Ординатура / Офтальмология / Английские материалы / The Lacrimal System Diagnosis, Management, and Surgery_Cohen, Mercandetti, Brazzo_2006

xvi Contributors

Marco Carvessacio, MD

The Ocular Suface, Ethis Communications Inc., New York, NY 10038,

USA

Francois Codere, MD

Associate Professor, Department of Ophthalmology, McGill University, and Royal Victoria Hospital, Montreal, Quebec, Canada

Adam J. Cohen, MD

Consulting Surgeon, Eyelid and Facial Aesthetic and Reconstructive

Surgery, Craniofacial Surgery, Neuro-Ophthalmology, Evanston, IL

60201, USA

Steven C. Dresner, MD

Associate Clinical Professor, Keck School of Medicine, University of Southern California; Fellowship Director, Ophthalmic Plastic and Reconstructive Surgery, Eyesthetica, Los Angeles, CA 90033, USA

Mark T. Duffy, MD, PhD

Orbital, Oculoplastic, Facial and Reconstructive Surgery, Green Bay Eye Clinic, Green Bay, WI 54307, USA

Jonathan J. Dutton, MD, PhD

Professor and Vice Chair, Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA

Karl-Heinz Emmerich, Priv.Doz.

Direktor der Augenklinik, Klinikum Darmstadt – Akad. Lehrhospital der Universitäten Frankfurt und Mannheim-Heidelberg – Heidelberger Landstr. 379, 64297 Darmstadt, Germany

Irene D. Enriquez, MD

Fellow in Ophthalmic Plastic and Reconstructive Surgery, University of Hawaii School of Medicine, Honolulu, HI 96817, USA

Robert G. Fante, MD

Clinical Assistant Professor, Fante Eye and Face Center, Department of Ophthalmology and Otolaryngology, University of Colorado Medical School, Denver, CO 80205, USA

Roberta E. Gausas, MD

Director of Oculoplastic and Orbital Surgery, Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA 19104, USA

Geoffrey J. Gladstone, MD, FACS

Clinical Professor, Department of Ophthalmology, Michigan State University School of Medicine, East Lansing, MI 48824; Assistant Clinical Professor, Department of Ophthalmology and Otolaryngology, Kresge

Contributors xvii

Eye Institute, Wayne State University School of Medicine, Detroit, MI 48201; Co-director, Oculoplastic Surgery, Department of Ophthalmology, William Beaumont Hospital, Royal Oak, MI 48073; and Consultants in Ophthalmic and Facial Plastic Surgery, Southfield, MI 48034, USA

John D. Griffiths, MD, FACS

Clinical Associate Professor, Department of Ophthalmology, University of Nebraska College of Medicine, Omaha, NE 68198, USA

Richard H. Hart, MD, MBChB, FRANZCO

Adnexal Fellow, Moorfields Eye Hospital, London, England

Morris E. Hartstein, MD

Associate Professor, Department of Ophthalmology and Surgery, St. Louis University Eye Institute, St. Louis, MO 63104, USA

Jan Lei Iwata, Pharm D, DO, MS

Attending Medical Staff, Advocate-Illinois Masonic, Medical Center, Oculoplastics Service, Chicago, IL 60657, USA

Reynaldo M. Javate, MD, FICS

Professor of Ophthalmology, Chief, Oculofacial, Orbit, and Lacrimal Section, Department of Ophthalmology, University of Santo Tomas, Manila, The Philippines

James A. Katowitz, MD

Professor, Department of Ophthalmology and Director of Oculoplastic and Orbital Surgery at The Children’s Hospital of Philadelphia and the Edwin and Fannie Gray Hall Center for Human Appearance, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA

William R. Katowitz, MD

Resident, Department of Ophthalmology. The Scheie Eye Institute and The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA

Jennifer S. Landy, MD

Brandon Eye Associates, 1463 Oakfield Drive, Brandon, FL 33511, USA

Susan Irene E. Lapid-Lim, MD, DPBO

Visiting Consultant, Department of Ophthalmology, University of Santo Tomas, Manila, Philippines

Michael A. Lemp, MD

Clinical Professor, Department of Ophthalmology, Georgetown University, Washington, DC 20016; Clinical Professor, Department of Ophthalmology, George Washington University, Washington, DC 20016, USA

xviii Contributors

Mark J. Lucarelli, MD

Director, Oculoplastics Service, and Associate Professor, University of Wisconsin – Madison, Madison, WI 53792, USA

Harry Marshak, MD

Clinical Instructor, Department of Ophthalmology, Doheny Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USA

Michael Mercandetti, MD, MBA, FACS

Attending Staff, Department of Surgery, Doctor’s Hospital, Sarasota, FL 34239, USA

Hans-Werner Meyer-Rüsenberg, Prof. Dr. Med.

Direktor der Universitäts-Augenklinik, St. Josefs-Hospital Hagen Universität Witten/Herdecke, Deutschland

Joseph P. Mirante, MD, MBA, FACS

Clinical Assistant Professor, Department of Otolaryngology, University of South Florida, Tampa, FL 33620; Attending Otolaryngologist, Halifax Medical Center, Daytona Beach, FL 32114, USA

Showkat Mirza, BmedSci, FRCSEd

Senior Specialist Registrar, Queens Medical Center, Nottingham,

United Kingdom

Frank A. Nesi, MD, FAACS

Assistant Clinical Professor, Department of Ophthalmology and Otolaryngology: Co-Director, Oculoplastic Surgery, Kresge Eye Institute, Wayne State University School of Medicine, Detroit, MI 48201; Clinical Professor, Department of Ophthalmology and Neurology, Michigan State University, Lansing, MI 48824; Director, Oculoplastic Surgery, Department of Ophthalmology, William Beaumont Hospital, Royal Oak, MI 48073; and Consultants in Ophthalmic and Facial Plastic Surgery, Southfield, MI 48034, USA

Niall P. O’Donnell, FRCS, FRCOphth

Oculoplastic and Orbital Surgeon, Leicester Royal Infirmary, University Hospitals Leicester, United Kingdom

Jay Justin Older, MD, FACS

Affiliate Professor, Department of Ophthalmology, University of South Florida College of Medicine, Tampa, FL, USA

John Pak, MD, PhD

Department of Ophthalmology and Visual Sciences, University of Illinois Eye and Ear Infirmary, Chicago, IL 60611, USA

Contributors xix

Ferdinand G. Pamintuan, MD

Clinical Faculty, Department of Otorhinolaryngology, University of

Santo Tomas, Manila, Philippines

Jerry K. Popham, MD, FACS

Park Avenue OculoPlastic Surgeons, St. Denver, CO 80218, USA

Suzanne Powrie, MRCS, LRCP, FRCA, FANZCA, DA

Consultant, Anaesthetist and Clinical Director, Department of Anesthesia, Moorfields Eye Hospital, London, United Kingdom

Andrew K. Robson, FRCS

Consultant, Cumberland Infirmary, Carlisle, United Kingdom

Geoffrey E. Rose, BSc, MBBS, MS, DSc, MRCP, FRCS, FRCOphth

Consultant, Orbital and Lacrimal Surgeon, Moorfields Eye Hospital, London, United Kingdom

David W. Rossman, MD

Fellow, Oculoplastic Surgery, Montreal, Canada

Daniel P. Schaefer, MD, FACS

Director, Department of Oculoplastic, Facial, Orbital, and Reconstructive Surgery, Clinical Professor, Department of Ophthalmology, and Clinical Assistant Professor, Department of Otolaryngology, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY 14214, USA

David I. Silbert, MD, FAAP

Family Eye Group, Lancaster, PA 17604, USA

Hampson A. Sisler, MD

Manhattan Eye, Ear and Throat Hospital, New York, NY 10021, USA

Charles B. Slonim, MD, FACS

Affiliate Professor, Department of Ophthalmology, University of South Florida College of Medicine, Tampa, FL 33613, USA

Ajay Tripathi, MS, FRCS (Glasgow), FRCS (Edinburgh)

Oculoplastic and Orbital Surgeon, Southport and Ormskirk Hospitals, United Kingdom

Angelo Tsirbas, FRACO, AAFPS

Department of Ophthalmology, Flinders University, Adelaide, Australia; Department of Ophthalmology, Columbia University, New York, NY 10032, USA

xx Contributors

F. Campbell Waldrop, MD

Oculoplastic Division, EYE-Q Vision Care, Fresno, CA 93720, USA

David A. Weinberg, MD, FACS

Associate Professor, Department of Surgery (Ophthalmology) and Neurology, University of Vermont College of Medicine; Director, Orbital and Ophthalmic Plastic Surgery and Neuro-Ophthalmology, Fletcher Allen Health Care, Burlington, VT 05401, USA

Robert A. Weiss, MD, FACS

Director, Oculoplastic and Reconstructive Surgery Service, Advocate Illinois Masonic Medical Center and Chicago Eye Institute, and Clinical Associate Professor, Departments of Ophthalmology and Visual Science, and Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA

Jeffrey J. White, MD

Carolina Eye Associates, Southern Pines, NC 27378, USA

William L. White, MD

Associate Clinical Professor, Department of Pediatrics and Ophthalmology, Children’s Mercy Hospital, University of Missouri, Kansas City, Kansas City, MO 64108, USA

Peter John Wormald, MD, FRACS, FRCS, FCS (SA), MBChB

Chairman, Otolaryngology Head and Neck Surgery, Adelaide and Flinders Universities, Adelaide, Australia

Mary Ann Yasay-Luis, MD

Fellow in Ophthalmic Plastic and Reconstructive Surgery, University of Hawaii School of Medicine, Honolulu, HI 96817, USA

Section 1

Anatomy

4C.N. Burkat and M.J. Lucarelli

superioris muscle divides the gland into two lobes around the tenth week of development.1,5 The lacrimal gland continues to develop until 3–4 years after birth.3

The excretory system begins its development at an earlier stage. In the 7-mm embryo, a depression termed the naso-optic fissure develops, bordered superiorly by the lateral nasal process and inferiorly by the maxillary process. The naso-optic fissure or groove gradually shallows as the structures bordering it grow and coalesce. Before it is completely obliterated, however, a solid strand of surface epithelium thickens along the floor of the rudimentary fissure extending from the orbit to the nose. The thickened cord of epithelium becomes buried to form a rod connected to the surface epithelium at only the orbital and nasal ends. This separation from the surface typically occurs at 43 days of embryologic age.6 The superior end of the rod enlarges to form the lacrimal sac, and gives off two columns of cells that grow into the eyelid margins to become the canaliculi.7,8

Canalization of this nasolacrimal ectodermal rod begins at the fourth month or the 32to 36-mm stage of development, proceeding first in the lacrimal sac, the canaliculi, and lastly in the nasolacrimal duct.7–9 The central cells of the rod degenerate by necrobiosis, forming a lumen closed at the superior end by conjunctival and canalicular epithelium and closed at the inferior end by nasal and nasolacrimal epithelium. The superior membrane at the puncta is usually completely canalized when the eyelids separate at 7 months of gestation, and therefore is normally patent by birth. In contrast, the inferior membrane frequently persists in newborns, resulting in congenital nasolacrimal obstruction.10–12 Abnormalities of development in this region, occurring typically after the fourth month of gestation, can result in congenital absence of any segment of the nasolacrimal system, supernumerary puncta, and lacrimal

fistulae.6–9,12–15

Osteology

Whitnall16 described the orbital rim as a spiral with its two ends overlapping medially on either side of the lacrimal sac fossa. The medial orbital rim is formed anteriorly by the frontal process of the maxillary bone rising to meet the maxillary process of the frontal bone. The lacrimal sac fossa is a depression in the inferomedial orbital rim, formed by the maxillary and lacrimal bones. It is bordered by the anterior lacrimal crest of the maxillary bone and the posterior lacrimal crest of the lacrimal bone. The fossa is approximately 16-mm high, 4- to 9-mm wide, and 2-mm deep,16,17 and is narrower in women.18 The fossa is widest at its base, where it is confluent with the opening of the nasolacrimal canal. On the frontal process of the maxilla just anterior to the lacrimal sac fossa, a fine groove termed the sutura notha or sutura longitudinalis imperfecta of Weber, runs parallel to the anterior lacrimal crest (Figure 1.1).16 It is a vascular groove through which small twigs of the infraorbital artery pass through to supply the bone and nasal

Chapter 1. Anatomy of the Lacrimal System 5

FIGURE 1.1. Bony anatomy of the lacrimal sac fossa and medial orbital wall. The anterior and posterior lacrimal crests are formed by the maxillary and lacrimal bones, respectively.

mucosa, and should be anticipated during lacrimal surgery to avoid bleeding.

The medial orbital wall is formed, from anterior to posterior, by the frontal process of the maxilla, the lacrimal bone, the ethmoid bone, and the lesser wing of the sphenoid bone. The thinnest portion of the medial wall is the lamina papyracea, which covers the ethmoid sinuses laterally. The many bullae of ethmoid pneumatization appear as a honeycomb pattern medial to the ethmoid bone (Figure 1.2). The medial wall becomes thicker posteriorly at the body of the sphenoid and again anteriorly at the posterior lacrimal crest of the lacrimal bone.

The frontoethmoidal suture is important in orbital bony decompression or lacrimal surgery as it marks the roof of the ethmoid sinus. Bony dissection superior to this suture may expose the dura of the cranial cavity. The anterior and posterior ethmoidal foramina conveying branches of the ophthalmic artery and the nasociliary nerve are located at the frontoethmoidal suture, 24and 36-mm posterior to the anterior lacrimal crest, respectively (Figure 1.3).19

The anterior lacrimal crest is an important landmark during external dacryocystorhinostomy, as the anterior limb of the medial canthal tendon attaches to the anterior lacrimal crest superiorly. This attachment of the medial canthal tendon is often detached from the underlying bone along with the periosteum in order to gain better exposure during surgery.

6C.N. Burkat and M.J. Lucarelli

Ethmoid bone

Lacrimal sac fossa

Ethmoidal air cells medial to removed lacrimal bone

FIGURE 1.2. The ethmoidal air cells are medial to the removed lacrimal bone, and may extend anteriorly to pneumatize the maxillary bone of the lacrimal sac fossa.

Ostium of maxillary sinus

FIGURE 1.3. Anteroposterior distances of the foramina from the anterior lacrimal crest. The ostium of the maxillary sinus lies approximately in a vertical line to the anterior ethmoidal foramen.