O'Rourke Michéal, Tang Yi Fan, Pick Zelda, Tan Jennifer S, Tan Priscilla E Z, Athavale Dnyaneshwar D, O'Donnell Brett, Selva Dinesh, Gajdatsy Adam, Hardy Thomas G, McNab Alan, Khong Jwu Jin
Department of Ophthalmology, Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland.
Orbital, Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.
Ophthalmic Plast Reconstr Surg. 2025;41(3):306-314. doi: 10.1097/IOP.0000000000002834. Epub 2024 Dec 9.
This study aimed to determine risk factors, and describe management and outcomes in patients who developed orbital cellulitis secondary to dacryocystitis.
Multicenter retrospective case series with 18 patients and review of published cases.
The mean age was 62 years, 56% were female and 50% had recurrent dacryocystitis. Visual acuity was reduced in the affected eye with a mean of 0.27 logMAR (Snellen 20/40) which improved to 0.15 logMAR (Snellen 20/30) at final follow up. Two cases (12%) had dacryoliths and 1 patient had sarcoidosis within the lacrimal sac. Gram-positive bacteria were identified in 73% (11/15), gram-negative bacteria in 13% (2/15), and mixed infection in 13% (2/15), respectively. Cases who had dacryocystorhinostomy as definitive treatment, either acutely (n = 3) or electively (n = 10) had full resolution. Transcutaneous drainage of the medial wall abscess in 10 patients helped resolve acute cellulitis. Four patients declined dacryocystorhinostomy after transcutaneous drainage; 2 had repeated dacryocystitis and orbital cellulitis, while 2 had no further infective episodes. One immunosuppressed patient had rapid progression to non-perception-of-light vision due to fungal invasion. Forty-six published cases reported up to 28% permanent loss of vision (perception-of-light and non-perception-of-light). Dacryoliths were discovered in 17% of published cases.
Orbital cellulitis complicating dacryocystitis appears to be related to recurrent dacryocystitis and possibly the presence of dacryoliths. Immunosuppression is identified as a poor prognostic factor in this series. While transcutaneous drainage works well as a temporizing measure, dacryocystorhinostomy either done acutely or deferred until resolution of orbital cellulitis is required for definitive cure.
本研究旨在确定继发于泪囊炎的眼眶蜂窝织炎患者的危险因素，并描述其治疗及预后情况。
一项包含18例患者的多中心回顾性病例系列研究，并对已发表的病例进行综述。
患者平均年龄为62岁，56%为女性，50%有复发性泪囊炎。患眼视力下降，平均为0.27 logMAR（Snellen 20/40），在末次随访时改善至0.15 logMAR（Snellen 20/30）。2例（12%）有泪石，1例患者泪囊内有结节病。分别有73%（11/15）鉴定出革兰氏阳性菌，13%（2/15）为革兰氏阴性菌，13%（2/15）为混合感染。接受泪囊鼻腔吻合术作为确定性治疗的病例，无论是急性手术（n = 3）还是择期手术（n = 10），均完全治愈。10例患者经皮引流内侧壁脓肿有助于急性蜂窝织炎消退。4例患者在经皮引流后拒绝接受泪囊鼻腔吻合术；其中2例出现复发性泪囊炎和眼眶蜂窝织炎，另外2例未再发生感染发作。1例免疫抑制患者因真菌感染导致视力迅速恶化为无光感。46例已发表病例报告高达28%的患者出现永久性视力丧失（光感和无光感）。17%的已发表病例发现有泪石。
并发泪囊炎的眼眶蜂窝织炎似乎与复发性泪囊炎以及可能存在的泪石有关。在本系列研究中，免疫抑制被确定为不良预后因素。虽然经皮引流作为一种临时措施效果良好，但对于确定性治愈，需要急性进行泪囊鼻腔吻合术或推迟至眼眶蜂窝织炎消退后进行。
