Law David Zhiwei, Goh E-Shawn
Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore; Vision Performance Centre, Military Medicine Institute, Singapore Armed Forces, Singapore.
Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore; Eagle Eye Centre, Mount Elizabeth Novena Specialist Centre, Singapore.
Can J Ophthalmol. 2017 Jun;52(3):258-263. doi: 10.1016/j.jcjo.2016.10.013. Epub 2017 Jan 10.
The aim of this study was to describe the outcomes of conservative (punctal dilation, manual expression, microcurettage, and canalicular irrigation with antibiotics) and surgical (punctoplasty) modalities for the management of canaliculitis in an Asian population.
The medical records of 11 consecutive patients (12 eyes) presenting with canaliculitis to one surgeon from August 2010 to January 2014 were reviewed. The clinical presentation, findings, management, microbiology, and treatment outcomes were studied.
The mean age was 70.6 years (57-91 years), 8 (72.7%) patients were females, and all 11(100%) were Chinese. The majority had unilateral canaliculitis-8 (66.7%) right eye only and 4 (33.3%) left eye only (1 patient had consecutive right canaliculitis followed by left canaliculitis)-involving the lower canaliculi (75%). Ten (83.3%) eyes had primary canaliculitis, and 2 (16.7%) eyes had secondary canaliculitis from punctal plug insertion. Common presenting symptoms included eye discharge (75%) and eyelid swelling/redness (50%). Common clinical signs included mucopurulent punctal regurgitation (75%) and pouting punctum (58.3%). Facultative anaerobes (56.3%) formed the majority of organisms, and the most common bacteria isolated were Streptococcus spp. (18.8%). Mean duration to definitive treatment was 35 days (0-126 days). Ten (83.3%) eyes were successfully treated with incision-sparing modalities, and 2 (16.7%) eyes were treated surgically. No recurrences were observed at 3, 6, and 12 months, and only 1 (10.0%) of the 10 conservatively managed eyes had a recurrence of canaliculitis after 3.8 years.
Surgical modalities remain effective for the treatment of canaliculitis. However, they are not without disadvantages, such as scarring, discomfort, infection, and recurrence of punctal stenosis. In our experience, incision-sparing modalities are effective in the treatment of canaliculitis and have low recurrence rates.
本研究旨在描述在亚洲人群中采用保守治疗（泪点扩张、手工挤压、微刮除以及用抗生素进行泪小管冲洗）和手术治疗（泪点成形术）方式管理泪小管炎的结果。
回顾了2010年8月至2014年1月期间同一位外科医生连续收治的11例（12只眼）泪小管炎患者的病历。研究了临床表现、检查结果、治疗方法、微生物学以及治疗结果。
平均年龄为70.6岁（57 - 91岁），8例（72.7%）患者为女性，所有11例（100%）均为中国人。大多数患者为单侧泪小管炎——8例（66.7%）仅累及右眼，4例（33.3%）仅累及左眼（1例患者先后出现右眼和左眼泪小管炎），累及下泪小管的占75%。10只眼（83.3%）为原发性泪小管炎，2只眼（16.7%）为泪点栓植入后继发性泪小管炎。常见的症状包括眼部分泌物（75%）和眼睑肿胀/发红（50%）。常见的临床体征包括黏液脓性泪点反流（75%）和泪点外翻（58.3%）。兼性厌氧菌占微生物的大多数（56.3%），分离出的最常见细菌为链球菌属（18.8%）。明确治疗的平均时长为35天（0 - 126天）。10只眼（83.3%）通过保留切口的方式成功治愈，2只眼（16.7%）接受了手术治疗。在3个月、6个月和12个月时均未观察到复发情况，在10只接受保守治疗的眼中，只有1只眼（10.0%）在3.8年后出现了泪小管炎复发。
手术治疗方式对泪小管炎的治疗仍然有效。然而，它们并非没有缺点，如瘢痕形成、不适、感染以及泪点狭窄复发。根据我们的经验，保留切口的方式在治疗泪小管炎方面有效且复发率低。
