McNab A A
Royal Victorian Eye and Ear Hospital, Melbourne, Australia.
Aust N Z J Ophthalmol. 1998 Aug;26(3):219-23. doi: 10.1111/j.1442-9071.1998.tb01315.x.
To describe the association between the use of various types of topical ocular medications and acquired lacrimal canalicular obstruction in 14 patients.
The records of all patients in the author's practice with either lacrimal canalicular or punctal occlusion associated with the use of topical ocular medication were reviewed.
Fourteen cases were identified. The obstructions occurred at any point from the punctum to the common canaliculus, but most commonly occurred 2-5 mm from the lacrimal punctum. There was an association with various degrees of clinically apparent subconjunctival scarring maximal at the inner canthus, rarely to a severe degree, with symblepharon, medial canthal keratinization and cicatricial medial entropion. In some cases, no subconjunctival scarring could be clinically detected. Topical medications used were often multiple and included prednisolone acetate/phenylephrine hydrochloride (n = 5), timolol maleate (n = 5), pilocarpine (n = 3), dipivefrine hydrochloride or adrenaline (n = 3), chloramphenicol (n = 3), tobramycin (n = 3), indomethacin (n = 2), ecothiopate iodide (n = 1), betaxolol (n = 1), dexamethasone (n = 1), tropicamide (n = 1) and the long-term use of naphazoline and various artificial tear preparations (n = 1). The duration of exposure ranged from 3 weeks to 20 years, with seven patients having used drops for 3-6 weeks. Seven patients had surgical repair, three by dacryocystorhinostomy (DCR) and glass by-pass tube (all successful), three by canalicular repairs (one failed) and one by DCR and canalicular repair that restenosed at the puncta, who then had successful punctoplasty and silicone intubation.
Lacrimal canalicular obstruction may occur after relatively short-term exposure to topical ocular medications or as part of a more widespread cicatricial reaction in patients on long-term medication. While a direct causal relationship cannot be confirmed, there appears to be a strong association and the site of the obstructions makes other causes unlikely.
描述14例患者使用各类局部眼用药物与获得性泪小管阻塞之间的关联。
回顾了作者诊所中所有因使用局部眼用药物而出现泪小管或泪点阻塞的患者记录。
共确定了14例病例。阻塞发生在从泪点到泪总管的任何部位，但最常见于距泪点2 - 5毫米处。与不同程度的临床明显睑结膜下瘢痕形成有关，在内眦处最为明显，很少达到严重程度，伴有睑球粘连、内眦角角化和瘢痕性内睑内翻。在某些情况下，临床上无法检测到睑结膜下瘢痕形成。使用的局部药物通常为多种，包括醋酸泼尼松龙/盐酸去氧肾上腺素（5例）、马来酸噻吗洛尔（5例）、毛果芸香碱（3例）、盐酸地匹福林或肾上腺素（3例）、氯霉素（3例）、妥布霉素（3例）、吲哚美辛（2例）、碘化依可碘酯（1例）、倍他洛尔（1例）、地塞米松（1例）、托吡卡胺（1例）以及长期使用萘甲唑啉和各种人工泪液制剂（1例）。暴露时间从3周至20年不等，7例患者使用滴眼液3 - 6周。7例患者接受了手术修复，3例通过泪囊鼻腔吻合术（DCR）和玻璃旁路管（均成功），3例通过泪小管修复（1例失败），1例通过DCR和泪小管修复，在泪点处再狭窄，随后成功进行了泪点成形术和硅胶插管。
泪小管阻塞可能在相对短期接触局部眼用药物后发生，或作为长期用药患者更广泛瘢痕反应的一部分。虽然不能确认直接因果关系，但似乎存在很强的关联，且阻塞部位排除了其他原因。
