Department of Ophthalmology, University of Ottawa Eye Institute and The Ottawa Hospital, Ottawa, Ontario, Canada.
Ophthalmic Plast Reconstr Surg. 2011 May-Jun;27(3):155-7. doi: 10.1097/IOP.0b013e3181ef728d.
To determine the etiology of tearing among referrals to a tertiary care ophthalmology practice specializing in oculoplastics.
A retrospective chart review was conducted of 150 consecutive referrals to our practice for tearing. The main diagnosis was noted in all cases as well as treatment offered and response to therapy. An anatomical approach was used to classify the tearing etiology. The categories included the following: dry eye with reflex tearing, tear hypersecretion, ocular surface disease (e.g., pterygium, pinguecula), lid abnormalities (e.g., entropion, ectropion), upper lacrimal system (e.g., punctal stenosis, canalicular block), and lower lacrimal system (e.g., dacryocystitis, dacryostenosis, nasolacrimal duct obstruction).
Review of the charts of 150 consecutive pts referred for tearing revealed that although the most common etiology was obstruction of the nasolacrimal system, dry eye with reflex tearing was almost as common. Specifically, 48.7% (n = 73) had a blockage of the lacrimal system (8% [n = 12] upper system, 40.7 [n = 61] lower system), 40% (n = 60) were felt to have dry eye with reflex tearing, 6.7% (n = 10 patients) had a lid abnormality, 1.3% (n = 2 patients) had lacrimal hypersecretion, 0.7% (n = 1 patient) had ocular surface disease, and 2.7% (n = 4 patients) had a normal lacrimal system on exam.
Our retrospective review of a series of patients referred to our practice for tearing revealed a significant proportion of patients whose tearing etiology was other than a nasolacrimal duct obstruction. Of particular interest is the fact that 40% of patients had dry eye with reflex tearing, and the majority of these improved with lubrication. These patients were all identified by performing a Schirmer test to quantify the basal tear production. We believe that the Schirmer test is a useful diagnostic tool in assessing patients with tearing and ensuring that the appropriate management approach is undertaken.
确定专门从事眼整形的三级眼科保健机构转诊患者流泪的病因。
对我院 150 例连续转诊患者的病历进行回顾性分析。所有病例均记录主要诊断、治疗方法及治疗效果。采用解剖学方法对流泪病因进行分类。分类包括以下内容：反射性溢泪伴干眼症、泪液过度分泌、眼表面疾病（如翼状胬肉、结膜黄斑）、眼睑异常（如睑内翻、睑外翻）、上泪道系统（如泪小点狭窄、泪小管阻塞）和下泪道系统（如泪囊炎、泪道狭窄、鼻泪管阻塞）。
对 150 例连续转诊患者的病历进行回顾性分析，结果显示，尽管最常见的病因是鼻泪管阻塞，但反射性溢泪的发生率几乎与之相同。具体而言，48.7%（n=73）有泪液系统阻塞（8%[n=12]为上泪道系统，40.7%[n=61]为下泪道系统），40%（n=60）被认为患有反射性溢泪伴干眼症，6.7%（n=10 例）患有眼睑异常，1.3%（n=2 例）患有泪液过度分泌，0.7%（n=1 例）患有眼表面疾病，2.7%（n=4 例）经检查发现泪液系统正常。
我们对我院因流泪而转诊的一系列患者进行了回顾性分析，结果显示，相当一部分患者的流泪病因并非鼻泪管阻塞。特别值得注意的是，40%的患者患有反射性溢泪伴干眼症，且大多数患者经润滑治疗后症状改善。这些患者均通过行 Schirmer 试验来量化基础泪液分泌量，从而得到明确诊断。我们认为 Schirmer 试验是评估流泪患者的一种有用的诊断工具，可以确保采取适当的治疗方法。
