Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea.
Eye (Lond). 2019 May;33(5):746-753. doi: 10.1038/s41433-018-0305-y. Epub 2018 Dec 10.
To evaluate the clinical features and treatment outcomes of patients complaining of tearing after receiving chemotherapy.
The clinical records of patients who complained of tearing between August 2014 and February 2016, and underwent or were undergoing chemotherapy were retrospectively reviewed. Clinical measurements were as follows: LipiView interferometer (lipid layer thickness and meibography), lacrimal drainage examinations (syringing), and outcomes at 6 months after treatment.
This study included 34 eyes of 17 patients with a mean age of 62.4 ± 14.82 years. The mean follow-up period was 9.6 months. On syringing, 10 eyes (29.4%) showed total regurgitation, 19 eyes (55.9%) showed partial regurgitation, and 5 eyes (14.7%) showed no regurgitation. On LipiView, mean lipid layer thickness was 34.5 nm (range, 20-89 nm). Mean meiboscore was 2.15 ± 0.86 in upper eyelid and 2.53 ± 0.79 in lower eyelid. Patients were treated with silicon tube intubation (STI) (10 eyes, 29.4%), dacryocystorhinostomy (DCR) (4 eyes, 17.6%), conjunctivodacryocystorhinostomy (CDCR) (8 eyes, 11.8%), DCR combined with CDCR (1 eyes, 8.8%), and conservative care (11 eyes, 32.4%). Mean time interval from onset of tearing to first clinic visit was 1.4 months in the conservative care group, 2.9 months in the STI and DCR groups, and 6.0 months in the CDCR group.
Because of the high incidence of accompanying meibomian gland loss in cases of lacrimal drainage system (LDS) obstruction, reflex tearing by mebibomian gland dysfunction should also be considered for proper management of tearing. Early recognition and management of LDS stenosis could result in patients undergoing surgery with a lower burden.
评估接受化疗后出现流泪症状患者的临床特征和治疗效果。
回顾性分析 2014 年 8 月至 2016 年 2 月间因化疗后出现流泪而就诊且正在或已接受化疗的患者的临床资料。临床检查包括：LipiView 干涉仪（脂质层厚度和睑板腺照相）、泪道冲洗检查（冲洗）以及治疗后 6 个月的疗效。
本研究共纳入 17 例 34 眼患者，平均年龄为 62.4±14.82 岁。平均随访时间为 9.6 个月。泪道冲洗时，10 眼（29.4%）表现为完全反流，19 眼（55.9%）表现为部分反流，5 眼（14.7%）表现为无反流。LipiView 检查示，平均脂质层厚度为 34.5nm（范围 20-89nm）。上睑和下睑的平均睑板腺评分分别为 2.15±0.86 和 2.53±0.79。患者接受了泪道塞硅管（STI）（10 眼，29.4%）、泪囊鼻腔吻合术（DCR）（4 眼，17.6%）、结膜囊鼻腔吻合术（CDCR）（8 眼，11.8%）、DCR 联合 CDCR（1 眼，8.8%）和保守治疗（11 眼，32.4%）。保守治疗组首次就诊至流泪开始的平均时间间隔为 1.4 个月，STI 和 DCR 组为 2.9 个月，CDCR 组为 6.0 个月。
由于在伴有泪道阻塞的情况下，泪液排出系统（LDS）阻塞的同时常伴有睑板腺损失，对于反射性流泪也应考虑到睑板腺功能障碍，以便进行适当的流泪管理。早期识别和治疗 LDS 狭窄可使患者在接受手术时的负担更低。
