急性泪囊炎常由慢性泪囊炎急性发作引发，典型症状为流泪，异常分泌物增多等慢性泪囊炎症状，继发泪囊区红肿热痛等急性泪囊炎表现，多为单眼发病。慢性淋巴细胞白血病（chronic lymphocytic leukemia, CLL）属于原发于造血组织的恶性血液疾病，从表面看这两种疾病在病理生理方面没有直接联系。本研究报告了1例以急性泪囊炎作为首发症状的CLL患者，表现为双眼急性泪囊炎体征，经全身检查确诊为CLL。同时，通过回顾相关文献，发现有类似报道，但一例为小儿白血病患者以急性泪囊炎首发体征出现，一例急性泪囊炎患者泪囊摘除后经病理活检确诊为CLL，目前尚未见关于CLL保守治疗后急性泪囊炎明显缓解的报道。该病的发生可能与泪道引流相关淋巴组织（lacrimal drainage-associated lymphoid tissue, LDALT）改变有关，它作为黏膜免疫系统的一部分，可引导CLL细胞向LDALT迁移并定植，破坏局部的免疫微环境，干扰泪道的免疫平衡，抑制正常免疫细胞的功能，促进导致鼻泪管淋巴细胞异常增生等，引发泪道系统引流不畅。同时，此外，CLL所致的全身免疫抑制状态，也使得机体整体抗感染能力降低，增加了泪囊感染的风险，最终导致急性泪囊炎的发生和发展。通过对该病例的潜在发病机制进行综合分析，并探讨其为临床诊疗带来的启示。

Acute dacryocystitis often results from the acute attack exacerbation of chronic dacryocystitis. Typical symptoms include those of chronic dacryocystitis, such as persistent tearing, increased abnormal secretions, as well secondary manifestations of acute dacryocystitis like redness, swelling, heat and pain in the lacrimal sac area, which are predominantly unilateral. Chronic lymphocytic leukemia (CLL) is a malignant blood disorder originating from hematopoietic tissue. On the surface, these two diseases do not appear to be directly related in terms of pathophysiology. This study reported a case of CLL presenting with acute dacryocystitis as the initial symptom. The patient exhibited signs of acute dacryocystitis in both eyes, and was subsequently diagnosed with CLL following a systemic examination. Meanwhile, a review of the relevant literature revealed similar reports. However, in one instance, acute dacryocystitis in children with leukemia appeared as the first sign of acute leukemia itself, while in another, acute dacryocystitis was diagnosed as CLL by pathological biopsy after dacryocystectomy. At present, there have been no report of significant remission of acute dacryocystitis following conservative treatment for CLL. The occurrence of this condition may be related to the changes in lacrimal drainage-associated lymphoid tissue (LDALT). As a part of the mucosal immune system, LDALT can guide CLL cells to migrate and colonize within it, thereby disrupting the local immune microenvironment, interfering with the immune balance of the lacrimal passage, inhibiting the function of normal immune cells, promoting abnormal lymphocyte proliferation in the nasolacrimal duct, and ultimately leading to impaired drainage of the lacrimal passage system. Additionally, the systemic immunosuppressive state induced by CLL reduces the body’s overall anti-infective capacity, increasing the risk of dacryocystal infection and ultimately contributing to the onset and progression of acute dacryocystitis. Through a comprehensive analysis of the potential pathogenesis of this case, we aim to explore its implications for clinical diagnosis and treatment.

目的：分析鼻内镜下泪囊鼻腔吻合术手术疗效的影响因素。方法：纳入2021年1月—2023年7月在成都中医药大学附属医院眼科行鼻内镜下泪囊鼻腔吻合术(endoscopic dacryocystorhinostomy, En-DCR)治疗的单眼慢性泪囊炎患者90例(90只眼)。所有患者均进行泪道CT造影检查及鼻内镜下泪囊鼻腔吻合术，术后随访6个月，评估手术疗效，分析手术疗效的影响因素。结果：本研究显示，慢性泪囊炎患者中女性占比为90%，平均年龄为(49.97±13.10)岁。单因素分析结果显示，术中是否置入引流管、下鼻甲肥厚与EnDCR手术疗效有关(P < 0.05)。Logistic多因素回归分析结果显示，下鼻甲肥厚为En-DCR手术疗效的危险因素(P < 0.05)。结论：慢性泪囊炎多发生于中老年女性。下鼻甲肥厚为En-DCR手术疗效的危险因素。

Objective: To analyze the influencing factors for effect of endoscopic dacryocystorhinostomy. Methods: A total of 90 patients (90 eyes) diagnosed with unilateral chronic dacryocystitis undergoing endoscopic dacryocystorhinostomy in the Department of ophthalmology, Hospital of Chengdu University of Traditional Chinese Medicine from January 2021 to July 2023 were included. All patients underwent lacrimal duct CT imaging and endoscopic dacryocystorhinostomy, and were followed up for 6 months to evaluate the efficacy of surgery. Results: This study showed that 90% of patients with chronic dacryocystitis were female, and the average age of patients was (49.97±13.096) years. The results of univariate analysis showed that there was a correlation between intraoperative drainage tube placement and inferior turbinate hypertrophy and the efficacy of En-DCR (P < 0.05). The results of Logistic regression analysis showed that inferior turbinate hypertrophy was a risk factor for the efficacy of En-DCR (P < 0.05). Conclusions: Dacryocystitis mostly occurs in middle-aged and elderly women. Inferior turbinate hypertrophy are the influencing factors of surgical effect. Chronic dacryocystitis mostly occurs in middle-aged and elderly women. Inferior turbinate hypertrophy is a risk factor affecting the curative effect of En-DCR surgery.

铁死亡是一种以铁沉积和脂质过氧化为主要特征的新型细胞死亡方式，目前在眼科方面的研究不断深入。视网膜因其本身功能和结构特点，易受到氧化应激的影响，而铁死亡已被证明在年龄相关性黄斑变性、青光眼、糖尿病性视网膜病变、视网膜色素变性等视网膜退行性疾病进程中发挥了重要作用。铁代谢途径作为铁死亡的主要调控方式之一，可通过调控细胞内铁稳态，介导芬顿反应形成脂质过氧化物，从而调控细胞铁死亡。转铁蛋白(transferrin,TF)、二价金属转运蛋白1(divalent metal transporter 1,DMT1)、铁蛋白(ferritin,FT)、铁转运蛋白1(ferroportin 1,FPN1)等铁代谢途径关键蛋白涉及细胞内铁离子的摄入、利用、储存、输出等多个方面，对细胞内铁稳态具有重要影响。通过调控铁代谢途径关键蛋白减少铁沉积而抑制铁死亡，可能成为延缓和治疗视网膜退行性疾病的新途径。文章对铁死亡概念、视网膜与铁死亡、铁死亡调控途径、铁代谢途径关键蛋白与视网膜退行性疾病的研究进展进行综述。

Ferroptosis, a novel form of cell death primarily characterized by iron deposition and lipid peroxidation, has been increasingly studied in the feld of ophthalmology. Te retina, due to its specifc functions and structure, is susceptible to oxidative stress. Ferroptosis has been proven to play a crucial role in the progression of retinal degenerative diseases such as age-related macular degeneration, glaucoma, diabetic retinopathy, and retinitis pigmentosa. Te iron metabolism pathway is one of the main regulatory mechanisms of ferroptosis, regulating intracellular iron homeostasis and mediating the formation of lipid peroxides through the Fenton reaction, thereby controlling cellular ferroptosis. Iron metabolism pathways, as one of the main regulatory mechanisms of ferroptosis, can regulate intracellular iron homeostasis and mediate the formation of lipid peroxides through the Fento reaction, thereby controlling cellur ferroptosis. Key proteins involved in iron metabolism pathways, including transferrin (TF), divalent metal transporter 1 (DMT1), ferritin (FT), and ferroportin 1 (FPN1), act as important roles in various aspects such as intracellular iron intake, utilization, storage, and export, exerting signifcant impacts on intracellular iron homeostasis. Regulating key proteins in iron metabolism pathways to reduce iron deposition and inhibiting ferroptosis may emerge aas a novel approach for delaying and treating retinal degenerative diseases. Tis article provides a comprehensive review of the concept of ferroptosis, the relationship between the retina and ferroptosis, the regulatory mechanisms of ferroptosis, and the research progress on key proteins in iron metabolism pathways and retinal degenerative diseases.