Department of Ophthalmology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Ophthalmic Plast Reconstr Surg. 2009 Nov-Dec;25(6):481-4. doi: 10.1097/IOP.0b013e3181b8c185.
To review the clinical findings, treatment outcomes, and microbiology of primary canaliculitis.
A medical record database was queried to identify cases of primary canaliculitis. The 23 cases identified were reviewed for clinical presentation, treatment, microbiology, pathology, and patient outcome at the time of most recent follow-up. Participants were also surveyed to determine long-term treatment outcomes.
Twenty-three patients met the criteria for primary canaliculitis. The median duration of symptoms was 135 days. The most common symptoms were mattering and epiphora. Punctal regurgitation was the most common clinical finding. Seven patients had multiple canalicular involvement. Treatment included either medical therapy or surgical intervention. Cultures were obtained from 16 participants. Sixty-two percent of identified organisms were gram positive, and most organisms were anaerobes or facultative anaerobes. The most common organisms identified were Streptococcus and Staphylococcus species. Actinomyces and Propionibacterium species followed. Actinomyces israelii was not cultured. Eighteen patients responded to a mailed survey (response rate, 67%). Most respondents (83%) denied having either epiphora or mattering at median 90 months follow-up. Three of the respondents reported having had an additional episode of canaliculitis since last clinical follow-up. Two of these occurred in a previously uninvolved punctum.
Although involvement of multiple canaliculi over time is more common than previously recognized, most patients do not have lingering problems with epiphora or mattering. The microbiology of primary canaliculitis does not appear to be evolving, with Actinomyces, and other anaerobes or facultative anaerobes being common pathogens.
回顾原发性泪小管炎的临床发现、治疗结果和微生物学情况。
通过查询病历数据库，确定原发性泪小管炎的病例。对确定的 23 例患者的临床表现、治疗、微生物学、病理学和最近随访时的患者结局进行回顾分析。还对参与者进行调查，以确定长期治疗结果。
23 名患者符合原发性泪小管炎的标准。症状的中位数持续时间为 135 天。最常见的症状是溢泪和溢脓。溢泪是最常见的临床发现。7 名患者存在多条泪小管受累。治疗方法包括药物治疗或手术干预。16 名参与者进行了培养。62%的鉴定菌为革兰阳性菌，大多数菌为厌氧菌或兼性厌氧菌。最常见的鉴定菌为链球菌和葡萄球菌。紧随其后的是放线菌和丙酸杆菌。未培养出衣氏放线菌。18 名患者对邮寄的调查问卷做出了回应（应答率 67%）。大多数受访者（83%）在中位数 90 个月的随访中否认有溢泪或溢脓。3 名受访者报告在最后一次临床随访后出现了另一次泪小管炎发作。其中 2 例发生在之前未受累的泪点。
尽管随着时间的推移，多个泪小管受累更为常见，但大多数患者没有持续的溢泪或溢脓问题。原发性泪小管炎的微生物学似乎没有发生变化，常见病原体为放线菌和其他厌氧菌或兼性厌氧菌。
