Ishimoto Atsuko, Araki-Sasaki Kaoru, Shima Chieko, Tajika Miwako, Toyokawa Noriko, Takahashi Kanji
Department of Ophthalmology, Kansai Medical University, 2-5-1, Shinmachi, Hirakata City, Osaka, 573-1010, Japan.
Nagata Eye Clinic, 1147 Horaicho, Nara City, Nara, 631-0844, Japan.
Am J Ophthalmol Case Rep. 2022 Jul 9;27:101651. doi: 10.1016/j.ajoc.2022.101651. eCollection 2022 Sep.
To describe the clinical features of corneal ulcers with non-infectious appearance due to nasolacrimal disease in a retrospective case series.
Eight eyes of 8 patients (aged 74.4 ± 11.1 years) with corneal disease due to nasolacrimal duct obstruction or canaliculitis, who were treated between October 2013 and December 2020 at 3 hospitals were included. Patient background, anterior ocular findings, organisms in secretion, and time course during treatment were retrospectively analyzed. The corneal findings were peripheral ulcers (5 cases), phlyctenular keratitis (1 case), and paracentral perforation with slight cellular infiltration (2 cases). All cases were suspected as autoimmune disease-related-corneal ulcers because of the pathogenic region and clinical appearance and later diagnosed as corneal disorders derived from nasolacrimal duct obstruction or canaliculitis. The autoimmune disease-like appearance and purulent secretion connecting the punctum with/without swelling were characteristic. The most common microorganism detected in the purulent secretions was spp.. The resolution of corneal lesions needed steroid eye drops with antibiotic eye drops. Two patients required a superficial corneal transplantation. The extraction of nasolacrimal calculus, punctal tube insertion, or dacryocystorhinostomy was necessary for complete healing of ocular surface disease.
Nasolacrimal duct diseases cause corneal disorders without bacterial colonization and growth. When corneal ulcers resemble autoimmune disease in shape and are not accompanied by systemic disease, attention should be paid to nasolacrimal duct obstruction or canaliculitis.
在一项回顾性病例系列研究中描述因鼻泪疾病导致外观呈非感染性的角膜溃疡的临床特征。
纳入2013年10月至2020年12月期间在3家医院接受治疗的8例患者（年龄74.4±11.1岁）的8只眼，这些患者患有因鼻泪管阻塞或泪小管炎引起的角膜疾病。对患者背景、眼前节检查结果、分泌物中的微生物以及治疗期间的病程进行回顾性分析。角膜表现为周边溃疡（5例）、泡性角膜炎（1例）和中央旁穿孔伴轻度细胞浸润（2例）。由于病变部位和临床表现，所有病例最初均怀疑为自身免疫性疾病相关的角膜溃疡，后来诊断为源自鼻泪管阻塞或泪小管炎的角膜疾病。自身免疫性疾病样外观以及脓性分泌物连接泪点且伴有/不伴有肿胀是其特征。在脓性分泌物中检测到的最常见微生物是 spp.。角膜病变的消退需要使用类固醇眼药水和抗生素眼药水。2例患者需要进行浅表角膜移植。为使眼表疾病完全愈合，需要取出鼻泪结石、插入泪点管或进行泪囊鼻腔吻合术。
鼻泪管疾病可导致角膜病变而无细菌定植和生长。当角膜溃疡在形态上类似自身免疫性疾病且不伴有全身疾病时，应注意鼻泪管阻塞或泪小管炎。
