Bosshard C
Klin Monbl Augenheilkd. 1981 Apr;178(4):248-52. doi: 10.1055/s-2008-1057196.
Tear drainage may be disturbed due to the lack of a connection between the drainage system and the lacus lacrimalis or an obstruction within the drainage system. The connection to the drainage system may be reconstructed by surgery of the puncta. The one-snip and two-snip procedures described by L. T. Jones and the plasty of the punctum by Bangerter are mentioned. A torn canaliculus is repaired by internal splinting with silastic tubing which is inserted as a small, continuous loop. As the upper canaliculus may be of greater importance for the transportation of tears, a reconstruction of the upper canaliculus should also be attempted. Canalicular obstruction may be treated by intubation of the drainage system with silastic tubing. The following complications of this treatment have been observed: ulcera of the cornea and conjunctiva, slitting of the punctum, expression of the intubated silastic loop, closure of the nasal ostium after dacryocystorhinostomy as a result of a chronic irritation by the silastic tube. If reconstruction of the canalicular system is no longer possible, a direct anastomosis between conjunctiva, lacrimal sac and nose may be performed. The dacryocystorhinostomy remains the first choice operation for obstructions below the lacrimal sac. Treatment of the connatal lacrimal obstruction is performed in three steps: conservative treatment with compression of the lacrimal sac, hydraulic pressure flushing and probing.
由于引流系统与泪湖之间缺乏连接或引流系统内存在阻塞，泪液引流可能会受到干扰。泪点手术可重建与引流系统的连接。文中提到了L.T.琼斯描述的单剪和双剪手术以及班格特的泪点成形术。泪小管撕裂可通过插入硅橡胶管作为小的连续环进行内部支撑修复。由于上泪小管对泪液运输可能更为重要，因此也应尝试对上泪小管进行重建。泪小管阻塞可通过向引流系统插入硅橡胶管进行插管治疗。已观察到该治疗的以下并发症：角膜和结膜溃疡、泪点裂开、插入的硅橡胶环脱出、泪囊鼻腔吻合术后由于硅橡胶管的慢性刺激导致鼻泪管开口闭合。如果泪小管系统不再能够重建，可以进行结膜、泪囊和鼻腔之间的直接吻合。泪囊鼻腔吻合术仍然是泪囊以下阻塞的首选手术。先天性泪道阻塞的治疗分三步进行：泪囊压迫保守治疗、水压冲洗和探通。
