MacEwen C J, Young J D, Barras C W, Ram B, White P S
Department of Ophthalmology, Ninewells Hospital, Dundee DD1 9SY, UK.
Br J Ophthalmol. 2001 Mar;85(3):314-8. doi: 10.1136/bjo.85.3.314.
Congenital nasolacrimal obstruction is usually the result of failure of canalisation of the distal end of the nasolacrimal duct. The most common outcome is spontaneous resolution, but some children do require surgical treatment by probing. Probing is a blind procedure with a recognised failure rate.
In 52 lacrimal systems of 40 children nasal endoscopy was combined with a "stepwise" systematic probing in an attempt to improve the outcome and reduce the number of repeat procedures.
Combined nasal endoscopy and probing improved the understanding of outflow obstruction in young children. The success of the procedure depended upon the level of the obstruction within the outflow system. Formation of a false passage was seen in six cases (15%). The probe was rerouted under direct visualisation in these cases to form a functioning passage. Reasons for failure were identified in those who did not have a successful outcome and only one repeat procedure was required.
Using nasal endoscopy the area of lacrimal outflow obstruction at the lower end of the nasolacrimal duct can be observed directly and it is possible to guide the progress of probing under direct vision. This gives better information about the nature of the obstruction, minimises the formation of false passages, and allows a wider range of treatment options under a single anaesthetic.
先天性鼻泪管阻塞通常是鼻泪管远端管道化失败的结果。最常见的结果是自然缓解，但有些儿童确实需要通过探通术进行手术治疗。探通术是一种盲目操作，失败率已知。
对40名儿童的52个泪器系统，将鼻内镜检查与“逐步”系统探通术相结合，以试图改善治疗效果并减少重复操作的次数。
鼻内镜检查与探通术相结合提高了对幼儿泪液流出道阻塞的认识。手术的成功取决于流出道系统内阻塞的程度。6例（15%）出现假道形成。在这些病例中，在直视下重新调整探针方向以形成通畅的通道。对未取得成功结果的患者确定了失败原因，仅需一次重复操作。
使用鼻内镜可以直接观察鼻泪管下端泪液流出道阻塞的部位，并有可能在直视下引导探通术的进程。这能更好地了解阻塞的性质，减少假道的形成，并在单次麻醉下提供更广泛的治疗选择。
