先天性鼻淚管阻塞

Congenital Nasolacrimal Duct Obstruction

馬俐(Lih Ma) ； 黃瑞冰(Sui-Ping Wong) ； 吳金玉(Chin-Yuh Wu) ； 姚序駒(H-G Yao)

《中華民國眼科醫學會會刊》 25卷1期 (1986/05) Pp. 59-67

https://doi.org/10.30048/ACTASOS.198605.0013

摘要

本文收集64例（67側眼）先天性鼻淚管阻塞的病患，依其治療方式分成四組。其結果如下：第一組：單一淚管探針組，60人，年齡小於8個月小組，治療成功率96%，8個月至18個月小組，成功率為58%，18個月以上小組，成功率為50%。第二組：二次探針術組，5人，皆為18個月以上小組，成功率為50%。第三組：淚管矽小管插管組：12人，此組皆是年齡較大（大於2歲），或曾經一次或以上淚管探針術失敗的病患，經插管後，成功率可達100%。第四組：4人，單一淚管探針術合併下鼻甲內折術組，此組患者年齡較輕，皆屬18個月以下組，成功率也可達100%。
依據發生學的觀點，先天性鼻淚管阻塞在初生嬰兒發生的概率，依統計學者的不同，有很大的差距，文獻上可見的數據自50%至1.75%，而約有1/2的病患在六個月前，會自動打開，因此處理的原則是依患者的年齡，嚴重的程度，及曾經處理的方式，而有很大的不同，在本文最後討論中，我們也以流程圖的方式則出，以利大家參考。

並列摘要

Here we have collected 64 cases that included 43 males and 21 females, from ages of 1 month to 7 years old. 3 Cases were bilaterally involved and in all cases symptoms occured before the age of 6 months. We divided these into 4 groups. Gr Ⅰ consisted of patients receiving single probing, a total of 60 cases. Gr Ⅱ contained 5 cases receiving secondary probing. In Gr Ⅲ, all of the 12 cases had silicone intubation. Gr Ⅳ, 4 cases, had initial probing combined with infracture of inferior turbinate. The ages of onset are as follows: 73.4% was at the time of birth yet most (92.2%) was before 3 months old. All the cases were before the age of 6 months. We did not regard the obstruction as congenital if the symptoms occured after the age of 6 months.
The results are as follow:
1) Success rate of initial probing: 96% in patients younger than 8 months old; 58% in patients older than 8 months old.
2) Success rate of secondary probing: 50% at all age groups.
3) Success rate of LIS tube group: Nearly 100% success rate with one receiving a second intubation. The only one patient's failure came from the premature removal of the LIS tube by the patient himself.
4) Success rate of initial probing combined with infracture of inferior turbinate: 100% at all age groups.
The developmental anatomy of nasolacrimal duct:
The nasolacrimal passageway arises from a thickening of the ectoderm in the naso-optic fissure. The thickened ectoderm buries itself in the mesenchyme between the lateral nasal process and the maxillary process, detaches itself from the surface, and extends downward. Later, the epithelial cord is canalized, and becomes patent at the ocular end and, finally, at its lower nasal end. However, the nasal connection, may often incomplete at birth.
The congenital nasolacrimal duct obstruction is not an uncommon disease in the infants and young children. The etiology is due to the imperforated membrane between the nasolacrimal passage and the nasal cavity.
Congenital obstruction of the nasolacrimal duct, with associated epiphora or infection, or both, usually resolves spontaneously before 6 months old. If the obstruction persists, conventional probing of the nasolacrimal duct is generally successful. If this initial probing fails, and the patient is older than 1 year old, silicone tubing used as a stent in the lacrimal drainage system is more likely to result in a cure. Sometimes in the younger age group (younger than 1 year old), we may use probing combined with infracture of the inferior turbinate as an alternative to silicone intubation.

並列關鍵字

congenital nasolacrimal duct obstruction ； valve of hasner ； lacrimal intubation