Geerling Gerd, Tost Frank H W
Department of Ophthalmology, University of Würzburg, Würzburg, Germany.
Dev Ophthalmol. 2008;41:213-229. doi: 10.1159/000131091.
If a lacrimal plug that successfully improves dry eye symptoms is spontaneously lost or causes unwanted effects other than epiphora, surgical occlusion of the lacrimal drainage system should be considered. Here we review current irreversible and reversible techniques to occlude the lacrimal drainage and describe a new surgical technique, termed 'punctum switch', which has the advantage of being permanent and yet potentially is reversible.
A PubMed search was performed to identify the current literature on surgical occlusion of the puncta and canaliculi for dry eyes. The characteristics of the procedures are described, classifying them as temporary or permanent and their localization being either on the level of the lacrimal puncta or canaliculi. A 'punctum switch' graft involves a superficial excision of a piece of lid margin including the punctum. This graft is then rotated and fixated so that the excised punctum comes to rest lateral to the remaining lacrimal ampulla, which in turn is covered by full-thickness lid margin tissue.
Established methods include cauterizing or ligating the puncta or canaliculi as well as everting the medial portion of the lid. Both thermal and surgical techniques show a high rate of reopening. If permanent occlusion is achieved, this however often is irreversible and can only be treated by means of lacrimal bypass surgery. The 'punctum switch' procedure can achieve long-term occlusion of the canalicular system while offering potential reversibility.
A large variety of surgical techniques to occlude the nasolacrimal drainage system exists. These vary significantly in terms of complexity and reversibility. Surgical occlusion should be used more often in patients with moderate or severe dry eye, which previously responded well to temporary occlusion with plugs.
如果能成功改善干眼症状的泪点塞自然脱落，或引发除溢泪之外的不良影响，则应考虑对泪道系统进行手术阻塞。在此，我们回顾当前用于阻塞泪道的不可逆和可逆技术，并描述一种名为“泪点转换”的新手术技术，其优点是永久性的，但仍有可能可逆。
通过在PubMed上检索，以确定目前关于手术阻塞泪点和泪小管治疗干眼的文献。描述了这些手术的特点，将其分为临时性或永久性，并根据其定位在泪点或泪小管水平进行分类。“泪点转换”移植术包括对包括泪点在内的一部分睑缘进行浅表切除。然后将该移植物旋转并固定，使切除的泪点位于剩余泪囊壶腹的外侧，而泪囊壶腹则被全层睑缘组织覆盖。
已有的方法包括烧灼或结扎泪点或泪小管，以及翻转眼睑内侧部分。热凝和手术技术都显示出较高的再通率。如果实现了永久性阻塞，然而这通常是不可逆的，只能通过泪道旁路手术进行治疗。“泪点转换”手术可以实现泪小管系统的长期阻塞，同时具有潜在的可逆性。
存在多种用于阻塞鼻泪引流系统的手术技术。这些技术在复杂性和可逆性方面差异很大。对于中度或重度干眼患者，如果之前使用泪点塞进行临时阻塞效果良好，则应更频繁地使用手术阻塞方法。
