Varma Deepali, Chang B, Musaad Sahar
Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Orbit. 2005 Mar;24(1):11-4. doi: 10.1080/01676830590890774.
Primary chronic canaliculitis is an uncommon disease, which is often misdiagnosed and insufficiently treated. We present two cases of canaliculitis caused by two different organisms, Actinomycetes spp. and Arcanobacterium haemolyticum. To the best of our knowledge, canaliculitis due to Arcanobacterium haemolyticum has not been reported before.
The two cases described in this series show typical clinical features of canaliculitis with an inflamed upper canaliculus, not responsive to topical antibiotics. Appropriate treatment was delayed as they were initially treated for conjunctivitis. Both patients were treated with a canaliculotomy, with curettage and subsequent treatment with topical and systemic penicillin. The contents were sent for microbiological examination.
There was complete resolution following treatment. Actinomyces spp. was grown from one patient as expected. However, in the second patient, Arcanobacterium haemolyticum was isolated. Although this organism was not expected, the patient did respond to similar, conventional treatment.
Actinomyces spp. is a cast-forming Gram-positive anaerobe. They are difficult to isolate and identify and can cause infections of hollow spaces with formation of canaliculiths. Arcanobacterium (Corynebacterium) haemolyticum closely resembles Actinomyces (Corynebacterium) pyogenes. Ocular infections reported with this organism include orbital cellulitis and subperiosteal abscesses. The difficulty encountered in the isolation and identification of these organisms is discussed and the need for thorough curettage in the treatment of persistent or recurrent canaliculitis is emphasised.
Chronic canaliculitis should be considered in any patient who presents with chronic or recurrent conjunctivitis. Definitive cure will not be affected until all concretions are removed, either at surgery or by mechanical expression.
原发性慢性泪小管炎是一种罕见疾病，常被误诊且治疗不充分。我们报告两例由两种不同病原体引起的泪小管炎病例，分别为放线菌属和溶血隐秘杆菌。据我们所知，此前尚未有溶血隐秘杆菌引起泪小管炎的报道。
本系列描述的两例病例呈现出泪小管炎的典型临床特征，即上泪小管发炎，对局部抗生素治疗无反应。由于最初被误诊为结膜炎，适当治疗被延误。两名患者均接受了泪小管切开术，刮除术，并随后使用局部和全身青霉素治疗。病变组织被送去做微生物学检查。
治疗后完全康复。正如预期的那样，从一名患者身上培养出了放线菌属。然而，在第二名患者中分离出了溶血隐秘杆菌。尽管未预料到会有这种病原体，但该患者对类似的传统治疗有反应。
放线菌属是一种形成菌落的革兰氏阳性厌氧菌。它们难以分离和鉴定，可导致中空器官感染并形成泪小管结石。溶血隐秘杆菌（棒状杆菌属）与化脓放线菌（棒状杆菌属）非常相似。该病原体引起的眼部感染包括眼眶蜂窝织炎和骨膜下脓肿。讨论了分离和鉴定这些病原体时遇到的困难，并强调在治疗持续性或复发性泪小管炎时进行彻底刮除的必要性。
任何出现慢性或复发性结膜炎的患者都应考虑慢性泪小管炎。在手术或通过手法挤压清除所有结石之前，确切的治愈不会受到影响。
