Orbital and Adnexal Service, Villa Tiberia Hospital - GVM Care & Research, Rome, Italy.
Oftalmoplastica Roma, Rome, Italy.
Acta Ophthalmol. 2021 Nov;99(7):701-711. doi: 10.1111/aos.14762. Epub 2021 Jan 17.
The aims of the review are to summarize the aethiopathogenesis, management and outcomes of different treatments of proximal lacrimal obstructions.
An electronic database (PubMed, MEDLINE and Google Scholar) search of all articles written in English and non-English language with abstract translated to English on proximal lacrimal obstructions was performed. The articles were reviewed along with their relevant cross references. Data reviewed included demographics, presentations, investigations, management, complications and outcomes.
Punctoplasty is as effective as punctal dilatation with monocanalicular or bicanalicular stent in case of punctal stenosis. Dacryocystorhinostomy with retrograde intubation is more effective in case of proximal canalicular obstructions than in case of mid-canalicular obstructions. Trephination and intubation is effective in both mid and distal canalicular obstructions in patients with no associated nasolacrimal duct obstruction. Canaliculodacryocystorhinostomy has a specific indication in case of proximal common canalicular obstruction. Bypass surgery is the preferred treatment if there is no residual patency, however surgical success may not match patient satisfaction.
Optimal choice of surgical method depends on identification of the site of obstruction. Mini-invasive techniques should be avoided in cases that would only benefit from standard surgical treatment.
本文旨在总结近端泪道阻塞的病因、治疗方法和不同治疗方案的疗效。
对所有英文和非英文文献进行电子数据库（PubMed、MEDLINE 和 Google Scholar）检索，对有英文摘要的近端泪道阻塞文献进行综述，并查阅其相关参考文献。综述内容包括人口统计学、临床表现、检查、治疗、并发症和疗效。
与单通道或双通道支架相比，对于泪小点狭窄，泪道探通术与扩张术同样有效。与治疗中泪小管阻塞相比，逆行插管泪囊鼻腔吻合术治疗近段泪小管阻塞更有效。对于无鼻泪管阻塞的患者，在中、远段泪小管阻塞中，环钻和插管术同样有效。在近端共同泪小管阻塞的情况下，泪小管吻合术具有特定的适应证。如果没有残余通畅性，旁路手术是首选治疗方法，但手术成功率可能与患者满意度不匹配。
最佳手术方法的选择取决于阻塞部位的确定。对于仅能从标准手术治疗中获益的病例，应避免使用微创技术。
