泪点炎的临床观察研究

Clinical research of puncta lacrimalis

摘要:

目的:通过临床的系统观察研究泪点发生炎症的原因及泪点炎发展转归的临床规律,以及设计实施相应的手术治疗等,显示把泪点炎作为独立疾病列出的必要性。方法:用裂隙灯观察泪点和眼表,并泪道冲洗、探通检查;用微距照相记录泪点典型病变,其中有24眼泪点切除组织进行病理学检查。结果:泪点炎病临床特征:几乎所有泪点炎患者都合并急、慢性结膜炎;多数为泪点单独发炎,少数与后续泪道炎性阻塞疾病合并存在。急性泪点炎少见,溢热泪,泪点局部红肿、痒痛,泪点壁贴合关闭泪点口,以抗炎药物治疗为主。慢性泪点炎多见,溢冷泪,主要有泪点壁软缩,泪点乳头平坦,泪点口向心性缩小;增殖膜覆盖泪点口;泪点壁肿胀、增生贴合关闭泪点口;增生的睑结膜包裹稀薄的积脓包埋泪点口,形成白色隆起的泪点外观四种类型。以手术治疗为主,效果良好。结论:本研究结果显示,泪点炎病多发而常见,有独特的发展转归临床规律,和单独的手术治疗方法,把泪点炎作为独立疾病单独列出,以减少泪道病诊治的疏漏和错误等非常必要。

Abstract:

AIM:To identify the causes of puncta lacrimalis inflammation, and to research its clinical development and prognosis as an independent disease. METHODS: The lacrimal puncta and ocular surface of patients with puncta lacrimalis were observed by slit-lamp, and lacrimal duct was washed and then examed. The changes of puncta in those study eyes were recorded by microphoto detector. Twenty-four eyes underwent tissue resection of lacrimal puncta and pathological examination. RESULTS: The rate of lacrimal punctum obstruction which needed surgical treatment was 11.95% in the patients with puncta lacrimalis. The clinical features of puncta lacrimalis were as following: the majority happened separately, minority combined with the inflammatory lacrimal duct obstruction. The diseases have acute and chronic divisions: Acute puncta lacrimalis is less common with the symptoms of warm tears overflow, local lacrimal puncta swelling, the fitting point wall. Chronic puncta lacrimalis is common with the symptoms of cold tears overflow, lacrimal puncta wall swelling or with proliferative membrane at the mouth of the lacrimal puncta, and then gradually the lacrimal puncta becoming close and flat surrounded by the conjunctive. The surgery of opening the lacrimal puncta was helpful in that case. CONCLUSION:Puncta lacrimalis is a common disease in the lacrimal disease, and needs to be treated as an independent disease, which is very important to make the diagnosis and treatment.