Wang Wushuang, Gong Lan, Wang Yan
Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.
Quant Imaging Med Surg. 2022 Nov;12(11):5068-5079. doi: 10.21037/qims-22-170.
Studies of local anatomic characteristics of primary acquired nasolacrimal duct obstruction (PANDO) are important for understanding the etiology of PANDO and guiding surgical treatment. The purpose of this study was to review computed tomography (CT) scans to identify the anatomic differences in the obstructed and unobstructed sides of PANDO patients as well as in control patients in a Chinese population.
In this retrospective comparative observational study, the CT scans of 126 PANDO patients were reviewed. A total of 76 patients who underwent CT examinations for eyeball atrophy or an intraocular foreign body but had a healthy lacrimal drainage system and orbit structure were enrolled as controls. The nasolacrimal canal (NLC) widths, lacrimal sac fossa structures, and nasal abnormalities in the obstructed and unobstructed sides in patients and both sides in controls were evaluated.
Both obstructed and unobstructed sides in PANDO patients showed significant differences to the sides of controls in NLC width (obstructed: 3.91±0.90 mm, unobstructed: 3.86±0.83 mm, control: 4.31±0.95 mm; obstructed and control: P<0.01, unobstructed and control: P<0.01, respectively), ethmoid sinusitis (26%, 28%, 16%; P=0.03 and P=0.03, respectively), osteomeatal complex opacification (18%, 14%, 7%; P<0.01 and P=0.04, respectively), and agger nasi cell opacification (22%, 20%, 9%; P<0.01 and P<0.01, respectively). However, although no significant differences (all P>0.05) were found between the obstructed and unobstructed sides of unilateral PANDO patients in these characteristics, there were correlations (r=0.714, 0.209, 0.376, and 0.112; P<0.01, P=0.03, P<0.01, P=0.24, respectively). We also found expanded lacrimal sac fossa width (6.45±1.01 mm) and decreased frontal process proportion (45.9%±15.4%) only in the obstructed sides of PANDO patients compared to the lacrimal sac fossa width in controls (6.08±1.16 mm, P<0.01) and the frontal process proportion in controls (49.9%±15.4%, P0.03). There was no difference in the positional relationship of the uncinate process (UP) with the lacrimal fossa between patients and controls.
A narrow NLC and nasal inflammation are associated with PANDO, while an expanded lacrimal sac fossa and a decreased frontal process proportion could be pathological changes. The healthy sides of unilateral PANDO patients might have a high risk of developing an obstruction. We also found an increased probability of the UP overlapping the lower lacrimal sac fossa in an Asian population compared to the published European data.
原发性获得性鼻泪管阻塞（PANDO）局部解剖特征的研究对于理解PANDO的病因及指导手术治疗具有重要意义。本研究旨在回顾计算机断层扫描（CT）图像，以确定中国人群中PANDO患者阻塞侧与非阻塞侧以及对照患者的解剖差异。
在这项回顾性对比观察研究中，对126例PANDO患者的CT图像进行了回顾。选取76例因眼球萎缩或眼内异物接受CT检查但泪道引流系统及眼眶结构正常的患者作为对照。评估患者阻塞侧与非阻塞侧以及对照双侧的鼻泪管（NLC）宽度、泪囊窝结构及鼻腔异常情况。
PANDO患者的阻塞侧与非阻塞侧在NLC宽度（阻塞侧：3.91±0.90mm，非阻塞侧：3.86±0.83mm，对照：4.31±0.95mm；阻塞侧与对照：P<0.01，非阻塞侧与对照：P<0.01）、筛窦炎（分别为26%、28%、16%；P=0.03和P=0.03）、窦口鼻道复合体浑浊（分别为18%、14%、7%；P<0.01和P=0.04）以及鼻丘气房浑浊（分别为22%、20%、9%；P<0.01和P<0.01）方面与对照侧均存在显著差异。然而，尽管单侧PANDO患者的阻塞侧与非阻塞侧在这些特征上未发现显著差异（均P>0.05），但存在相关性（r分别为0.714、0.209、0.376和0.112；P<0.01、P=0.03、P<0.01、P=0.24）。与对照的泪囊窝宽度（6.08±1.16mm，P<0.01）及对照的额突比例（49.9%±15.4%，P=0.03）相比，我们还发现仅PANDO患者的阻塞侧泪囊窝宽度扩大（6.45±1.01mm）且额突比例降低（45.9%±15.4%）。患者与对照之间钩突（UP）与泪窝的位置关系无差异。
NLC狭窄及鼻腔炎症与PANDO相关，而泪囊窝扩大及额突比例降低可能是病理改变。单侧PANDO患者的健康侧可能有发生阻塞的高风险。与已发表的欧洲数据相比，我们还发现亚洲人群中UP与泪囊窝下部重叠的概率增加。
