Mazow Mark L, McCall Tyrone, Prager Thomas C
Eye Plastic Surgery Associates, Dallas, Texas 75231, USA.
Ophthalmic Plast Reconstr Surg. 2007 Mar-Apr;23(2):138-42. doi: 10.1097/IOP.0b013e318031d62a.
To evaluate the complications and success of treatment of migrated or lodged intracanalicular and punctal plugs.
A retrospective chart review of all cases having either a dacryocystorhinostomy or surgical removal of an intracanalicular or punctal plug from 1992 to 2006, in a single physician referral oculoplastics practice, was performed to identify cases in which a retained lacrimal plug required surgical intervention. Patients presented with symptoms of tearing, infection, or granuloma formation. The charts of 998 surgical cases were reviewed, from which 66 eyes (6.6%) were determined to have had lodged lacrimal plugs that required surgical removal, thus qualifying them for inclusion in this study. Patients were followed after surgery until reconstructive silicone tubing was removed (range, 6 weeks to 6 months), and each patient was questioned regarding symptoms. A comparison group of 336 eyes that had collared punctal plugs placed served as the control group.
All cases were noted to have complications from intracanalicular plugs. No complications were noted from other forms of lacrimal plugs. All eyes in this series required a canaliculotomy or a dacryocystorhinostomy after office irrigation failed to dislodge the plug. Five eyes presented with canaliculitis, 28 eyes presented with epiphora, and 29 eyes presented with dacryocystitis. Four of 66 eyes (6%) in this cohort presented with a pyogenic granuloma. Five eyes (8%) presented with canaliculitis. Forty-nine of 66 eyes (74%) were asymptomatic following treatment, with no observable infection or epiphora. Seven of 66 eyes (11%) had some improvement in symptoms and another 10 of 66 eyes (15%) had no change in symptoms after treatment. No complications requiring surgical intervention were encountered in the control group of collared punctal plugs.
Intracanalicular-type plugs may lodge in the lacrimal outflow system. This may result in epiphora, canaliculitis, or dacryocystitis that may require major reconstructive surgery. Despite surgical intervention, these symptoms do not always resolve (26% of eyes in this study had persistent epiphora). Intracanalicular plugs were observed to be associated with a higher rate of granulation tissue formation in the lacrimal outflow tract when compared with other forms of punctal plugs. As a result of the increased number of complications seen with intracanalicular plugs, caution is advised with respect to use of these devices. The relative infrequency of complications seen with collared punctal plugs suggests a safer alternative. Data from this study lead the authors to advocate the consideration of other forms of lacrimal occlusion due to the high number of complications noted with intracanalicular plugs, and the availability of other reversible forms of punctal occlusion.
评估移位或嵌顿的泪小管及泪点栓子治疗的并发症及成功率。
对1992年至2006年在单一医生转诊的眼科整形诊所接受泪囊鼻腔吻合术或手术取出泪小管或泪点栓子的所有病例进行回顾性病历审查，以确定需要手术干预取出残留泪道栓子的病例。患者表现为流泪、感染或肉芽肿形成等症状。回顾了998例手术病例的病历，其中66只眼（6.6%）被确定有嵌顿的泪道栓子需要手术取出，因此符合纳入本研究的标准。术后对患者进行随访，直至取出重建硅胶管（范围为6周至6个月），并询问每位患者的症状。336只植入带环泪点栓子的眼睛作为对照组。
所有病例均发现泪小管栓子有并发症。其他形式的泪道栓子未发现并发症。本系列所有眼睛在门诊冲洗未能取出栓子后均需要进行泪小管切开术或泪囊鼻腔吻合术。5只眼出现泪小管炎，28只眼出现溢泪，29只眼出现泪囊炎。该队列中的66只眼中有4只（6%）出现脓性肉芽肿。5只眼（8%）出现泪小管炎。66只眼中有49只（74%）在治疗后无症状，无明显感染或溢泪。66只眼中有7只（11%）症状有所改善，另有66只眼中的10只（15%）在治疗后症状无变化。带环泪点栓子对照组未出现需要手术干预的并发症。
泪小管型栓子可能会嵌顿在泪液流出系统中。这可能导致溢泪、泪小管炎或泪囊炎，可能需要进行大型重建手术。尽管进行了手术干预，但这些症状并不总是能缓解（本研究中26%的眼睛持续溢泪）。与其他形式的泪点栓子相比，观察到泪小管栓子与泪液流出道肉芽组织形成率较高有关。由于泪小管栓子出现的并发症增多，建议谨慎使用这些装置。带环泪点栓子出现并发症的频率相对较低，提示是一种更安全的选择。本研究的数据使作者主张考虑采用其他形式的泪道阻塞，因为泪小管栓子出现的并发症较多，且有其他可逆的泪点阻塞形式。
