Kim Min Ho, Ra Ho
Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Medicine (Baltimore). 2018 Dec;97(49):e13508. doi: 10.1097/MD.0000000000013508.
For the treatment of primary canaliculitis, 1,2,3-snip punctoplasty and canalicular curettage are commonly used; however, a recurrence rate of 6.6% to 22% has been reported. Herein, we describe a case of recurrent primary canaliculitis that was completely cured by 4-snip punctoplasty and canalicular curettage.
A 53-year-old woman was admitted to our hospital with chief complaints of epiphora, discharge, eyelid flare up, and swelling near the inferior lacrimal punctum in the left eye, which initially presented 6 months earlier.
Based on the aforementioned symptoms, the patient was initially diagnosed with bacterial conjunctivitis at a local ophthalmologic clinic and used antibiotic eye drops for 6 months. However, her symptoms did not improve and they worsened at 2 weeks prior to admission. She was subsequently diagnosed with chronic dacryocystitis and referred to our hospital for surgical treatment. Slit lamp examination results showed conjunctival congestion in the inner corner of the left eye, along with eyelid flare up, swelling near the inferior lacrimal punctum, and yellowish discharge and concretion from the lacrimal punctal orifice. Furthermore, punctal regurgitation was not observed in the lacrimal sac compression test. Thus, the patient was diagnosed with primary canaliculitis on the basis of her clinical symptoms and laboratory findings.
Based on the diagnosis of primary canaliculitis, 1-snip punctoplasty and canalicular curettage were performed, and the patient was prescribed oral antibiotics for 2 weeks together with topical antibiotics for 4 weeks. Overall, the patient's symptoms improved after surgery, but epiphora and yellowish discharge from the lacrimal punctal orifice developed again 2 months after surgery during outpatient follow-up. Based on the diagnosis of recurrent primary canaliculitis, 4-snip punctoplasty and canalicular curettage were performed, and the patient was prescribed oral antibiotics for 2 weeks together with topical antibiotics for 4 weeks.
Over a 6-month follow-up period, the symptoms disappeared completely and no other findings were observed.
Four-snip punctoplasty and canalicular curettage are simple clinical procedures that can minimize the recurrence rate of primary canaliculitis. Hence, 4-snip punctoplasty and canalicular curettage should be considered as the 1st-line treatment for primary canaliculitis and recurrent cases.
对于原发性泪小管炎的治疗，常用1,2,3点剪开泪点成形术和泪小管刮除术；然而，据报道其复发率为6.6%至22%。在此，我们描述一例复发性原发性泪小管炎患者，该患者通过4点剪开泪点成形术和泪小管刮除术完全治愈。
一名53岁女性因左眼溢泪、分泌物增多、眼睑红肿及泪小点下方肿胀等主要症状入院，这些症状最初出现于6个月前。
基于上述症状，患者最初在当地眼科诊所被诊断为细菌性结膜炎，并使用抗生素眼药水6个月。然而，她的症状并未改善，且在入院前2周加重。随后她被诊断为慢性泪囊炎，并转诊至我院接受手术治疗。裂隙灯检查结果显示左眼内眦结膜充血，伴有眼睑红肿、泪小点下方肿胀，以及泪小点有黄色分泌物和结石。此外，泪囊压迫试验未观察到泪点反流。因此，根据患者的临床症状和实验室检查结果，诊断为原发性泪小管炎。
基于原发性泪小管炎的诊断，实施1点剪开泪点成形术和泪小管刮除术，并给患者开了2周的口服抗生素以及4周的局部抗生素。总体而言，患者术后症状有所改善，但在门诊随访期间，术后2个月再次出现溢泪和泪小点黄色分泌物。基于复发性原发性泪小管炎的诊断，实施4点剪开泪点成形术和泪小管刮除术，并给患者开了2周的口服抗生素以及4周的局部抗生素。
在6个月的随访期内，症状完全消失，未观察到其他异常。
4点剪开泪点成形术和泪小管刮除术是简单的临床操作，可将原发性泪小管炎的复发率降至最低。因此，4点剪开泪点成形术和泪小管刮除术应被视为原发性泪小管炎及其复发病例的一线治疗方法。
