原发性泪小管炎119例诊治体会及病原学特征分析

Analysis of the diagnosis and treatment experience and etiological characteristics of 119 cases of primary canaliculitis

摘要:

目的：探讨原发性泪小管炎的临床特征、诊疗经验以及病原微生物的分布特征，为原发性泪小管炎的诊治提供一定的参考。方法：回顾性临床研究。纳入2019-06/2023-02期间在无锡市第二人民医院眼科诊断为原发性泪小管炎119例120眼。治疗方法主要分为保守治疗(经泪点清除泪小管结石联合管内注入抗生素眼膏)和手术治疗。病原微生物检查方法包括分泌物涂片镜检和微生物培养。结果：原发性泪小管炎多见于中老年女性，主要表现为长期眼红、分泌物增多，但多不伴有流泪症状。118例(99.2%)单眼发病，下泪小管发病63例63眼(52.5%)。实验室检查：119例120眼中有4例4眼未行实验室检查，余115例116眼检查结果如下：分泌物涂片革兰染色镜检，102例103眼(88.8%)检出放线菌，真菌涂片均为阴性； 微生物培养，85例86眼(74.1%)细菌培养阳性。共培养出111株细菌，26种菌株。其中需氧菌32株(28.8%)，厌氧菌26株(23.4%)，兼性厌氧菌53株(47.7%)。最常见菌种为：链球菌20株，葡萄球菌13株，丙酸杆菌和二氧化碳嗜纤维菌各10株。放线菌仅4例4眼(3.4%)培养阳性，真菌培养均为阴性。治疗情况：119例120眼中，114例115眼(95.8%)通过保守治疗经泪点清除泪小管结石联合管内注入抗生素眼膏(微创治疗方法，IOI)后痊愈，5例5眼保守治疗效果不佳，接受手术治疗后均达到治愈，总的治愈率100.0%。结论：原发泪小管炎发病率低，好发于中老年女性，单眼下泪小管多见，临床易漏诊误诊，放线菌为主要致病菌，多为混合感染，菌种异质，厌氧或兼性厌氧菌为主，链球菌、葡萄球菌最为常见。真菌性泪小管炎罕见。泪小管炎确诊后治愈率高，推荐IOI法作为泪小管炎初始治疗。

Abstract:

AIM: To explore the clinical features, diagnosis and treatment experience and the distribution characteristics of pathogenic microorganisms of primary canaliculitis, and provide reference for its diagnosis and treatment. METHODS: Retrospective clinical study. A total of 119 cases(120 eyes)diagnosed as primary canaliculitis in the department of ophthalmology of Wuxi No.2 People's Hospital from June 2019 to February 2023 were included. The treatment methods were mainly divided into conservative treatment(removing canaliculus stones through lacrimal punctum combined with injecting antibiotic eye ointment into the tube)and surgical treatment. The inspection methods of pathogenic microorganisms included secretion smear microscopy and microbial culture.RESULTS: Primary canaliculitis was more common in middle-aged and older female, mainly manifested by long-term red eye and increased secretion; however, the majority was not accompanied by tearing. Totally, 118 cases(99.2%)had monocular disease, while 63 cases(63 eyes; 52.5%)had inferior lacrimal canaliculus disease. Laboratory examination: Among 119 cases(120 eyes), 4 cases(4 eyes)did not undergo laboratory examination, and the other 115 cases(116 eyes)were as follows: Gram staining microscopy of secretion smear showed that Actinomyces were detected in 102 cases(103 eyes; 88.8%), while no fungus was detected; Microbial culture: 85 cases(86 eyes; 74.1%)were positive for bacterial culture. A total of 111 bacterial strains were cultured, which contained 26 types of bacteria. Among them, 32 strains were aerobic(28.8%); 26 strains were anaerobic(23.4%); and 53 strains were facultative anaerobic(47.7%). The most common bacteria were streptococcus(20 strains), staphylococcus(13 strains), Propionibacterium(10 strains), and capnocytophaga(10 strains). Only 4 cases(4 eyes; 3.4%)of microbial cultures were positive for Actinomyces. Fungus was negative in all microbial cultures. Treatment: Of the 119 cases(120 eyes), 114 cases(115 eyes; 95.8%)were cured by conservative treatment of removing lacrimal canaliculus stones through lacrimal punctum and intracanalicular ointment infiltration(IOI), while 5 cases(5 eyes)were not effective in conservative treatment; however, all of them were cured after surgical treatment, and the cure rate for primary canaliculitis was 100.0%.CONCLUSION: The incidence of primary canaliculitis is low, and it is prevalent in middle-aged and older female. Single lacrimal canaliculus is more common, which could be missed and misdiagnosed in clinic. Actinomyces is the major pathogen observed mostly in mixed infections, with heterogeneous strains, mainly anaerobic or facultative anaerobic bacteria. Streptococcus and Staphylococcus are the most common whereas fungal canaliculitis is rare. The cure rate of primary canaliculitis is high after diagnosis, and IOI method is recommended as the initial treatment of canaliculitis.