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两例鼻泪管阻塞患者在使用植入物进行眼眶骨折重建后接受了内镜下泪囊鼻腔造口术。

Two cases of nasolacrimal duct obstruction operated by endoscopic dacryocystorhinostomy after orbital fracture reconstruction with an implant.

作者信息

Tomita Kosei, Matsuyama Hiroko, Akimoto Masayuki

机构信息

Osaka Red Cross Hospital, Osaka, Japan.

出版信息

Am J Ophthalmol Case Rep. 2023 Apr 29;30:101853. doi: 10.1016/j.ajoc.2023.101853. eCollection 2023 Jun.

DOI:10.1016/j.ajoc.2023.101853
PMID:37168519
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10165391/
Abstract

PURPOSE

To report two cases of nasolacrimal duct obstruction (NLDO) caused by orbital fracture reconstruction with an implant successfully treated with endoscopic dacryocystorhinostomy (EnDCR).

OBSERVATIONS

Two patients presented with NLDO after orbital fracture reconstruction with an implant. Case 1 was a 67-year-old female. She became aware of epiphora in her left eye after undergoing orbital fracture reconstruction with an implant for a left orbital floor fracture 14 years previously. Dacryocystitis was diagnosed based on a lacrimal syringing test because of pus reflux. Computed tomography (CT) showed that the implant was inserted on the left orbital floor, crossing into the lacrimal sac; dacryoendoscopy showed that the implant blocked the nasolacrimal duct. EnDCR was performed without implant removal. The symptoms resolved postoperatively. Case 2 involved a 6-year-old male who had been aware of epiphora in his left eye since undergoing orbital fracture reconstruction with an implant for a left orbital floor fracture one month prior. Dacryocystitis was diagnosed based on a lacrimal syringing test because of pus reflux. CT showed an unclear implant location, but dacryoendoscopy showed that the implant blocked the nasolacrimal duct. The implant was removed. However, EnDCR was performed because there was no improvement in NLDO. The symptoms resolved after EnDCR.

CONCLUSIONS AND IMPORTANCE

One previous report of NLDO after orbital floor fracture reconstruction was performed with external dacryocystorhinostomy with implant removal. Dacryoendoscopy and CT are useful for confirming the location of the implant and obstruction. Depending on the implant's location, it may be possible to perform EnDCR without removing the implant.

摘要

目的

报告两例因眼眶骨折重建植入物导致鼻泪管阻塞（NLDO）并成功接受内镜下泪囊鼻腔造口术（EnDCR）治疗的病例。

观察结果

两名患者在眼眶骨折重建植入物后出现NLDO。病例1为一名67岁女性。14年前她因左侧眶底骨折接受眼眶骨折重建植入物手术后，左眼出现溢泪。泪道冲洗试验因有脓性反流而诊断为泪囊炎。计算机断层扫描（CT）显示植入物插入左侧眶底，延伸至泪囊；泪道内镜检查显示植入物阻塞鼻泪管。未取出植入物即进行了EnDCR。术后症状缓解。病例2为一名6岁男性，1个月前因左侧眶底骨折接受眼眶骨折重建植入物手术后左眼一直有溢泪。泪道冲洗试验因有脓性反流而诊断为泪囊炎。CT显示植入物位置不明确，但泪道内镜检查显示植入物阻塞鼻泪管。取出了植入物。然而，由于NLDO没有改善，仍进行了EnDCR。EnDCR后症状缓解。

结论与意义

之前有一篇关于眶底骨折重建后NLDO的报道采用了外置泪囊鼻腔造口术并取出植入物。泪道内镜检查和CT有助于确定植入物的位置和阻塞情况。根据植入物的位置，有可能在不取出植入物的情况下进行EnDCR。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bcd2/10165391/fc4893778b1d/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bcd2/10165391/df9e1a30daca/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bcd2/10165391/92718203e5d4/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bcd2/10165391/cebdce7d6864/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bcd2/10165391/775b76e87b1c/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bcd2/10165391/fc4893778b1d/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bcd2/10165391/df9e1a30daca/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bcd2/10165391/92718203e5d4/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bcd2/10165391/cebdce7d6864/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bcd2/10165391/775b76e87b1c/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bcd2/10165391/fc4893778b1d/gr5.jpg

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Longitudinal randomized study to evaluate the long-term outcome of endoscopic primary dacryocystorhinostomy with or without silicone tube.评估内镜下一期泪囊鼻腔造口术加或不加硅胶管的长期疗效的纵向随机研究。
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