Mukherjee Bipasha, Gudkar Avriel Isaac, Nair Akshay Gopinathan, Poonam Nisar Sonam, Alam Md Shahid
Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India.
Ophthalmic Plastic Surgery and Ocular Oncology Services, Advanced Eye Hospital and Institute, Mumbai, Maharashtra, India.
Oman J Ophthalmol. 2021 Oct 20;14(3):157-161. doi: 10.4103/ojo.ojo_462_20. eCollection 2021 Sep-Dec.
Isolated cases of nasolacrimal duct obstruction (NLDO) secondary to rhino-orbito-facial reconstructive surgeries have been reported previously. We report the clinical profiles and management outcomes of a series of patients with iatrogenic INDO.
Case records of all patients who presented with secondary NLDO over 5 years were retrospectively analyzed. The case series included seven patients with NLDO secondary to orbito-facial surgeries.
The study included six males and one female patient with a mean age of 29 ± 12.58 years. All the patients had a history of road traffic accidents following which they underwent an open reduction and internal fixation by maxilla-facial surgeons. All of them presented to the Ophthalmology outpatient department with epiphora following the surgical intervention. Imaging revealed the implants were responsible for obstructing the nasolacrimal ducts in all seven cases. Five patients underwent external dacryocystorhinostomy while dacryocystectomy was performed in two. Implant removal was necessary for five patients without any compromise on the structural integrity of the orbital walls.
Precise knowledge of the orbital anatomy, especially that of the lacrimal drainage system is imperative for surgeons performing surgeries in the midface area. A multidisciplinary approach and inclusion of surgeons trained in lacrimal surgeries can prevent such avoidable complications.
先前已有关于鼻眶面部重建手术后继发鼻泪管阻塞（NLDO）的孤立病例报道。我们报告一系列医源性鼻泪管阻塞患者的临床特征及治疗结果。
回顾性分析5年来所有出现继发性鼻泪管阻塞患者的病例记录。该病例系列包括7例因眶面部手术继发鼻泪管阻塞的患者。
该研究纳入6例男性和1例女性患者，平均年龄为29±12.58岁。所有患者均有道路交通事故史，随后接受了颌面外科医生的切开复位内固定术。他们在手术干预后均因溢泪就诊于眼科门诊。影像学检查显示，在所有7例病例中植入物均导致鼻泪管阻塞。5例患者接受了外路泪囊鼻腔吻合术，2例患者接受了泪囊切除术。5例患者需要取出植入物，且眶壁结构完整性未受影响。
对于在面中部区域进行手术的外科医生而言，精确了解眼眶解剖结构，尤其是泪液引流系统的解剖结构至关重要。多学科方法以及纳入接受过泪道手术培训的外科医生可预防此类可避免的并发症。
