Xu Y, Tao H, Wang P, Wang F
Lacrimal Disease Center of Ophthalmology, the Third Medical Center of Chinese PLA General Hospital, Beijing 100039, ChinaXu Yu was a graduate student and is now working at the Department of Ophthalmology, Tianjin Children's Hospital, Tianjin 300074, China.
Zhonghua Yan Ke Za Zhi. 2020 Sep 11;56(9):688-692. doi: 10.3760/cma.j.cn112142-20191008-00502.
To summarize the clinical characteristics of congenital lacrimal fistula for reference in its clinical diagnosis and treatment. Retrospective case series study. The clinical data of 27 patients (32 eyes) with congenital lacrimal fistula admitted to the Lacrimal Center of Third Medical Center of PLA General Hospital from July 2011 to November 2017 were analyzed, including gender, age of diagnosis, left eye or right eye, family history, physical examination, ophthalmic examination, fistula opening location and appearance, symptoms, results of lacrimal duct irrigation, three-dimensional reconstruction of the lacrimal drainage system with CT, lacrimal endoscopy, treatment, outcomes and follow-up. In the 27 patients, the male to female ratio was 1∶2. The age of diagnosis was 1 to 74 years old, and the median was 32 years old. The ratio of unilateral fistula to bilateral fistula was 4.4∶1 (22/5), and the ratio of left eyes to right eyes was 1.2∶1 (12/10). The disease was sporadic in 22 patients, and 5 patients had a family history. Genetic analysis showed that congenital lacrimal fistula presented autosomal dominant inheritance. Fistulas were found on the skin surface of the lacrimal sac area under the medial canthus in 30 eyes, on the lacrimal caruncle in one eye, and on the conjunctiva of the medial canthus in one eye. All the patients presented with epihora, and irrigation liquid outflowed from the fistulas with purulence in 18 eyes. Lacrimal CT of the 27 patients showed contrast agents were left in the lacrimal sac. Lacrimal duct fistula was found open in the common canaliculus with concretions in the lacrimal system in four patients. Eight patients with mild symptoms underwent observation. Three patients underwent lacrimal therapeutic irrigation and probing. Sixteen patients underwent fistulectomy and were cured without recurrence during the follow-up of 1 to 6 years. Congenital lacrimal fistula is usually unilateral, and the opening is mostly located on the skin surface of the lacrimal sac area under the inner canthus ligament. Most cases are sporadic, and some cases are of familial inheritance in an autosomal dominant condition. .
总结先天性泪囊瘘的临床特征，为其临床诊断与治疗提供参考。回顾性病例系列研究。分析2011年7月至2017年11月解放军总医院第三医学中心泪道中心收治的27例（32眼）先天性泪囊瘘患者的临床资料，包括性别、诊断年龄、左眼或右眼、家族史、体格检查、眼科检查、瘘口位置及外观、症状、泪道冲洗结果、泪道系统CT三维重建、泪道内镜检查、治疗方法、治疗效果及随访情况。27例患者中，男女比例为1∶2。诊断年龄为1至74岁，中位数为32岁。单眼瘘与双眼瘘的比例为4.4∶1（22/5），左眼与右眼的比例为1.2∶1（12/10）。22例患者为散发病例，5例有家族史。基因分析显示先天性泪囊瘘呈常染色体显性遗传。30眼瘘口位于内眦泪囊区皮肤表面，1眼位于泪阜，1眼位于内眦结膜。所有患者均有溢泪，18眼冲洗液自瘘口流出且伴有脓性分泌物。27例患者的泪道CT显示造影剂残留于泪囊。4例患者泪道瘘口开放于泪小管，泪道系统有结石形成。8例症状较轻的患者接受观察。3例患者接受泪道治疗性冲洗及探通。16例患者接受瘘管切除术，随访1至6年无复发。先天性泪囊瘘通常为单侧，瘘口多位于内眦韧带下方泪囊区皮肤表面。多数病例为散发性，部分病例为常染色体显性遗传的家族性遗传。
