눈물점폐쇄 환자에서 눈물점성형술과 실리콘관삽입술의 효과 비교

최창욱,서상우,김상덕,Chang Uk Choi,Sang Woo Seo,Sang Duck Kim 대한안과학회 2008 대한안과학회지 Vol.49 No.4

Purpose: To compare surgical results of two patient groups with punctal obstruction. One group underwent punctoplasty while the other group underwent silicone tube intubation. Methods: We compared postoperatively 48 eyes of 37 patients with punctal obstruction within and after one year of the procedure. 24 eyes of 17 patients had punctoplasty and 24 eyes of 20 patients had silicone tube intubation by the same surgeon. Results: Upon follow-up within one year after the punctoplasty, 13 eyes (54%) showed no epiphora, nine eyes (38%) showed intermittent epiphora, and two eyes (8%) showed persistent epiphora. However, after silicone tube intubation, 20 eyes (83%) showed no epiphora, three eyes (13%) showed intermittent epiphora, and one eye (4%) showed persistent epiphora. Over one year after the punctoplasty, one eye (4%) showed no epiphora, 19 eyes (78%) showed intermittent epiphora, and four eyes (17%) showed persistent epiphora. However, after the silicone tube intubation, 17 eyes (71%) showed no epiphora, six eyes (25%) showed intermittent epiphora, and one eye (4%) showed persistent epiphora. Conclusions: Silicone tube intubation is more effective than punctoplasty in the long term treatment of punctal obstruction. J Korean Ophthalmol Soc 49(4):543-547, 2008

상악골 내측절제술후 발생하는 유루증에 대한 고찰

조재식,임상철,조연,이재홍,정형수 대한이비인후과학회 1999 대한이비인후과학회지 두경부외과학 Vol.42 No.8

유루증(流淚症)의 원인(原因).증상(症狀).치법(治法).침치료(鍼治療)에 관(關)한 문헌적(文獻的) 고찰(考察)

오기남,남상수,이재동,최도영,안병철,박동석,이윤호,최용태,O Gi-Nam,Nam Sang-Soo,Lee Jae-Dong,Choi Do-Young,Ahn Byoung-Choul,Park Dong-Seok,Lee Yun-Ho,Choi Yong-Tae 대한침구의학회 1998 대한침구의학회지 Vol.15 No.2

Purpose ; This Investigation was aimed to find out the Causes, Symptoms, Treatment, and Acupuncture of Epiphora(Watery Eye) in Oriental Medicine Methods ; 49 books were surveyed from <Neiching> to recent published books those referred to Epiphora. Results ; In Oriental Medicine, Epiphora is divided into two types; Cool Watery eye and Hot Watery eye. Both cool and hot type can be redivided into the mild and serious cases. The mild Watery eye means tears on the cheek with the wind; The serious Watery eye means tears on the cheek unrelated the wind from time to time. Conclusions ; The cause of Epiphora can be concluded with the shortage of functional division of Liver and Kidney(肝腎虛), and the chaos and fever of Liver meridian(肝經風熱). In Acupuncture agenst Epiphora, the acupuncture point at Bladder, Gallbladder and Liver meridian occupied the high level of the most often-used acupuncture point list; The acupuncture point at the portion of head and neck, upper extremities, lower extremities, and back, especially around orbit, were mainly used against Epiphora. Recently, beyond conventional acupuncture, Auricular- Acupuncture(耳鍼療法), Herb- Acupuncture(藥鍼療法), Bleeding-Acupuncture(潟血療法), Manipulation(手技療法) used against Epiphora.

내안각 췌피교정술 후 발생한 유루

송선호,윤을식,동은상 대한두개안면성형외과학회 2010 Archives of Craniofacial Surgery Vol.11 No.1

Purpose: The epicanthus is a specific feature in Asian. Many techniques have been described to eliminate the epicanthal fold: resection of glabellar skin, resection of medial canthal skin, V-Y advancement, V-W technique,modified Z-plasty, multiple Z-plasties, and others. The authors observed postoperative epiphora after correction of epicanthal fold by periciliary skin flap without damaging lacrimal duct. Methods: A 19-year-old woman underwent non-incisional blepharoplasty, septorhinoplasty, and periciliary epicanthoplasty. On her history, she didn’t have any symptom of epiphora preoperatively. And there was no specific complaint of epiphora during the postoperative two weeks. However epiphora got worse from one month after the surgery. She was out of this country, so the patient re-visited the clinic on the postoperative six months for this on-going symptom. On an ophthalmologic examination,patient’s lacrimal duct and sac was intact but both lacrimal puncta of the patient were covered with a thin membrane. This membrane was punctuated by a 25 gauge needle and dilated with a standard dilator. Results: After ophthalmologic treatment, no recurrence was observed during five weeks of follow-up periods. Conclusion: Both lacrimal puncta of the patient were only covered with membranes. And we could not confirm the direct relationship between periciliary epicanthoplasty and postoperative epiphora. The probable factors will be a predisposing narrowed punctum, post operative peri-punctal edema and decrease in muscular function of orbicularis oculi. (J Korean Cleft Palate Craniofac Assoc 11: 41, 2010)

정상인과 퇴행성 아래 눈꺼풀 속말림 및 눈물 흘림 환자에서 안쪽, 가쪽 눈구석 인대 이완의 측정

이태은,이화,이종미,백세현,Tae Eun Lee,Hwa Lee,Jongmi Lee,Sehyun Baek 대한안과학회 2011 대한안과학회지 Vol.52 No.12

Purpose: The degree of laxity of the medial and lateral canthal tendon in Korean subjects with and without involutional entropion and epiphora was evaluated in the present study. Methods: The present study included 180 normal subjects (360 eyes), 12 patients (15 eyes) with involutional entropion, and 41 patients (58 eyes) with epiphora. The degree of laxity of the medial and lateral canthal tendon, which grades the position of the inferior punctum, was measured using the lateral and medial distraction test. Results: The mean degree of medial and lateral canthal tendon laxity was 1.83/1.08 in normal subjects. A statistical difference was not observed between sexes, and the mean degree of laxity tended to be higher in older patients. The mean degree of laxity was 2.78/2.18 and 2.28/1.22 in the involutional entropion group and the epiphora group, respectively. The involutional entropion group and the epiphora group underwent endoscopic endonasal dacryocystitis (D), medial spindle procedure (M), and endoscopic endonasal dacryocystitis with the medial spindle procedure and/or the tarsal strip procedure (T). The mean degree of laxity was 1.84/1.04 in group D, 3.00/1.20 in group M, 2.33/2.00 in group D + T, 3.20/1.40 in group D + M and 3.50/2.00 in group D + T + M before surgery. Conclusions: The results from the present study may aid in the selection of a basic treatment plan for Korean patients with involutional entropion or epiphora. J Korean Ophthalmol Soc 2011;52(12):1385-1390

Development of Predictive Models in Patients with Epiphora Using Lacrimal Scintigraphy and Machine Learning

박용진,배지훈,신무헌,현승협,조영석,최연성,최준영,이경한,김병태,문승환 대한핵의학회 2019 핵의학 분자영상 Vol.53 No.2

Purpose We developed predictive models using different programming languages and different computing platforms for machine learning (ML) and deep learning (DL) that classify clinical diagnoses in patients with epiphora.We evaluated the diagnostic performance of these models. Methods Between January 2016 and September 2017, 250 patients with epiphora who underwent dacryocystography (DCG) and lacrimal scintigraphy (LS) were included in the study.We developed five different predictive models usingMLtools, Pythonbased TensorFlow, R, and Microsoft Azure Machine Learning Studio (MAMLS). A total of 27 clinical characteristics and parameters including variables related to epiphora (VE) and variables related to dacryocystography (VDCG) were used as input data. Apart from this, we developed two predictive convolutional neural network (CNN) models for diagnosing LS images. We conducted this study using supervised learning. Results Among 500 eyes of 250 patients, 59 eyes had anatomical obstruction, 338 eyes had functional obstruction, and the remaining 103 eyes were normal. For the data set that excluded VE and VDCG, the test accuracies in Python-based TensorFlow, R, multiclass logistic regression in MAMLS, multiclass neural network in MAMLS, and nuclear medicine physician were 81.70%, 80.60%, 81.70%, 73.10%, and 80.60%, respectively. The test accuracies of CNN models in three-class classification diagnosis and binary classification diagnosis were 72.00% and 77.42%, respectively. Conclusions ML-based predictive models using different programming languages and different computing platforms were useful for classifying clinical diagnoses in patients with epiphora and were similar to a clinician’s diagnostic ability.

Surgical treatment of epiphora with eyelid retraction after a lower eyelid surgery

Jae Hun Lee,Nam Yeong Kim,Hee Bae Ahn 대한미용의학회 2020 대한미용의학회지 Vol.4 No.2

Background: Because of the rapidly increasing demand for cosmetic surgery in Korea, the number of patients presenting with epiphora after lower eyelid surgery and diagnosed with retraction is currently increasing. Objective: To evaluate the effect of the lateral tarsal strip procedure (LTS) in patients with epiphora and eyelid retraction after lower eyelid surgery. Methods: A total of 145 eyes of 81 patients who reported to our hospital between January 2010 and February 2020 were included in the study. Twenty-six eyes of 17 patients underwent LTS, and 119 eyes of 64 patients underwent LTS combined with silicone tube intubation or endonasal dacryocystorhinostomy (DCR). The pre- and postoperative symptoms, margin reflex distance 2 (MRD2), tear meniscus height (TMH), and complications were retrospectively compared. Results: Seventy-two of the 81 patients (88.9%) showed improvements in epiphora. The improvements in TMH in the combined surgery and single surgery groups were 0.45±0.28 and 0.44±0.18 mm, respectively, showing postoperative improvements in both groups. MRD2 also improved to 0.62±0.66 and 0.27±0.68 mm in the combined surgery and single surgery groups, respectively. No significant difference was observed between the two groups. Conclusion: LTS is an effective surgical method for epiphora in patients experiencing eyelid retraction after lower eyelid surgery. Its combination with silicone tube intubation or endonasal DCR is considered effective for lacrimal pathway disorders.

눈물길 조영검사 시 양측 안 와 사위 상 획득의 유용성에 대한 연구

박좌우,이범희,박승환,박수영,정찬욱,류형기,김호신,Park, Jwa-Woo,Lee, Bum-Hee,Park, Seung-Hwan,Park, Su-Young,Jung, Chan-Wook,Ryu, Hyung-Gi,Kim, Ho-Shin 대한핵의학기술학회 2014 핵의학 기술 Vol.18 No.1

눈물길 조영검사 시 눈물기관 해부학적 구조의 다양성, 눈물길기형, 검사 중 발생하는 유루증과 같은 경우 전면상 외에 코 안으로의 배출을 좀 더 자세히 표현해낼 수 있으며, 유루증과 코 눈물관으로의 배출을 구별할 수 있는 방법의 필요성을 생각해 보았다. 이에 전면상 지연 촬영 외에 양측 안 와 사위상을 획득하는 방법의 유용성에 대해 알아 보고자 하였다. 2013년 1월부터 2013년 8월까지 눈물길폐쇄로 인한 유루증을 주소로 하는 78명의 환자를 대상으로 하였다. 평균나이는 $56.96{\pm}13.36$세였다. $^{99m}TcO4^-$ 3.7 MBq (0.1 mCi)을 $10{\mu}L$ 씩 마이크로피펫을 이용하여 양 안 하결막낭에 1-2방울 점안 후 1분 씩 20frame, 20분 간 동적 검사를 시행 하였다. 동적 검사 직후 양 안에서 코 안으로 배출이 확인되는 경우는 즉시 사위상을 획득하였고 어느 한쪽의 안 와라도 배출이 보이지 않는 경우 40분 뒤 전면상으로 확인 후 안 와 사 위상을 획득하였다. 검사 시 사용한 장비로는 Pin-hole Collimator를 장착한 Gamma Camera (Siemens Orbiter, Hoffman Estates, IL, USA)장비를 사용하였다. 실험대상 78건의 영상 중 전면상에서 코 안으로의 배출이 확인되었던 환자는 35명이었다. 그 중 양 안 모두에서 코 안으로 배출을 보인 환자는 15명이었고 양 안 8명, 좌 안 2명, 우 안 1명에서 사위상을 통해 보다 나은 배출 양상 관찰이 가능하였다. 좌 안 및 우 안에서 배출이 있었던 환자는 20명이었고 10명이 전면상에 비해 명확한 배출을 보여 주었다. 그 외 배출 가능성이 있는 환자는 13명이었으며 코 눈물관으로의 추적자이동이 보이지 않은 환자는 30명이었다. 기술통계 결과 총 35명 중 21명(60%)이 사위상 추가 촬영으로 전면상보다 뚜렷한 배출 양상을 나타내었다. 배출 감별유용성에 관한 Likert 5점 척도 blind test를 통해 사위상 획득이 전면상에서 자세히 보이지 않는 부분을 나타내 줌으로써 배출 유무 확인이나 배출 지연, 코 눈물관 폐쇄를 진단하는 데 도움이 된다고 응답하였다. 또한 유루증 발생시 코 눈물관으로의 배출과 피부로의 흘림을 구별할 때 사위상이 전면상에 비해 구별능이 높다고 응답하였다(전면상:$4.14{\pm}0.3$, 사위상:$4.55{\pm}0.4$). 눈물길 조영검사 시 양측 안 와 사위상을 전면상 이외에 추가적으로 획득한다면 전면상에서 충분히 보여주지 못하는 영역의 검사가 가능하여 코 눈물관 이후로의 배출 유무를 확인하고 피부에서 유루증의 흐름을 코 눈물관과 구별하는 데 용이하기에 판독의 진단능을 높일 수 있을 것이라 사료된다. Purpose: Diversity and the lachrymal duct deformities and the passage inside the nasal cavity except for anterior image such as epiphora happens during the test were able to express more precisely during the dacryoscintigraphy. Also, we thought about the necessity of a method to classify the passage into the naso-lachrymal duct from epiphora. Therefore, we are to find the validity of the method to obtain both oblique views except for anterior views. Materials and Methods: The targets of this research are 78 patients with epiphora due to the blockage at the lachrymal duct from January 2013 to August 2013. Average age was $56.96{\pm}13.36$. By using a micropipette, we dropped 1-2 drops of $^{99m}TcO4^-$ of 3.7 MBq (0.1 mCi) with $10{\mu}L$ of each drop into the inferior conjunctival fold, then we performed dynamic check for 20 minutes with 20 frames of each minute. In case of we checked the passage from both eyes to nasal cavity immediately after the dynamic check, we obtained oblique view immediately. If we didn't see the passage in either side of the orbit, we obtained oblique views of the orbit after checking the frontal film in 40 minutes. The instrument we used was Pin-hole Collimator with Gamma Camera(Siemens Orbiter, Hoffman Estates, IL, USA). Results: Among the 78 patients with dacryoscintigraphy, 35 patients were confirmed with passage into the nasal cavity from the anterior view. Among those 35 patients, 15 patients were confirmed with passage into the nasal cavity on both eyes, and it was able to observe better passage patterns through oblique view with a result of 8 on both eyes, 2 on left eye, and 1 on right eye. 20 patients had passage in left eye or right eye, among those patients 10 patients showed clear passage compared to the anterior view. 13 patients had possible passage, and 30 patients had no proof of motion of the tracer. To sum up, 21 patients (60%) among 35 patients showed clear pattern of passage with additional oblique views compared to anterior view. People responded obtaining oblique views though 5 points scale about the utility of passage identification helps make diagnoses the passage, passage delayed, and blockage of naso-lachrymal duct by showing the well-seen portions from anterior view. Also, when classifying passage to naso-lachrymal duct and flow to the skin, oblique views has higher chance of classification in case of epiphora (anterior:$4.14{\pm}0.3$, oblique:$4.55{\pm}0.4$). Conclusion: It is considered that if you obtain oblique views of the bilateral orbits in addition to anterior view during the dacryoscintigraphy, the ability of diagnose for reading will become higher because you will be able to see the areas that you could not observe from the anterior view so that you can see if it emitted after the naso-lachrymal duct and the flow of epiphora on the skin.

Epiphora by Non-viral Squamous Papilloma of the Conjunctiva in a Dog

김주리,최을수,caryn E. Plummer,Dennis E. Brooks,김민수 한국임상수의학회 2014 한국임상수의학회지 Vol.31 No.4

A 12-year-old mixed breed male dog was referred to Chonbuk National University Animal Medical Centerwith unilateral left epiphora. Magnified ophthalmic examination revealed a very small tissue mass on the palpebralconjunctiva of the left eye. The mass was surgically removed and microscopic examination confirmed moderate papillaryhyperplasia of the squamous epithelium without viral cytopathic effects. Based on the histology, the mass was diagnosedas a non-viral squamous papilloma. After removal of the mass, the epiphora was completely solved. This case reportdescribes the non-viral squamous papilloma arising from the conjunctiva in a dog with epiphora.

이침치료를 동반한 한방치료로 호전된 유루증 환자 치험 1례

김지원,노현민,윤덕원,김용현 대한한방안이비인후피부과학회 2017 한방안이비인후피부과학회지 Vol.30 No.3

Objectives : The purpose of this study is to report the effect of traditional Korean medical treatment and auricular acupuncture on the patient suffered from epiphora. Methods : One patient suffering from epiphora was treated with traditional Korean medical treatment including auricular acupuncture. HRQL(Health-related quality of life) and VAS(Visual Analogue Scale) were measured and compared to evaluate its treatment effectiveness. Results : We attained results which show recovery from watery eye, pain, eye strain in symptoms and improvement on quality of life. Conclusions : In this study, traditional Korean medical treatment can be effective in obtunding symtoms and improving quaility of life for patients suffering from epiphora.