HNS & ENT Department, CHU-Mont-Godinne, UCL, Yvoir, Belgium.
Rhinology. 2012 Dec;50(4):436-41. doi: 10.4193/Rhino12.067.
Epiphora is a frequent reason for ophthalmologic consultation. Among the multiple causes, obstructions of the lacrimal excretory system are common. Sacal and postsacal obstructions are much more frequent than presacal obstructions. Obstruction at the level of the Hasner's valve is rare and likely underestimated. The authors report the clinical history and the imaging of 3 patients with a cystic dilation of the distal end of the nasolacrimal duct (NLD). These patients were easily managed by an ENT surgeon. In one case, the surgery consisted of an endonasal DCR where in the 2 other cases, a marsupialisation of the cystic expansion of the nasolacrimal duct was successfully performed with the micro- debrider. The authors review the world literature on this specific topic. They conclude that a coronal sinus CT scan and an inferior meatus endoscopy should be included in the ophthalmologic work-up performed in all cases of low obstruction of the lacrimal system. When there is a dilation of the distal end of the NLD the marsupialisation of the cystic expansion in the inferior meatus is the option of treatment instead of performing a DCR. ENTs must play a role in the assessment and treatment of low obstructions of the lacrimal excretory system.
溢泪是眼科就诊的常见原因。在多种病因中，泪液排出系统阻塞较为常见。泪囊和泪囊后阻塞比泪囊前阻塞更为常见。Hasner 瓣水平的阻塞很少见，且可能被低估。作者报告了 3 例鼻泪管末端囊性扩张（NLD）患者的临床病史和影像学资料。这些患者很容易被耳鼻喉科医生治疗。在 1 例患者中，手术为鼻内 DCR；在另外 2 例患者中，使用微型清创机成功地对鼻泪管囊性扩张进行了经鼻切开造口术。作者回顾了该特定主题的世界文献。他们得出结论，在所有低泪液系统阻塞的眼科检查中，应包括冠状窦 CT 扫描和下鼻道内窥镜检查。当 NLD 末端扩张时，下鼻道的囊性扩张经鼻切开造口术是治疗选择，而不是进行 DCR。耳鼻喉科医生必须在评估和治疗低泪液排出系统阻塞方面发挥作用。
