Alexandrakis G, Tse D T, Rosa R H, Johnson T E
Bascom Palmer Eye Institute, University of Miami School of Medicine, Fla, USA.
Arch Ophthalmol. 1999 Dec;117(12):1617-22. doi: 10.1001/archopht.117.12.1617.
To report the association of acquired nasolacrimal duct obstruction and orbital cellulitis in patients with a history of chronic intranasal cocaine abuse.
Retrospective, consecutive case series. Results of imaging, histopathologic examinations, and clinical courses of these patients were studied.
Five women and 2 men (mean age, 41 years) with a history of chronic intranasal cocaine abuse (mean, 11 years; range, 5-20 years) presented with epiphora and in some cases acute onset of periorbital pain, edema, and erythema associated with fever. The suspicion of intranasal cocaine abuse was made on anterior rhinoscopy with the detection of an absent nasal septum and inferior turbinate. Computed tomographic and magnetic resonance imaging findings in 4 patients included extensive bony destruction of the normal orbital wall architecture, opacification of the sinuses, and the presence of an intraorbital tissue mass. Histopathologic examination of the nasolacrimal duct in 2 patients and of the orbital mass in a third patient revealed marked chronic inflammation with fibrosis causing secondary nasolacrimal duct obstruction. Six patients were treated with systemic antibiotics followed by dacryocystorhinostomy in 3 patients, and a pericranial flap to insulate the exposed orbit in 1 patient.
Chronic intranasal cocaine abuse can result in extensive bony destruction of the orbital walls with associated orbital cellulitis, and should be included in the differential diagnosis of acquired nasolacrimal duct obstruction. Anterior rhinoscopy is very helpful in establishing the correct diagnosis in these patients.
报告有慢性鼻内可卡因滥用史患者中获得性鼻泪管阻塞与眼眶蜂窝织炎之间的关联。
回顾性连续病例系列研究。对这些患者的影像学检查结果、组织病理学检查结果及临床病程进行研究。
5名女性和2名男性（平均年龄41岁）有慢性鼻内可卡因滥用史（平均11年；范围5 - 20年），表现为溢泪，部分病例伴有眶周疼痛、水肿、红斑及发热的急性发作。在前鼻镜检查中发现鼻中隔缺失和下鼻甲，从而怀疑存在鼻内可卡因滥用。4例患者的计算机断层扫描和磁共振成像结果显示正常眶壁结构广泛骨质破坏、鼻窦混浊及眶内组织肿块。2例患者鼻泪管及第3例患者眶内肿块的组织病理学检查显示明显的慢性炎症伴纤维化，导致继发性鼻泪管阻塞。6例患者接受了全身抗生素治疗，3例患者随后接受了泪囊鼻腔吻合术，1例患者采用颅周皮瓣隔离暴露的眼眶。
慢性鼻内可卡因滥用可导致眶壁广泛骨质破坏并伴有眼眶蜂窝织炎，应纳入获得性鼻泪管阻塞的鉴别诊断。前鼻镜检查对这些患者确立正确诊断非常有帮助。
