AIM:To review the success rates and complications of interventions for functional epiphora in adults.METHODS:A systematic review of English-language articles from the electronic databases PubMed,SCOPUS,and Google Scho...AIM:To review the success rates and complications of interventions for functional epiphora in adults.METHODS: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.RESULTS: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.CONCLUSION: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.展开更多
AIM： To investigate the etiology, diagnosis, management and outcome of epiphora referrals to an oculoplastic practice.METHODS： Retrospective chart review of patients referred for epiphora to an oculoplastic clinic b...AIM： To investigate the etiology, diagnosis, management and outcome of epiphora referrals to an oculoplastic practice.METHODS： Retrospective chart review of patients referred for epiphora to an oculoplastic clinic between 2005 and 2009. Patient demographics, past history, ophthalmic examination, treatment and outcome were analyzed.RESULTS： There were 237 subjects with a primary complaint of epiphora. They included 130 （55%） females and 107 （45%） males with an average age of 55.9±25.9y. The most common cause of epiphora was lacrimal obstruction （46%）; followed by multifactorial epiphora （22%）, reflex tearing （22%） and eyelid malposition （11%）. Differences in prevalence of etiology were noted in terms of age and gender distribution. Of the 182 （77%） patients who returned for follow up, 41 （23%） reported a complete resolution and 102 （56%） reported a significant improvement in their symptoms.CONCLUSION： Epiphora is a common condition with many causes. A thorough history and examination are required to provide the appropriate treatment tailored to the underlying cause.展开更多
AIM： To evaluate the effectiveness of the Crawford tube in treating symptomatic epiphora without nasolacrimal obstruction. METHODS： A protocol was adopted for the management of symptomatic epiphora without nasolacri...AIM： To evaluate the effectiveness of the Crawford tube in treating symptomatic epiphora without nasolacrimal obstruction. METHODS： A protocol was adopted for the management of symptomatic epiphora without nasolacrimal obstruction. Patients who suffered symptomatic epiphora without nasolacrimal obstruction in both eyes were included in the study. One eye was treated with Crawford tube intubation and the other eye was treated with medication therapy. Degree of watering, patient satisfaction, and symptomatic improvement were carefully evaluated by one of the authors at the end of the follow-up period, after Crawford tube removal, to ascertain functional results. RESULTS： Thirty-seven adult patients （37 eyes） underwent Crawford tube intubation for functional epiphora. The mean follow-up time after removal of the tube was 14.8 ~4.8mo. The procedure was an overall success in 28 eyes （75.7%）, with symptoms improving significantly. Two eyes （5.4%） were relieved of indoor epiphora, two （5.4%） had minimal epiphora outdoors, but only with wind or cold, and five （13.5%） continued to experience tearing both indoors and outdoors. Thirty of the patients （81%） expressed satisfaction with the procedure. CONCLUSION： Crawford tube insertion is an effective, safe, simple, and relatively noninvasive treatment strategy for functional lacrimal system obstruction.展开更多
AIM:To identify the risk factors of epiphora in patients with anatomical patency after surgical repair of canalicular laceration.METHODS:This retrospective case series included 178 cases of canalicular laceration repa...AIM:To identify the risk factors of epiphora in patients with anatomical patency after surgical repair of canalicular laceration.METHODS:This retrospective case series included 178 cases of canalicular laceration repair from 2005 to 2012.Demographic data collected from each patient included age,sex,type of injury,distance from the distal lacerated end of the canaliculus to the punctum,the severity score for the structural abnormity of the medial canthus,the duration of stent placement,and the timing of surgery.The risk factors for epiphora were evaluated using Logistic regression models.RESULTS:Among the 178 cases,45(25.3%)with lacrimal patency after irrigation had symptomatic epiphora at the final follow-up.Patients'sex,age,type of injury,duration of stent placement,timing of surgery,and concurrent trauma were not found to be significantly associated with symptomatic epiphora after surgical repair of the lacerated canaliculus(P>0.05).A distance of more than 5 mm from the distal cut end to the punctum was closely and significantly associated with symptomatic epiphora after surgical repair of the lacerated canaliculus(P<0.01).Symptomatic epiphora was significantly more frequent in patients with higher severity scores for structural abnormities of the medial canthus(P<0.01).CONCLUSION:Our results indicate that the risk factors for postoperative symptomatic epiphora include a further distance between the distal cut end and the lacrimal punctum and a higher severity score for structural abnormities of the medial canthus.These findings could be used to prognosticate postoperative symptomatic epiphora.展开更多
AIM:To investigate the effect of bicanalicular silicone tube intubation(BSTI)in the treatment of functional epiphora after endoscopic dacryocystorhinostomy(En-DCR).METHODS:Clinical data of 84 patients(95 eyes)with fun...AIM:To investigate the effect of bicanalicular silicone tube intubation(BSTI)in the treatment of functional epiphora after endoscopic dacryocystorhinostomy(En-DCR).METHODS:Clinical data of 84 patients(95 eyes)with functional epiphora after En-DCR were retrospectively analyzed.Functional epiphora was confirmed as persistent or recurrent epiphora by fluorescein dye disappearance test(FDDT),lacrimal irrigation test,as well as endoscopic examination.Secondary BSTIs were recommended for patients with functional epiphora.These tubes were removed 1mo after surgery.Functional success and associated complications were assessed after 2y of follow-up.RESULTS:Seven patients(9 eyes)refused intervention,5 patients(6 eyes)did not complete postoperative followup,and 1 patient(1 eye)developed tube prolapse within 1mo after surgery.Seventy-one patients(79 eyes)were included at last.Functional success ratios at six months,one year,as well as two years post-operation were 94.9%(75/79),92.4%(73/79),and 91.1%(72/79),respectively.Three eyes presented with punctal slitting(2 eyes without epiphora),1 eye with proximal canaliculus slitting,1 eye with canaliculus stenosis and 4 eyes with still present functional epiphora without detectable abnormal at the last follow-up.CONCLUSION:Secondary intubation is an effective procedure with low recurrence probability for functional epiphora after En-DCR.Punctal and canaliculus injury are the main tube-associated complications after secondary intubation.展开更多
BACKGROUND Functional epiphora is a clinical condition which is not due to an anatomic defect.Most studies agree that it involves the action of the orbicularis oculi muscle,particularly its deeper segment(Horner’s mu...BACKGROUND Functional epiphora is a clinical condition which is not due to an anatomic defect.Most studies agree that it involves the action of the orbicularis oculi muscle,particularly its deeper segment(Horner’s muscle),but the exact mechanism is not clear.AIM To evaluate the orbicularis oculi muscle in functional epiphora patients using electromyography(EMG).METHODS A total of 8 Chinese patients(16 eyes)with functional epiphora were enrolled in this study,and ten volunteers(10 eyes)were included as normal controls.Five epiphora patients(five eyes)with facial palsy served as positive controls.Quantitative EMG was performed in the deeper segment of orbicularis oculi muscle.The average duration of each EMG waveform was measured.RESULTS The average duration of EMG waveforms in the normal control group,the functional epiphora group,and the facial palsy group were 6.39±0.73 ms,9.39±1.32 ms and 11.2±1.42 ms,respectively.The duration of EMG waveforms was significantly longer in the functional epiphora group than in the normal control group(P<0.05),and shorter than that in the facial palsy group(P<0.05).CONCLUSION These data indicate the presence of neurogenic orbicularis oculi muscle damage in epiphora patients,which may be the cause of functional epiphora.The etiology of neurogenic damage in the orbicularis oculi muscle requires further investigation.展开更多
Objective:To compare the clinical therapeutic effect on epiphora as sequela of peripheral facial paralysis treated with pricking technqiue of fire needling therapy at Chengqi(承泣ST1)and acupuncture treatment at conve...Objective:To compare the clinical therapeutic effect on epiphora as sequela of peripheral facial paralysis treated with pricking technqiue of fire needling therapy at Chengqi(承泣ST1)and acupuncture treatment at conventional acupoints.Methods:From September 2018 through to October 2018,64 cases of epiphora as sequela of peripheral facial paralysis were collected from the Department of Acupuncture-Moxibustion in Suzhou TCM Hospital.According to random number table,they were divided into an observation group and a control group,32 cases in each one.In the observation group,pricking technique of fire needling therapy was used at ST1,once every two days.In the control group,acupuncture with filiform needle was applied to Jingming(睛明BL1),Taiyang(太阳EX-HN5),Tongziliao(瞳子髎GB1),Sibai(四白ST2)and Quanliao(颧髎SI18)on the affected side as well as Hegu(合谷LI4)on the contralateral side,once per day.The 10-day treatment was as one 1 course and the consecutive 3 courses of treatment were required in either of the groups.Before and after treatment,Munk grade,clinical effective rate and the number of treatments were observed in the evaluation of therapeutic effect.Results:After treatment,Munk grade was improved in the patients of the two groups(both P<0.05).The improvement range in the observation group was larger than that of the control group(P<0.05).The treatment in either group achieved the obviously therapeutic effect on epiphora as sequela of peripheral facial paralysis.The effective rate in the observation group was 90.32%,higher than 61.29%in the control group(P<0.05).The mean number of treatments of the curative case were 5.11 in the observation group and were 13.73 in the control group,indicating the statistical significance in difference(P<0.05).Conclusion:Pricking technique of fire needling therapy at ST1 achieves the better effect on epiphora as sequela of peripheral facial paralysis as compared with acupuncture at conventional acupoints.展开更多
Dear Editor,Iam Yoon Jin Kong from the Department of Ophthalmology,Soonchunhyang University Bucheon Hospital,Bucheon,Korea.Herein,we describe a series of three patients with active Graves＇ophthalmopathy（GO）who pres...Dear Editor,Iam Yoon Jin Kong from the Department of Ophthalmology,Soonchunhyang University Bucheon Hospital,Bucheon,Korea.Herein,we describe a series of three patients with active Graves＇ophthalmopathy（GO）who presented with epiphora caused by swollen caruncles whose symptoms improved after surgical excision of the caruncles.展开更多
Background: Cyclosporine A (CsA) is an inhibitor of calcineurin that prevents T-cell production of inflammatory cytokines and disrupts the immune-mediated inflammatory response that plays a crucial mechanism in puncta...Background: Cyclosporine A (CsA) is an inhibitor of calcineurin that prevents T-cell production of inflammatory cytokines and disrupts the immune-mediated inflammatory response that plays a crucial mechanism in punctal stenosis. Purpose: To evaluate the clinical outcomes and tolerances of CsA in treating epiphora in eyes with punctal stenosis. Study Design: Prospective study. Methods: The study included patients who presented with symptomatic epiphora associated with lower punctal stenosis during the period between July 2019 and December 2020. Patients were treated with topical 0.05% CsA on twice daily dose with topical preservative-free artificial tears Q.I. D. Patients were followed up monthly for at least 3 months by Munk epiphora grading, Fluorescein dye disappearance test (FDT) and evaluation of the patient satisfaction. Results: A total of 26 patients with 47 eyes were included in the study with a mean age of 55.1 ± 10.24 years. All the eyes had grade 0 lower punctal stenosis with grade 4 on Munk grading and grade 3 in FDT. There was a statistically significant difference in the Munk grading and FDT along the follow-up period compared to the baseline values (p Conclusion: CsA can control the inflammation of the conjunctival sac and restore the integrity of the ocular surface with subsequent symptomatic relief of the epiphora in eyes with punctal stenosis.展开更多
BACKGROUND Lacrimal sac rhinosporidiosis,with nil or minor nasal extensions,rarely presents as an acquired cutaneous fistula in the periocular area.The correct diagnosis in such cases can be challenging,leading to rep...BACKGROUND Lacrimal sac rhinosporidiosis,with nil or minor nasal extensions,rarely presents as an acquired cutaneous fistula in the periocular area.The correct diagnosis in such cases can be challenging,leading to repeated failure of conservative or surgical interventions.CASE SUMMARY A 39-year-old female presented with a 6-year history of swelling in the periocular area,specifically in the left lacrimal sac area.Symptoms were limited to epiphora and constant mucoid discharge from the fistula,clinically mimicking chronic lacrimal sac fistula.She had a history of treatment with multiple antibiotic courses and dacryocystectomy in the past,with no or transient symptomatic relief.On surgical exploration of the site,a large pedunculated polypoidal vascular mass,suspicious of rhinosporidiosis,was noted.En bloc resection of the mass with cauterization of the base and fistulectomy was performed.Histopathology confirmed the diagnosis of lacrimal sac rhinosporidiosis.The patient was further evaluated and treated for the nasal extension of rhinosporidiosis.The patient has been frequently followed up for the last 3 years with a good clinical outcome and no recurrence.CONCLUSION Lacrimal sac rhinosporidiosis,in isolated or limited nasal extension cases,can rarely mimic a chronic discharging fistula.Patients with this disease often face distress due to misdiagnosis and repeated failure of conservative or surgical interventions.A high index of suspicion is needed for early diagnosis.Proper surgical intervention at the right time can lead to an excellent prognosis in such patients.展开更多
文摘AIM:To review the success rates and complications of interventions for functional epiphora in adults.METHODS: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.RESULTS: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.CONCLUSION: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.
文摘AIM： To investigate the etiology, diagnosis, management and outcome of epiphora referrals to an oculoplastic practice.METHODS： Retrospective chart review of patients referred for epiphora to an oculoplastic clinic between 2005 and 2009. Patient demographics, past history, ophthalmic examination, treatment and outcome were analyzed.RESULTS： There were 237 subjects with a primary complaint of epiphora. They included 130 （55%） females and 107 （45%） males with an average age of 55.9±25.9y. The most common cause of epiphora was lacrimal obstruction （46%）; followed by multifactorial epiphora （22%）, reflex tearing （22%） and eyelid malposition （11%）. Differences in prevalence of etiology were noted in terms of age and gender distribution. Of the 182 （77%） patients who returned for follow up, 41 （23%） reported a complete resolution and 102 （56%） reported a significant improvement in their symptoms.CONCLUSION： Epiphora is a common condition with many causes. A thorough history and examination are required to provide the appropriate treatment tailored to the underlying cause.
基金Supported by the National Natural Science Foundation of China (No.81070705 No.81270974)+1 种基金Zhejiang Provincial Natural Science Foundation of China (No. LY13H120002)Science and Technology Department of Zhejiang Province (No. 2014KYB111)
文摘AIM： To evaluate the effectiveness of the Crawford tube in treating symptomatic epiphora without nasolacrimal obstruction. METHODS： A protocol was adopted for the management of symptomatic epiphora without nasolacrimal obstruction. Patients who suffered symptomatic epiphora without nasolacrimal obstruction in both eyes were included in the study. One eye was treated with Crawford tube intubation and the other eye was treated with medication therapy. Degree of watering, patient satisfaction, and symptomatic improvement were carefully evaluated by one of the authors at the end of the follow-up period, after Crawford tube removal, to ascertain functional results. RESULTS： Thirty-seven adult patients （37 eyes） underwent Crawford tube intubation for functional epiphora. The mean follow-up time after removal of the tube was 14.8 ~4.8mo. The procedure was an overall success in 28 eyes （75.7%）, with symptoms improving significantly. Two eyes （5.4%） were relieved of indoor epiphora, two （5.4%） had minimal epiphora outdoors, but only with wind or cold, and five （13.5%） continued to experience tearing both indoors and outdoors. Thirty of the patients （81%） expressed satisfaction with the procedure. CONCLUSION： Crawford tube insertion is an effective, safe, simple, and relatively noninvasive treatment strategy for functional lacrimal system obstruction.
基金Supported by National Natural Science Foundation of China(No.81600731)Projects of Science and Technology Research of Guangdong Province(No.2012B031800294)。
文摘AIM:To identify the risk factors of epiphora in patients with anatomical patency after surgical repair of canalicular laceration.METHODS:This retrospective case series included 178 cases of canalicular laceration repair from 2005 to 2012.Demographic data collected from each patient included age,sex,type of injury,distance from the distal lacerated end of the canaliculus to the punctum,the severity score for the structural abnormity of the medial canthus,the duration of stent placement,and the timing of surgery.The risk factors for epiphora were evaluated using Logistic regression models.RESULTS:Among the 178 cases,45(25.3%)with lacrimal patency after irrigation had symptomatic epiphora at the final follow-up.Patients'sex,age,type of injury,duration of stent placement,timing of surgery,and concurrent trauma were not found to be significantly associated with symptomatic epiphora after surgical repair of the lacerated canaliculus(P>0.05).A distance of more than 5 mm from the distal cut end to the punctum was closely and significantly associated with symptomatic epiphora after surgical repair of the lacerated canaliculus(P<0.01).Symptomatic epiphora was significantly more frequent in patients with higher severity scores for structural abnormities of the medial canthus(P<0.01).CONCLUSION:Our results indicate that the risk factors for postoperative symptomatic epiphora include a further distance between the distal cut end and the lacrimal punctum and a higher severity score for structural abnormities of the medial canthus.These findings could be used to prognosticate postoperative symptomatic epiphora.
文摘AIM:To investigate the effect of bicanalicular silicone tube intubation(BSTI)in the treatment of functional epiphora after endoscopic dacryocystorhinostomy(En-DCR).METHODS:Clinical data of 84 patients(95 eyes)with functional epiphora after En-DCR were retrospectively analyzed.Functional epiphora was confirmed as persistent or recurrent epiphora by fluorescein dye disappearance test(FDDT),lacrimal irrigation test,as well as endoscopic examination.Secondary BSTIs were recommended for patients with functional epiphora.These tubes were removed 1mo after surgery.Functional success and associated complications were assessed after 2y of follow-up.RESULTS:Seven patients(9 eyes)refused intervention,5 patients(6 eyes)did not complete postoperative followup,and 1 patient(1 eye)developed tube prolapse within 1mo after surgery.Seventy-one patients(79 eyes)were included at last.Functional success ratios at six months,one year,as well as two years post-operation were 94.9%(75/79),92.4%(73/79),and 91.1%(72/79),respectively.Three eyes presented with punctal slitting(2 eyes without epiphora),1 eye with proximal canaliculus slitting,1 eye with canaliculus stenosis and 4 eyes with still present functional epiphora without detectable abnormal at the last follow-up.CONCLUSION:Secondary intubation is an effective procedure with low recurrence probability for functional epiphora after En-DCR.Punctal and canaliculus injury are the main tube-associated complications after secondary intubation.
文摘BACKGROUND Functional epiphora is a clinical condition which is not due to an anatomic defect.Most studies agree that it involves the action of the orbicularis oculi muscle,particularly its deeper segment(Horner’s muscle),but the exact mechanism is not clear.AIM To evaluate the orbicularis oculi muscle in functional epiphora patients using electromyography(EMG).METHODS A total of 8 Chinese patients(16 eyes)with functional epiphora were enrolled in this study,and ten volunteers(10 eyes)were included as normal controls.Five epiphora patients(five eyes)with facial palsy served as positive controls.Quantitative EMG was performed in the deeper segment of orbicularis oculi muscle.The average duration of each EMG waveform was measured.RESULTS The average duration of EMG waveforms in the normal control group,the functional epiphora group,and the facial palsy group were 6.39±0.73 ms,9.39±1.32 ms and 11.2±1.42 ms,respectively.The duration of EMG waveforms was significantly longer in the functional epiphora group than in the normal control group(P<0.05),and shorter than that in the facial palsy group(P<0.05).CONCLUSION These data indicate the presence of neurogenic orbicularis oculi muscle damage in epiphora patients,which may be the cause of functional epiphora.The etiology of neurogenic damage in the orbicularis oculi muscle requires further investigation.
文摘Objective:To compare the clinical therapeutic effect on epiphora as sequela of peripheral facial paralysis treated with pricking technqiue of fire needling therapy at Chengqi(承泣ST1)and acupuncture treatment at conventional acupoints.Methods:From September 2018 through to October 2018,64 cases of epiphora as sequela of peripheral facial paralysis were collected from the Department of Acupuncture-Moxibustion in Suzhou TCM Hospital.According to random number table,they were divided into an observation group and a control group,32 cases in each one.In the observation group,pricking technique of fire needling therapy was used at ST1,once every two days.In the control group,acupuncture with filiform needle was applied to Jingming(睛明BL1),Taiyang(太阳EX-HN5),Tongziliao(瞳子髎GB1),Sibai(四白ST2)and Quanliao(颧髎SI18)on the affected side as well as Hegu(合谷LI4)on the contralateral side,once per day.The 10-day treatment was as one 1 course and the consecutive 3 courses of treatment were required in either of the groups.Before and after treatment,Munk grade,clinical effective rate and the number of treatments were observed in the evaluation of therapeutic effect.Results:After treatment,Munk grade was improved in the patients of the two groups(both P<0.05).The improvement range in the observation group was larger than that of the control group(P<0.05).The treatment in either group achieved the obviously therapeutic effect on epiphora as sequela of peripheral facial paralysis.The effective rate in the observation group was 90.32%,higher than 61.29%in the control group(P<0.05).The mean number of treatments of the curative case were 5.11 in the observation group and were 13.73 in the control group,indicating the statistical significance in difference(P<0.05).Conclusion:Pricking technique of fire needling therapy at ST1 achieves the better effect on epiphora as sequela of peripheral facial paralysis as compared with acupuncture at conventional acupoints.
基金Supported by the Soonchunhyang University Research Fund(No.20160003)
文摘Dear Editor,Iam Yoon Jin Kong from the Department of Ophthalmology,Soonchunhyang University Bucheon Hospital,Bucheon,Korea.Herein,we describe a series of three patients with active Graves＇ophthalmopathy（GO）who presented with epiphora caused by swollen caruncles whose symptoms improved after surgical excision of the caruncles.
文摘Background: Cyclosporine A (CsA) is an inhibitor of calcineurin that prevents T-cell production of inflammatory cytokines and disrupts the immune-mediated inflammatory response that plays a crucial mechanism in punctal stenosis. Purpose: To evaluate the clinical outcomes and tolerances of CsA in treating epiphora in eyes with punctal stenosis. Study Design: Prospective study. Methods: The study included patients who presented with symptomatic epiphora associated with lower punctal stenosis during the period between July 2019 and December 2020. Patients were treated with topical 0.05% CsA on twice daily dose with topical preservative-free artificial tears Q.I. D. Patients were followed up monthly for at least 3 months by Munk epiphora grading, Fluorescein dye disappearance test (FDT) and evaluation of the patient satisfaction. Results: A total of 26 patients with 47 eyes were included in the study with a mean age of 55.1 ± 10.24 years. All the eyes had grade 0 lower punctal stenosis with grade 4 on Munk grading and grade 3 in FDT. There was a statistically significant difference in the Munk grading and FDT along the follow-up period compared to the baseline values (p Conclusion: CsA can control the inflammation of the conjunctival sac and restore the integrity of the ocular surface with subsequent symptomatic relief of the epiphora in eyes with punctal stenosis.
文摘BACKGROUND Lacrimal sac rhinosporidiosis,with nil or minor nasal extensions,rarely presents as an acquired cutaneous fistula in the periocular area.The correct diagnosis in such cases can be challenging,leading to repeated failure of conservative or surgical interventions.CASE SUMMARY A 39-year-old female presented with a 6-year history of swelling in the periocular area,specifically in the left lacrimal sac area.Symptoms were limited to epiphora and constant mucoid discharge from the fistula,clinically mimicking chronic lacrimal sac fistula.She had a history of treatment with multiple antibiotic courses and dacryocystectomy in the past,with no or transient symptomatic relief.On surgical exploration of the site,a large pedunculated polypoidal vascular mass,suspicious of rhinosporidiosis,was noted.En bloc resection of the mass with cauterization of the base and fistulectomy was performed.Histopathology confirmed the diagnosis of lacrimal sac rhinosporidiosis.The patient was further evaluated and treated for the nasal extension of rhinosporidiosis.The patient has been frequently followed up for the last 3 years with a good clinical outcome and no recurrence.CONCLUSION Lacrimal sac rhinosporidiosis,in isolated or limited nasal extension cases,can rarely mimic a chronic discharging fistula.Patients with this disease often face distress due to misdiagnosis and repeated failure of conservative or surgical interventions.A high index of suspicion is needed for early diagnosis.Proper surgical intervention at the right time can lead to an excellent prognosis in such patients.
