Tai Evelyn Li Min, Lee Allan Lu, Kueh Yee Cheng, Abdullah Baharudin, Chang Bernard
Department of Ophthalmology, School of Medical Sciences, Health Campus Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia.
Hospital Universiti Sains Malaysia, Jln Raja Perempuan Zainab II, Kubang Kerian 16150, Kelantan, Malaysia.
Int J Ophthalmol. 2025 May 18;18(5):937-950. doi: 10.18240/ijo.2025.05.21. eCollection 2025.
To review the success rates and complications of interventions for functional epiphora in adults.
A systematic review of English-language articles from the electronic databases PubMed, SCOPUS, and Google Scholar. The primary outcome was subjective resolution or improvement of epiphora symptoms. Secondary outcomes were treatment-related adverse events. Subjects above 18 years of age who underwent surgical or non-surgical treatment for functional epiphora (exhibited symptoms of epiphora with a patent lacrimal system) were included. Articles were excluded if they were 1) case reports; 2) abstract only studies; 3) published in a language other than English. Data extraction was performed independently by two authors. The Effective Public Health Practice Project checklist was used for quality assessment of the included studies.
A total of 762 articles were identified; 28 met the study criteria. Most studies employed silicone tube intubation alone or as an adjuvant procedure to dacryocystorhinostomy (DCR). Other interventions included lacrimal probing, balloon dacryoplasty, lateral tarsal strip and botulinum toxin A. DCR had the highest success rate, as well as the longest mean follow-up time. Complications were minor, transient, and mostly stent-related.
This updated systematic review on the success rates of interventions for functional epiphora in adults proposes the following management algorithm. Dacryocystography (DCG) should be performed in all patients with functional epiphora. If DCG is abnormal, we advocate DCR. If DCG is normal, proceed with dacryoscintigraphy (DSG). We perform DCR for post-sac delay on DSG and lateral tarsal strip for pre-sac delay. Botulinum toxin A is an off-label, short-term treatment option in those with normal DSG.
回顾成人功能性溢泪干预措施的成功率及并发症。
对电子数据库PubMed、SCOPUS和谷歌学术中收录的英文文章进行系统评价。主要结局指标为主观上溢泪症状的缓解或改善。次要结局指标为治疗相关不良事件。纳入18岁以上因功能性溢泪（泪道系统通畅但有溢泪症状）接受手术或非手术治疗的患者。排除以下文章：1）病例报告；2）仅为摘要的研究；3）非英文发表的文章。由两名作者独立进行数据提取。采用有效公共卫生实践项目清单对纳入研究进行质量评估。
共检索到762篇文章；28篇符合研究标准。大多数研究单独采用硅胶管插管或作为泪囊鼻腔吻合术（DCR）的辅助手术。其他干预措施包括泪道探通术、球囊泪道成形术、外侧睑板条手术和肉毒杆菌毒素A。DCR成功率最高，平均随访时间最长。并发症轻微、短暂，大多与支架相关。
这项关于成人功能性溢泪干预措施成功率的最新系统评价提出了以下治疗方案。所有功能性溢泪患者均应行泪囊造影（DCG）。若DCG异常，建议行DCR。若DCG正常，则进行泪道闪烁造影（DSG）。DSG显示泪囊延迟则行DCR，显示泪囊前延迟则行外侧睑板条手术。对于DSG正常的患者，肉毒杆菌毒素A是一种超说明书用药的短期治疗选择。
