淚小管炎臨床特征及常見誤診情況分析

李乃洋，趙　岐

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淚小管炎臨床特征及常見誤診情況分析

李乃洋，趙岐

?METHODS:A total of 34 eyes of 34 patients were selected from 2011-06 to 2015-06 to our hospital for lacrimal duct incision. Clinical data of patients including age and gender distribution, eye and lesion location, duration, canaliculitis clinical symptoms and previous misdiagnosis were collected. The operation of lacrimal duct was carried out, and the secretion of lacrimal secretion was checked.

?RESULTS:Patients over the age of 40 accounted for 77% of the population, men accounted for 23.5%, women accounted for 76.5%. Left eye in 15 cases, right eye in 19 cases, and were monocular onset, 26 cases (76%) of patients with lower lacrimal duct inflammation. Clinical symptoms:increased secretion, canthal conjunctival congestion, swelling, lesion location around the lacrimal puncta swelling and tenderness, slightly raised, epiphora, foreign body sensation. The culture results Showed 34 cases of discharge inspection. A total of 20 cases were fungal growth, 6 cases of bacterial growth rate were 59%, 18%, and 8 cases were not detected, 10 cases of lacrimal duct stone were found by pathological examination. There were 3 cases of Aspergillus, 5 cases of Candida, 2 cases of actinomycetes, 4 cases found in Gram staining microscope. Misdiagnosis of canaliculitis for other eye diseases, including 12 cases of chronic dacryocystitis, 8 cases of chronic conjunctivitis, 6 cases of acute conjunctivitis, stye in 4 cases, the misdiagnosis rate reached 88%.

?CONCLUSION:In the middle and old aged people, the lacrimal duct is more than that of the male. The main pathogenic bacteria causing lacrimal duct infection may be fungi, which can be treated with anti-fungal drugs. For the removal of the lacrimal duct stone, we should distinguish the types of pathogenic bacteria for the treatment of the disease. In the case of misdiagnosis, the clinical manifestations of different clinical manifestations from the lacrimal duct infection and other diseases of the eye should be carefully examined and carefully treated.

目的：通過分析本院34例確診為淚小管炎的患者，探究淚小管炎致病因及其臨床特征，并研究常見誤診情況以提高確診率，為醫務工作者提供臨床經驗。

方法：選取2011-06/2015-06來我院進行淚小管切開術的患者臨床病例共34例34眼，統計患者的臨床資料，包括年齡與性別分布、眼別與病變位置、病程、淚小管炎的臨床癥狀及既往誤診情況。實行淚小管切開術，對淚小管分泌物行微生物培養檢查。

結果：所選患者40歲以上人群占77%，男性占23.5%，女性占76.5%。左眼15例，右眼19例，且均為單眼發病，下淚小管炎患者26例(76%)。患者臨床癥狀：分泌物增多、內眥部結膜充血、淚小管四周紅腫、病變位置輕微觸痛感、淚小點紅腫凸起、溢淚、異物感。分泌物送檢培養結果顯示，34 例中共有20例真菌生長，6例細菌生長，檢出率分別為59%、 18%，其余8例未檢出。10例淚小管結石經病理檢查共發現曲霉菌3例，念珠菌5例，放線菌2例，在Gram染色顯微鏡下有4例發現放線菌絲體。淚小管炎誤診為其他眼部疾病，其中慢性淚囊炎12例、慢性結膜炎8例、急性結膜炎6例、瞼腺炎4例，誤診率達到了88%。

結論：淚小管炎多發于中老年人群中，女性多于男性，且多見下淚小管病變。引發淚小管炎的主要致病菌可能是真菌，臨床治療可輔以抗真菌類藥物。對于淚小管結石的清除工作，應區分致病菌的種類進行針對性治療。對于誤診情況，要從淚小管炎與其他眼部疾病不同的臨床表現入手，仔細檢查，謹慎處理。……