Wydanie 1/2012
str. 37

Korekcja odwinięcia powieki dolnej techniką Smith Lazy-T w leczeniu patologicznego łzawienia

Correction of the medial ectropion with a Smith Lazy-T procedure as a treatment of epiphora

Radosław Różycki, Izabela Nowak-Gospodarowicz, Aleksandra Jakubaszek, Dominika Białas, Marek Rękas

Klinika Okulistyki Wojskowego Instytutu Medycznego w Warszawie
Kierownik: dr hab. n. med. Marek Rękas, prof. nadzw. WIM

Summary: The aim of this study is to present Lazy-T method of treatment in patients with medial ectropion and epiphora.
Materials and Methods: 46 eyes (29 rights, 17 lefts) in 26 patients (11 women, 15 men) were treated with Lazy-T procedure described by B. Smith in 1976.
Medical history with subjective assessment of epiphora grade in 1–10 scale, BCVA, slit lamp examination, laxity of the lower lid, medial and lateral canthal tendons’ laxity, fluorescein dye disappearance test and patency of the lacrimal tract were evaluated by each patient preoperatively. Transconjunctival diamond excision with horizontal lid shortening were performed by local anesthesia with Xylocaine 2%.
Follow-up scheme was: on 1–14-days, 3–6-months after treatment. Epiphora in 1–10 scale, lower lid laxity, inversion of the punctum, cosmetic effect and side-effects of the treatment have been evaluated. Statistical analysis was done (Wilcoxon test “Spearman rang correlation test”).
Results: Significant reduction of lower lid laxity, good lower punctum position and subjective improvement on the epiphora scale were noted by each patient. Mean lid laxity decreased statistically significant from 13.5 ± 2.1 mm before to 8.1 ± 1.1 mm after treatment (p<0.001). Epiphora grade dropped from 9 points (Me) to 4 (Me) 6 months after surgery (p<0.001). Lack of patency of the lacrimal tract was revealed only by one patient (2.17%) 6 months after the Lazy-T procedure. No patient complained about his appearance 6 moths postoperatively.
Conclusions: Presented method seems to be effective and has low complications rate.
Unfortunately there is lack of randomized studies needed to confirm its safety and effectiveness.
Due to restoration of the appropiate anatomical position of the lower eyelid described procedure can free the patient from epiphora.

Słowa kluczowe: przyśrodkowe odwinięcie powieki dolnej, odwinięcie dolnego punktu łzowego, metoda Smith Lazy-T, patologiczne łzawienie.

Keywords: medial ectropion, punctal ectropion, Smith Lazy-T procedure, epiphora.