Vagefi M Reza, Winn Bryan J, Lin Chun Cheng, Sires Bryan S, LauKaitis Steven J, Anderson Richard L, McCann John D
Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Ophthalmology. 2009 Mar;116(3):585-90. doi: 10.1016/j.ophtha.2008.09.050. Epub 2008 Dec 16.
To describe weakness of the orbicularis oculi muscle after external dacryocystorhinostomy (DCR) and propose an anatomic explanation for the complication.
Retrospective, observational study.
Sixteen patients (13 female, 3 male) with a mean age of 60 years (median, 61 years; range, 34-85 years).
A retrospective chart review was performed of consecutive patients who had nasolacrimal duct obstruction repair by external DCR. Patients were identified who developed postoperative orbicularis oculi muscle weakness that manifested as hypometric blink or lagophthalmos with or without punctate keratopathy on the operated side. Patient parameters collected included demographic data, type of incision, incision length, use of lacrimal stent, length of follow-up, intraoperative and postoperative complications, and time to resolution of clinical findings. Statistical analysis was performed using a 2-tailed Fisher exact test with clinical significance designated at alpha = 0.05.
Identification of patients with orbicularis oculi muscle weakness after external DCR, documentation of incision type, clinical findings, and recovery of function.
Among 215 patients and 247 surgeries, 16 individuals (7.4%) were identified who demonstrated abnormalities of eyelid closure in the postoperative period after external DCR. Of these, 13 patients had lagophthalmos with or without hypometric blink and 3 patients had hypometric blink alone. Eleven patients underwent surgery through a nasojugal incision, 4 patients underwent surgery through a vertical incision, and 1 patient underwent surgery through an eyelid margin incision. The degree of postoperative lagophthalmos was on average 1.5 mm. Four patients developed punctate keratopathy. Follow-up ranged from 3 to 50 weeks (mean, 20 weeks). Resolution of lagophthalmos was seen on average by 14 weeks with the longest time to resolution of 32 weeks. Three individuals continued to have residual hypometric blink at the time of last follow-up.
Damage to peripheral fibers of the zygomatic and buccal branches of the facial nerve as they course through the medial canthal area to innervate the upper eyelid orbicularis oculi muscle may occur during external DCR surgery. Such injury may be responsible for orbicularis oculi muscle weakness manifesting as postoperative abnormal eyelid closure and lagophthalmos. In our cohort of patients, these findings were temporary and typically resolved in several months.
描述外路泪囊鼻腔吻合术（DCR）后眼轮匝肌的无力情况，并对该并发症提出解剖学解释。
回顾性观察研究。
16例患者（13例女性，3例男性），平均年龄60岁（中位数61岁；范围34 - 85岁）。
对连续接受外路DCR修复鼻泪管阻塞的患者进行回顾性病历审查。确定术后出现眼轮匝肌无力的患者，表现为患侧眼的眨眼幅度减小或眼睑闭合不全，伴或不伴有点状角膜病变。收集的患者参数包括人口统计学数据、切口类型、切口长度、泪道支架的使用、随访时间、术中及术后并发症，以及临床症状缓解时间。采用双侧Fisher精确检验进行统计分析，设定α = 0.05为具有临床意义。
确定外路DCR术后眼轮匝肌无力的患者，记录切口类型、临床症状及功能恢复情况。
在215例患者的247例手术中，16例（7.4%）被确定在接受外路DCR术后出现眼睑闭合异常。其中，13例患者有眼睑闭合不全，伴或不伴有眨眼幅度减小，3例患者仅有眨眼幅度减小。11例患者通过鼻颧切口进行手术，4例患者通过垂直切口进行手术，1例患者通过睑缘切口进行手术。术后眼睑闭合不全的程度平均为1.5mm。4例患者出现点状角膜病变。随访时间为3至5周（平均20周）。眼睑闭合不全平均在14周时缓解，最长缓解时间为32周。3例患者在最后一次随访时仍有残余的眨眼幅度减小。
在进行外路DCR手术时，面神经颧支和颊支的外周纤维在穿过内眦区域支配上睑眼轮匝肌的过程中可能受到损伤。这种损伤可能导致眼轮匝肌无力，表现为术后异常的眼睑闭合和眼睑闭合不全。在我们的患者队列中，这些表现是暂时的，通常在几个月内缓解。
