Clement Colin I, O'Donnell Brett A
Department of Ophthalmology, Royal North Shore Hospital, Sydney, New South Wales, Australia.
Clin Exp Ophthalmol. 2004 Apr;32(2):170-4. doi: 10.1111/j.1442-9071.2004.00798.x.
Medial canthal tendon laxity is a common cause of epiphora and ocular irritation. It is difficult to treat due to the proximity of the lower canaliculus and punctum to the tendon.
The results of a prospective series of patients with involutional medial canthal tendon laxity between 1997 and 2002 were reviewed. Symptoms and measured laxity were recorded before and after medial canthal tendon repair. The medial canthal tendon was routinely repaired through a cut along the lid margin extending from the punctum medially. This avoids a vertical cut onto the anterior lamella of the eyelid, which is useful if a skin graft is required.
Twenty lower eyelid medial canthal tendon repairs were performed on 17 patients. Preoperatively, the lower punctum in all patients was able to be distracted to the medial limbus or further and in 50% of cases, the lower lid punctum was able to be distracted to the pupil midline or further. Postoperatively all patients had reduction of their medial canthal tendon laxity. Postoperatively in 85% of cases the lower punctum was not able to be distracted beyond the medial limbus; however, 15% of cases still had significant residual laxity. Eighty-five per cent of patients reported improvement in symptoms.
This is an effective procedure in the majority of patients with moderate to severe medial canthal tendon laxity; however, residual lower lid laxity persisted in some patients.
内眦韧带松弛是溢泪和眼部刺激的常见原因。由于下泪小管和泪点靠近韧带，治疗较为困难。
回顾了1997年至2002年间一系列患有退行性内眦韧带松弛的前瞻性患者的结果。记录内眦韧带修复前后的症状和测量的松弛度。内眦韧带通常通过沿睑缘从泪点向内延伸的切口进行修复。这样可避免在眼睑前层进行垂直切口，这在需要植皮时很有用。
对17例患者进行了20次下睑内眦韧带修复。术前，所有患者的下泪点均可被牵拉至内眦或更远，50%的病例中，下睑泪点可被牵拉至瞳孔中线或更远。术后所有患者的内眦韧带松弛度均降低。术后85%的病例下泪点无法被牵拉至内眦以外；然而，15%的病例仍有明显的残余松弛。85%的患者报告症状改善。
对于大多数中重度内眦韧带松弛的患者，这是一种有效的手术方法；然而，一些患者仍存在下睑残余松弛。
