagnosis of adenoid cystic carcinoma of the lacrimal gland with pseudocapsule. Conclusions: Haemorrhagic cyst developing beneath the pseudocapsule of a pleomorphic adenoma should be considered in the differential diagnosis of secondary development of malignancy in a pleomorphic adenoma. Adenoid cystic tumours of the lacrimal gland can present with a pseudocapsule.     

Pleomorphic adenoma of a subconjunctival ectopic lacrimal gland

This report describes a case of pleomorphic adenoma of an ectopic lacrimal gland arising subconjunctivally in the lateral fornix in a 13-year-old girl. The tumor was removed surgically in toto with the capsule. This is probably the first reported case.