Department of Ophthalmology, University of British Columbia, Vancouver, British Columbia, Canada Department of Ophthalmology, Mutah University, Al-Karak, Jordan.
Department of Ophthalmology, University of British Columbia, Vancouver, British Columbia, Canada.
Br J Ophthalmol. 2014 Oct;98(10):1435-6. doi: 10.1136/bjophthalmol-2013-304854. Epub 2014 May 15.
BACKGROUND/AIMS: To review management choices and outcomes for congenital lacrimal (anlage duct) fistulae performed by a single ophthalmologist over a 10-year interval.
All cases of congenital lacrimal fistulae with minimum follow-up of 1 year, seen and managed by the senior author (PJD) from 2000 to 2010, were retrieved from electronic medical records. Recorded data included demographic features, associated abnormalities of the lacrimal outflow apparatus and type of surgical intervention and outcome.
15 cases of lacrimal fistulae were identified. 67% were males, and mean age of presentation was 5 years. All presented with tearing from the eye or fistulous opening. Two patients had Down syndrome (13%). Mean follow-up was 7.3 years. While two cases required excision combined with endonasal dacryocystorhinostomy (DCR) or intubation, 9 of 11 (82%) operated cases were successfully treated with simple excision alone. Spontaneous resolution of symptoms occurred in 27% following successful treatment of concurrent nasolacrimal duct obstruction with lacrimal sac massage; in two of these cases, the fistulae were probed and found to have sealed spontaneously. The most common site of the fistula was at the inferior medial canthal area and was connected to the lacrimal sac or common canaliculus in all cases.
Congenital lacrimal fistulae may be successfully treated with simple excision alone in most cases. Adjunctive DCR or intubation can be reserved for those identified to have lacrimal outflow tract abnormalities.
背景/目的：回顾一位眼科医生在 10 年间对先天性（先天泪囊）瘘管的治疗选择和结果。
从电子病历中检索了 2000 年至 2010 年间由资深作者（PJD）诊治的所有至少随访 1 年的先天性泪囊瘘管病例。记录的数据包括人口统计学特征、泪液流出装置的相关异常以及手术干预和结果的类型。
共发现 15 例泪囊瘘管，其中 67%为男性，平均发病年龄为 5 岁。所有患者均表现为眼睛流泪或瘘管开口处流泪。2 例患者患有唐氏综合征（13%）。平均随访时间为 7.3 年。虽然有 2 例需要切除联合经鼻泪囊鼻腔吻合术（DCR）或插管，但 11 例手术病例中有 9 例（82%）仅通过单纯切除即可成功治疗。在成功治疗同时存在的鼻泪管阻塞后，27%的患者症状自行缓解，通过泪囊按摩；在这两例患者中，瘘管自行探查并发现已自行封闭。瘘管最常见的部位是内眦下内侧，在所有病例中均与泪囊或共同泪小管相连。
大多数情况下，单纯切除即可成功治疗先天性泪囊瘘管。对于那些被确定有泪液流出道异常的患者，可以保留辅助性 DCR 或插管。
