Of 258 cases of dacryocystorhinostomy performed on children in the period September 1981 to September 1991, 130 were for simple, unresolved congenital nasolacrimal duct obstruction. Other indications for surgery included punctal agenesis, lacrimal fistula, post-traumatic and post-inflammatory canalicular obstruction. Of 177 children without canalicular pathology, 171 (96%) were relieved of symptoms with one operation, without canalicular intubation. Of 81 cases with canalicular disease, 55 of 70 (79%) who underwent DCR plus canalicular intubation, and 10 of 11 who underwent DCR plus Lester-Jones tube, were substantially improved with one operation. No child required peroperative or postoperative blood transfusion. Dacryocystorhinostomy in childhood, in experienced surgical hands, is a safe procedure, achieving relief of symptoms in most cases, particularly in the absence of canalicular disease. 相似文献
Purpose:Functional epiphora is a clinical condition that presents with the complaint of watery eyes, but without anatomical stenosis in the lacrimal drainage system. Although the mechanism is not clear, there are various possibilities involving the movement of the orbicularis oculi muscle, especially its deeper segment (Horner’s muscle). We aimed to evaluate the function of the orbicularis oculi muscle in patients with patent, but dysfunctional lacrimal drainage system using a quantitative motor unit potential (MUP) analysis.Methods:Twenty-eight patients with functional epiphora (mean age = 59 years) and a control group of 28 volunteers were included in the study. Inclusion criteria were persistent and symptomatic epiphora or wiping >10 times per day and diagnosis confirmation by lacrimal irrigation test. Electromyography (EMG) was performed on the deeper segment of the orbicularis oculi muscle (medial and lateral parts). MUP parameters (duration time, amplitude, number of phases, number of turns, area, rise time, and thickness) were evaluated in both groups. Any increase in amplitude, prolongation time (>14 ms), number of turns, and satellite potential was taken as characteristic of the neurogenic type of epiphora, whereas shortened motor unit duration time, increased phase number, and low amplitude are the features of myopathic type.Results:Upon MUP analysis of the medial and lateral orbicularis oculi muscle, the increase in duration and thickness values in the medial part and the increase in duration, amplitude, area, and thickness values of the lateral part were found to be statistically significant in the patient group compared to the control group (P < 0.001). In the evaluation of the patients’ medial and lateral orbicularis oculi muscle, the increase in phase values and decrease in amplitude, area, and rise time values were found to be statistically significant (P = 0.024, P < 0.001, P < 0.001, and P = 0.010, respectively).Conclusion:These data show that functional epiphora is due to neurogenic damage of the orbicularis oculi muscle and should be investigated in more detail. 相似文献
AIM:To compare bacterial biofilm colonization in lacrimal stents following external dacryocystorhinostomy (EX-DCR), endoscopic dacryocystorhinostomy (EN-DCR), and transcanalicular dacryocystorhinostomy (TC-DCR) with multidiode laser.METHODS: This prospective study included 30 consecutive patients with nasolacrimal duct obstruction who underwent EXT-, EN-, or TC-DCR. Thirty removed lacrimal stent fragments and conjunctival samples were cultured. The lacrimal stent biofilms were examined by scanning electron microscopy (SEM).RESULTS:Eleven (36.7%) of the 30 lacrimal stent cultures were positive for aerobic bacteria (most commonly Staphylococcus epidermidis and Pseudomonas aeruginosa). However anaerobic bacteria and fungi were not identified in the lacrimal stent cultures. Twenty-seven (90%) patients had biofilm-positive lacrimal stents. The conjunctival culture positivity after the DCR, biofilm positivity on stents, the grade of biofilm colonization, and the presence of mucus and coccoid and rod-shaped organisms did not significantly differ between any of the groups (P>0.05). However, a significant difference was found when the SEM results were compared to the results of the lacrimal stent and conjunctival cultures (P<0.001).CONCLUSION: Type of dacryocystorhinostomy (DCR) surgery did not affect the biofilm colonization of the lacrimal stents. SEM also appears to be more precise than microbiological culture for evaluating the presence of biofilms on lacrimal stents. 相似文献
ObjectiveTo compare the efficacy of botulinum toxin A (BoNTA) injection into the lacrimal gland versus lateral tarsal strip (LTS) for functional epiphora.Material and methodsRandomized clinical trial. Sequential, parallel, non-blinded study design. Patients aged 18 years or older with functional epiphora and a minimum score of 3 in Munk Scale (MS) were randomized to BoNTA or LTS group. Changes in MS, Schirmer test and quality of life were assessed at week 6 and during follow-up until week 30. The mean time without epiphora and the adverse events were recorded.ResultsThe final analysis included 25 patients, 12 (21 eyes) assigned to BoNTA (5 U/0.05 mL) and 13 (20 eyes) to LTS. At 6 weeks there was an improvement in the MS in BoNTA versus LTS group (?2.48 vs. ?1.55, P = .0152) and at 12 weeks (?2.68 vs. ?1.69, P = .0267). A significant decrease was noted in the Schirmer test at week 2, 12 and 30 with BoNTA. The quality of life improved after both interventions without statistical significance. The mean duration of effectiveness in BoNTA group was 26.2 weeks (range 7.7-36.6) and in LTS group was 24.8 weeks (range 6.7-37.6), P = .9368. The main adverse events were temporary eyelid ptosis in 25% (3/12) of the BoNTA group and surgical scar discomfort in 23% (3/13) of the LTS group, P = .722. No adverse events were classified as severe.ConclusionBoNTA injection into the lacrimal gland is a safe and effective treatment for functional epiphora, with a greater decrease in MS at 6 and 12 weeks compared with LTS. 相似文献