Tanigawa Tohru, Sasaki Hirokazu, Kaneda Masahiro, Kuruma Tessei, Ueda Hiromi
Department of Otolaryngology, Aichi Medical University, Aichi, Japan; Department of Otolaryngology, Tohno-Kousei Hospital, Gifu, Japan.
Auris Nasus Larynx. 2012 Apr;39(2):233-5. doi: 10.1016/j.anl.2011.04.005. Epub 2011 May 14.
A 47-year-old woman developed intermittent shooting pain around the right side of the nose and eyes. A neurologist initially diagnosed trigeminal neuralgia, but carbamazepine did not improve the pain. Two months later, she presented with a pus-like eye discharge and was referred to us for further examination. Poor saline irrigation from the lacrimal puncta and computed tomography findings of a swollen lacrimal sac indicated a diagnosis of lacrimal dacryostenosis. At this point, the pain and dizziness as a side effect of carbamazepine had become intolerable. Endoscopic intranasal dacryocystorhinostomy confirmed stenosis of the nasolachrymal duct and a thickened lacrimal sac. The postoperative course was uneventful, and the facial pain disappeared. This experience suggests the importance of recognizing lacrimal dacryostenosis as a differential diagnosis of facial pain around the eyes and nose. We also recommend a review of an original diagnosis of trigeminal neuralgia if carbamazepine fails to relieve facial pain.
一名47岁女性在鼻右侧和眼睛周围出现间歇性刺痛。一名神经科医生最初诊断为三叉神经痛，但卡马西平未能缓解疼痛。两个月后，她出现脓性眼部分泌物，并被转诊至我院进一步检查。泪点生理盐水冲洗不畅以及泪囊肿胀的计算机断层扫描结果提示泪道狭窄的诊断。此时，卡马西平作为副作用引起的疼痛和头晕已变得难以忍受。鼻内镜下鼻内泪囊鼻腔造口术证实鼻泪管狭窄和泪囊增厚。术后过程顺利，面部疼痛消失。这一经验表明，认识到泪道狭窄是眼周和鼻周面部疼痛鉴别诊断的重要性。我们还建议，如果卡马西平未能缓解面部疼痛，应对三叉神经痛的初始诊断进行重新评估。
