Stahl Ulrike, Francis Ian C, Stapleton Fiona
Vision CRC, and the School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.
Am J Ophthalmol. 2006 Jun;141(6):1051-6. doi: 10.1016/j.ajo.2005.12.051.
To determine tear osmolality (TO) and tear meniscus height (TMH) in patients with functional (FNLDO) and primary acquired (PANDO) nasolacrimal duct obstruction. Additionally, to determine the effect of successful dacryocystorhinostomy surgery on these tear parameters.
Prospective case-controlled interventional case series.
Up to 20 microl of basal tears were collected from 20 age- and gender-matched control subjects, 33 patients with FNLDO, 28 patients with PANDO, and 31 patients after successful dacryocystorhinostomy. TMH was measured with videoreflective dacryomeniscometry, and TO was measured with vapor pressure osmometry.
Thirty-nine percent of the patients with FNLDO (13/33) elected to undergo dacryocystorhinostomy surgery, compared with 64% of the patients with PANDO (18/28; P = .09). TMH was significantly higher in the disease groups (FNLDO median, 630 +/- 187 microm; PANDO median, 620 +/- 210 microm) compared with the control subjects (median 262 +/- 50 microm; P < .01). In those patients who underwent surgery, TMH was slightly higher in FNLDO than PANDO (P = .08), and TMH reduced significantly after surgery (P < .05). Mean TO in the control subjects was 313 +/- 17 mmol/kg, in FNLDO was 309 +/- 19 mmol/kg, and in PANDO was 315 +/- 24 mmol/kg (P > .05). TO was similar in those patients who progressed to surgery compared with the total group and was unaffected by surgery.
TO was similar in normal control subjects and in the watery eye group and was unchanged after dacryocystorhinostomy surgery. Despite the slightly higher TMH in patients with FNLDO, a higher proportion of patients PANDO elected to have surgery. Relative to FNLDO, patients with PANDO who progressed to surgery had lower TMH and normal TO, which suggests that a complete lacrimal drainage obstruction induces negative feedback that results in no reduction in TO.
测定功能性鼻泪管阻塞（FNLDO）和原发性后天性鼻泪管阻塞（PANDO）患者的泪液渗透压（TO）和泪液半月皱襞高度（TMH）。此外，确定成功的泪囊鼻腔吻合术对这些泪液参数的影响。
前瞻性病例对照干预性病例系列研究。
从20名年龄和性别匹配的对照受试者、33例FNLDO患者、28例PANDO患者以及31例泪囊鼻腔吻合术成功后的患者中收集最多20微升的基础泪液。使用视频反射泪液半月皱襞测量法测量TMH，使用蒸气压渗透压计测量TO。
39%的FNLDO患者（13/33）选择接受泪囊鼻腔吻合术，而PANDO患者中有64%（18/28）选择接受该手术（P = 0.09）。与对照受试者（中位数262±50微米）相比，疾病组（FNLDO中位数为630±187微米；PANDO中位数为620±210微米）的TMH显著更高（P < 0.01）。在接受手术的患者中，FNLDO患者的TMH略高于PANDO患者（P = 0.08），且手术后TMH显著降低（P < 0.05）。对照受试者的平均TO为313±17毫摩尔/千克，FNLDO患者为309±19毫摩尔/千克，PANDO患者为315±24毫摩尔/千克（P > 0.05）。与整个组相比，进展至手术的患者的TO相似，且不受手术影响。
正常对照受试者和泪溢组的TO相似，泪囊鼻腔吻合术后TO无变化。尽管FNLDO患者的TMH略高，但选择手术的PANDO患者比例更高。相对于FNLDO，进展至手术的PANDO患者的TMH较低且TO正常，这表明完全性泪液引流阻塞会引发负反馈，导致TO无降低。
