Kouri A S, Tsakanikos M, Linardos E, Nikolaidou G, Psarommatis I
Ophthalmology Department, "P.& A. Kyriakou" Children's Hospital, Athens, Greece.
Int J Pediatr Otorhinolaryngol. 2008 Jun;72(6):891-6. doi: 10.1016/j.ijporl.2008.02.024. Epub 2008 Apr 25.
To evaluate the results of lacrimal probing with the use of nasal endoscopy and identify the anatomical anomalies responsible for the symptoms in older children.
Fifty-two eyes of 40 children with congenital nasolacrimal duct obstruction underwent primary probing of the lacrimal duct under general anaesthetic in conjunction with nasal endoscopy. Patients followed up for at least 6 months. Cure was defined as complete resolution of symptoms or minimal symptoms brought on by cold or wind.
The age range was 12-126 months. In 30/52 (57.7%) eyes the symptoms were attributed to a single mechanical obstruction. Seven eyes had canalicular stenosis. Three eyes had upper nasolacrimal duct obstruction. Nine eyes had narrow duct and nine eyes had atresia of the distal end of the duct. Two eyes had only intranasal abnormalities. In 16/52 (30.76%) eyes a combination of anomalies was responsible for the symptoms. Nine eyes had canalicular stenosis in association with: either a membrane at the valve of Hasner in four, or a narrow duct in three, or intranasal anomalies in two. Two eyes had punctual stenosis and narrow duct. Two eyes had narrow duct and tight inferior turbinate. Three eyes had abnormal openings in association with stenotic ducts. Six (11.54%) eyes had functional blockage. With the use of endonasal endoscopy, intranasal anomalies identified in 12 eyes and treated in nine. One eye had large inferior conchae. One eye had inferior concha adherent to lateral nasal wall. One eye had redundant nasal mucosa. Three eyes had tight inferior turbinate. Three had abnormal openings. In three eyes the probe went submucosally. The overall success rate was 84.6% (44/52 eyes). Eight eyes remained unchanged. Endoscopically treated cases contributed to the overall success by 17.31%.
Multiple anatomical anomalies within the lacrimal system and abnormalities of the nose are quite common in older children. Lacrimal probing remains the primary treatment and nasal endoscopy is a useful adjunct to probing increasing the success rate of the procedure.
评估使用鼻内镜进行泪道探通术的结果，并确定导致大龄儿童出现症状的解剖学异常。
40例先天性鼻泪管阻塞患儿的52只眼在全身麻醉下联合鼻内镜进行泪道初次探通术。对患者进行至少6个月的随访。治愈定义为症状完全缓解或由感冒或风引起的轻微症状。
年龄范围为12 - 126个月。在52只眼中，30只（57.7%）眼的症状归因于单一机械性阻塞。7只眼有泪小管狭窄。3只眼有鼻泪管上段阻塞。9只眼有泪管狭窄，9只眼有泪管远端闭锁。2只眼仅有鼻内异常。在（52只眼中的）16只（30.76%）眼中，多种异常共同导致了症状。9只眼有泪小管狭窄合并：4只眼在哈氏瓣膜处有膜，3只眼有泪管狭窄，2只眼有鼻内异常。2只眼有泪点狭窄和泪管狭窄。2只眼有泪管狭窄和下鼻甲紧。3只眼有异常开口合并狭窄泪管。6只（1）眼有功能性阻塞。使用鼻内镜检查时，在12只眼中发现鼻内异常并对其中9只进行了治疗。1只眼下鼻甲肥大。1只眼下鼻甲附着于鼻侧壁。1只眼有多余的鼻黏膜。3只眼下鼻甲紧。3只眼有异常开口。3只眼中探针进入黏膜下。总体成功率为84.6%（52只眼中的44只）。8只眼情况未改变。经内镜治疗的病例对总体成功率的贡献为17.31%。
泪道系统内的多种解剖学异常及鼻部异常在大龄儿童中相当常见。泪道探通术仍是主要治疗方法，鼻内镜是探通术的有用辅助手段，可提高手术成功率。
