Clinical Profile and Management Outcome of Acute Dacryocystitis: Two Decades of Experience in a Tertiary Eye Care Center

Abstract

Aim: To report the demographic profile, clinical presentation, and management outcome of acute dacryocystitis. Methods: Retrospective study of 347 eyes of 320 patients, who presented to the Ophthalmic Plastic Clinic of a tertiary eye care center over a period of 22 years from January 1990 to March 2012 with acute dacryocystitis, were reviewed for demographic profile, clinical presentation, and management outcome. The numbers of patients with lacrimal disorders during the same period were retrieved to assess the incidence of acute dacryocystitis. Successful anatomical outcome was defined as patency on irrigation and a successful functional outcome was defined as resolution of infection and epiphora. Results: The mean age at presentation was 37 years. The female to male ratio was 2:1. There was no difference in the laterality between the right and the left eyes. Bilateral disease was noted in 8.4% (27/320) patients. 23% (80/347) eyes presented with lacrimal abscess while 2.8% (10/347) eyes had orbital cellulitis. Intensive medical care with hospital admission was needed in 4.4% (14/320) patients. The mean time to resolution of acute symptoms was 10 days. 5.6% (18/320) patients developed a fistula, among which 83% (15/18) were following a spontaneous rupture of the lacrimal abscess. Dacryocystorhinostomy was performed in 82.5% (264/320) patients with an anatomical success of 94.5% and a functional success of 93.5%. Conclusions: Acute dacryocystitis comprises 2.4% of all patients presenting with lacrimal system disorders. Fistula formation is a sequel more commonly seen with spontaneous rupture of a lacrimal abscess. The long-term outcomes in patients presenting with acute dacryocystitis are good with a surgical success rate of 94.3%.     

婴幼儿先天性泪囊炎鼻泪管探通术操作体会

目的：探讨先天性泪囊炎鼻泪管探通术的阻塞性质与疗效预测的关系及其并发症的分析。方法：对474例3-47个月（平均25个月）婴幼儿先天性泪囊炎患儿作鼻泪管探通术的治疗进行回顾性分析。结果：在474例9494只眼）患儿中，存在膜性阻力的有360眼，治愈356眼，占98.89%；不存在阻力有122眼，治愈107眼，占85.25%；遇到狭窄的有12眼，治愈8眼，占66.67%；发生泪小管撕裂有3眼，皮下水肿1眼，未发生出血，感染，眼球损伤和窒息等并发症。结论：发现鼻泪管探通术的阻塞性质与疗效有密切关系。另外，婴幼儿鼻泪管探通术要求技术熟练，动作轻巧和固定良好，才能把并发症的发生率降到最低。     

High Prevalence of Biofilm-Forming MRSA in the Conjunctival Flora in Chronic Dacryocystitis

Objectives: To report the microbiological spectrum of conjunctival flora and prevalence of biofilm-forming Methicillin-resistant Staphylococcus aureus (MRSA) in conjunctival flora in chronic dacryocystitis.

Design: Prospective, case-control study.

Methods: We included patients with unilateral chronic dacryocystitis, and their unaffected eyes as control. Microbiological profile and antibiotic susceptibility of the isolates was determined by standard microbiological procedures. S. aureus isolates were further evaluated for Methicillin resistance by Oxacillin resistance screening agar method and mecA polymerase chain reaction (PCR) and for biofilm synthesis by Congo red agar method, Microtitre plate (MTP) assay, and ica A and ica D PCR.

Results: We found 95 patients with unilateral chronic dacryocystitis. Aerobic Gram-positive isolates (74.2%, n = 72) were more than Gram-negative (25.7%, n = 25) or anaerobic isolates (20.5%, n = 25). S. aureus was most common (46.4%, n = 45), followed by Pseudomonas aeruginosa (10.3%, n = 10). Gram-positive isolates showed highest sensitivity to Linezolid (100%) and higher generation fluoroquinolones. Gram-negative isolates showed good sensitivity (>90%) to all tested antibiotics. S. aureus isolates showed MRSA prevalence as 93.5% and 96.9% by Oxacillin resistance screening agar method and mecA PCR, respectively. Biofilm formation was found in 71.8% MRSA isolates by MTP assay and 58.1% MRSA isolates were resistant to ≥3 classes of antibiotics.

Conclusions: Gram-positive organisms, specifically S. aureus, are the major etiological agent in chronic dacryocystitis. There is high prevalence of MRSA in these isolates and concurrent biofilm formation.     

鼻内镜下泪囊鼻腔造口术治疗外伤性泪囊炎的临床效果

目的：探讨术前解读泪道造影和眼眶CT的重要性以及鼻内镜下泪囊鼻腔造口术治疗外伤性泪囊炎的治疗效果。方法：回顾性研究。统计分析2016年4月至2019年3月在吉林大学第二临床医院行鼻内镜下泪囊鼻腔造口术治疗外伤性泪囊炎的患者资料13例（14眼）,包括病史、术前泪道造影、眼眶 CT片和术中情况。术后观察患者症状改善与否,泪道冲洗结果及鼻内镜下观察造口的情况,随访6个月评估手术疗效。结果：通过CT阅片发现3眼泪囊移位（其中1眼合并泪骨骨折）,6眼同时合并上颌骨额突和鼻骨骨折（其中1眼见瘢痕组织增生于骨折片间）,5眼仅见鼻泪管骨折,泪囊位置及局部解剖未见明显异常。14眼均成功行鼻内镜下泪囊鼻腔造口术,其中1眼因泪囊移位明显联合植入泪囊鼻腔引流支架。12例（13眼）治愈,1例（1眼）未愈。术中易出血,术后无并发症,随访6个月均无复发。结论：鼻内镜下泪囊鼻腔造口术治疗外伤性泪囊炎安全有效,并发症少。术前阅读泪道造影 CT片有助于术中泪囊的准确定位和完全暴露,提高手术效率。     

泪囊鼻腔吻合术211例临床分析

目的探讨泪囊鼻腔吻合术中后泪嵴和内眦韧带后面的泪骨残留及泪囊后唇不缝合固定对手术成功率的影响。方法A组：对100例(106只眼)慢性泪囊炎行泪囊鼻腔吻合术,术中骨孔上界平内眦韧带下缘,后界为后泪嵴前缘,泪囊后唇不缝合固定。B组：对111例(122只眼)慢性泪囊炎行泪囊鼻腔吻合术,术中将内眦韧带向上剥离、咬除内眦韧带后方的泪骨,并将后泪嵴咬除,将泪囊后唇缝合固定。结果A组失败7例(7只眼),占6.60%;B组失败1例(1只眼),占0.82%。二组比较差异有显著性(P＜0.05)。结论将内眦韧带后方泪骨和后泪嵴咬除,并将泪囊后唇缝合固定能提高泪囊鼻腔吻合术的成功率。     

泪囊鼻腔吻合术后复发的手术治疗探讨

目的探讨泪囊鼻腔吻合术后复发的手术治疗及鼻腔泪囊吻合术后复发的原因。方法对20例鼻腔泪囊吻合术后复发的患者予以手术治疗,随访半年-1年。结果15例溢泪消失,泪道冲洗通畅,占75％,5例流泪减轻,冲洗基本畅通,占25％。结论鼻腔泪囊吻合术后复发患者可以通过再次手术予以治疗,手术成功率高,能明显改善患者的症状。是治疗鼻腔泪囊吻合术后复发的一种有效的方法。     

泪小管置管联合泪囊鼻腔吻合术治疗慢性泪囊炎103例

目的 探讨泪小管置管联合泪囊鼻腔吻合术治疗伴泪小管阻塞的慢性泪囊炎的临床效果。方法 对2007年7月至2009年12月103例慢性泪囊炎患者进行了泪囊鼻腔吻合术联合泪小管置管,术后随访6个月至18个月,观察疗效。结果 术后103例泪囊鼻腔吻合术联合泪小管置管术中,治愈97例,有效5例,无效1例,无效者在泪道内窥镜下进一步处理后治愈。结论 泪囊鼻腔吻合术联合泪小管置管术成功率高,是目前治疗慢性泪囊炎尤其是泪囊囊肿的较好手术方法。     

Spherical Headed Silicone Intubation in the Treatment of 26 Cases (31 eyes) of Chronic Dacryocystitis under Nasal Endoscopy

 Purpose:To observe the clinical efficacy of spherical headed silicone implantation in the treatment of chronic dacryocystitis under nasal endoscopy. Methods:Twenty six patients (31 eyes) with chronic dacryocystitis were subjected to spherical headed silicone implantation under topical anesthesia (lacrimal passage and nasal mucosal surface). Lacrimal passage irrigation was performed daily throughout the first postoperative week , and once each month thereafter. Results:All spherical headed silicone tube placements were successfully performed. The operative time ranged from 6 to 11 minutes. Symptoms of epiphora were immediately ameliorated post-operatively, and irrigation demonstrated patency of the lacrimal system in all patients. All patients were followed from 7 to 24 months, during which symptoms of tearing were improved. The lacrimal ducts of 27 eyes (87．7%) were normal. The lacrimal ducts of 4 others (12．3%) were still blocked. Lacrimal passage irrigation was open and secretion disappeared in 28 eyes (90.3%). Tearing was observed in 3 eyes (9.68%). Conclusion:Spherical headed silicone tube implantation under nasal endoscopy is successful in relieving symptoms of tearing     

Treatment of Acute Purulent Dacryocystitis by Early Bicanalicular Silicone Intubation: Safety,Efficacy, and Outcomes

Purpose: To evaluate the safety, efficacy, and outcomes of early bicanalicular silicone intubation in the treatment of acute purulent dacryocystitis. Methods: This prospective interventional case series focused on acute purulent dacryocystitis from February 2010 to March 2014. Of the 21 cases, 16 cases were treated at the Fujian Provincial Hospital, and five cases were treated at the Lianjiang Hospital. Bicanalicular silicone intubation was inserted in the original lacrimal duct within 10 days after abscess decompression by pus aspiration method and systemic antibiotic application. Data collection included demographic profiles, perioperative and postoperative complications, and revision surgery. Resolution of signs and symptoms of acute purulent dacryocystitis, as well as successful anatomical patency assessed by irrigation, was evaluated. Follow-up times were more than 12 months, and ranged from 14 to 63 months.

Results: All patients showed remarkable improvement of pain and swelling within 48 hours. Resolution of the erythema and edema was observed within one week after bicanalicular silicone intubation combined with topical antibiotic lavage. No intraoperative and postoperative complications were observed. After initial bicanalicular silicone intubation, anatomical success was observed in 66.7% (14/21) of the patients. Of the remaining seven patients who presented with severe reflux in irrigation, two patients chose re-intubation and five patients underwent standard external dacryocystorhinostomy. All patients had anatomical success at last follow-up. Conclusion: Early bicanalicular silicone intubation appears to be a safe, effective, and simple procedure, which offers a reasonable option in the treatment of acute purulent dacryocystitis, especially for those developing and underdeveloped areas.     

留置导尿管在泪囊鼻腔吻合术中的应用

目的探讨吻合口留置导尿管在泪囊鼻腔吻合术中的应用及远期疗效。方法对415例(432只眼)慢性泪囊炎在行泪囊鼻腔吻合术中,吻合口处留置导尿管3周。其中284例(297只眼)术后随访3个月～8年(平均随访2.6年)。结果随访3月以内者全部治愈。297只眼远期随访疗效:治愈268只眼(90.24%),好转25只眼(8.4%),无效4只眼(1.35%),总有效率98.65%。结论在泪囊鼻腔吻合术中留置导尿管是一种安全、简单的方法,可有效的防止吻合口再阻塞,提高手术成功率。     

新型泪道引流装置治疗泪道狭窄及泪小管断裂临床分析

目的设计泪道探通引流装置置入泪道，扩张泪道，缓解泪道狭窄，恢复泪液引流通路，消除眼表感染灶。方法设计新型泪道探通引流装置，由两端金属探子和中间的软性硅胶管组成。选择120例病人(女78例，男42例，80例慢性泪囊炎．20例泪小管断裂．20例泪小管狭窄)。1％氯麻液收敛鼻粘膜及眼表麻醉后．探通泪道，自上下泪小点插入泪道探通引流装置的探子至下鼻道前部鼻泪管开口处，用特制的鼻腔探子取出器钩出探子，硅胶管留置鼻腔内．术后每周冲洗泪道1次至1月，以后每月冲洗1次．3～6月取出引流管．泪小管断裂者插入探子后吻合泪小管。结果80例鼻泪管狭窄所致慢性泪囊炎患者流泪症状均在置管l周内消失．拔管1月后有18例慢性泪囊炎患者复发。20例泪小管断裂及20例泪小管狭窄患者术后流泪症状立即消失。拔管后观察3个月，无复发，泪道引流通畅。结论新型泪道探通引流装置治疗鼻泪管狭窄所致慢性泪囊炎、泪小管狭窄及泪小管断裂所致溢泪效果肯定，方法简单，组织创伤小，无局部及全身副作用，具有临床推广应用价值。     

显微镜灯光辅助下的泪囊鼻腔吻合术临床分析

目的分析手术显微镜下行泪囊鼻腔吻合术的方法和注意事项。方法对19例（19只眼）慢性泪囊炎患者,在手术显微镜下行泪囊鼻腔吻合术。结果 19例术后泪道冲洗通畅,无溢泪和流脓症状,内眦部皮肤瘢痕轻微。结论手术显微镜下的泪囊鼻腔吻合术,解剖结构清晰、操作准确、创伤小、皮肤瘢痕不明显,是治疗慢性泪囊炎的有效方法。     

泪道阻塞细菌培养的临床观察

目的确定泪道阻塞的细菌分布种类。方法共收治96例(其中单纯泪道阻塞27例,并发慢性泪囊炎患者84例)泪道阻塞的分泌物进行细菌培养观察。结果在111个标本中,有92个标本发现细菌生长,阳性率为82.9％,细菌菌落138个,革兰阳性菌为62个(55.8％),最常见的细菌为表皮葡萄球菌,革兰阴性细菌19个(17:1％),最常见的细菌为流感嗜血杆菌,泪道阻塞伴有脓性分泌物的病例,多见革兰阴性细菌生长。结论泪道阻塞的细菌分布与正常结膜表面的细菌分布相似,慢性泪囊炎常见的致病菌为革兰阴性细菌,因此,对于慢性泪囊炎的患者,在行内眼手术时,须治愈泪囊炎,这样可避免眼内炎的发生。     

Dacryocystectomy as a treatment of chronic dacryocystitis in the elderly

To evaluate the dacryocystectomy (DCT) outcomes for chronic dacryocystitis in an elderly population over 70 years old. A retrospective chart review was performed for patients over 70 years old who were diagnosed with chronic dacryocystitis and underwent DCT at the Botucatu School of Medicine, UNESP, Brazil, from 2007 to July 2014. Data were collected about patient demographics, age, gender, previous nasal, or ophthalmic diseases, symptoms related to the lacrimal drainage system preoperatively and postoperatively, signs of enlargement of the lacrimal sac (regurgitation of secretion), and histopathologic evaluation. The study sample was comprised of 17 patients with an average age of 76.5 ± 8.5 years. The major complaint for all patients was tearing and 17.6% patients had an additional complaint of discharge. Regurgitation of secretion with lacrimal sac expression was present in 76.5% of patients. Postoperatively, 76.5% of the patients reported improvement of the initial complaint, likely due to the total excision of the lacrimal sac which removed the focal site of chronic infection. Epiphora persisted in 23.5% of patients, of whom 11.7% underwent successful lacrimal stent intubation. DCT for chronic dacryocystitis should be considered a primary procedure in individuals over 70 years old. This procedure has a much lower risk to these patients who often have associated comorbidities.     

鼻内镜下鼻腔泪囊造孔术与传统泪囊鼻腔吻合术的比较

目的比较经鼻内镜下鼻腔泪囊吻合术与传统泪囊鼻腔吻合术的疗效。方法回顾性分析64例（64只眼）慢性泪囊炎患者手术治疗效果。其中经鼻内镜下行鼻腔泪囊吻合术33例,采用传统泪囊鼻腔吻合术治疗31例。结果鼻内镜组：泪道冲洗通畅者32例（97%）。1例通畅度不满意（3%）。传统吻合组：泪道冲洗通畅者29例（93.5%）,2例通畅度不满意（6.5%）。两组比较差异无统计学意义（P〉O.O5）。结论经鼻内镜下行鼻腔泪囊吻合术具有较多优点,其手术效果接近于传统手术,符合现代外科手术微创要求,避免了面部疤痕,满足了患者美容的需求。     

隐形人工鼻泪管置入与鼻腔泪囊吻合术治疗慢性泪囊炎238例对比研究

对比观察鼻腔泪囊吻合术、人工鼻泪管置入术治疗慢性泪囊炎的临床疗效。方法将患慢性泪囊炎162例（238只眼）患者按照随机的原则分成两组：A组（鼻腔泪囊吻合术组50例）,B组（人工鼻泪管置入术组188例）。观察手术后第6个月时的情况,冲洗泪道通畅并且无溢泪和溢脓者为治愈。结果 A组50只眼中治愈46只眼（92％）;B组188只眼中治愈170只眼（90．4％）。 A组与B组比较P ＞0．05,差异无统计学意义。结论两种术式相比较,A与B手术方法治愈率无明显差异。但是B术式创伤小,易耐受,对于年老体弱不能接受A术式者尤其适合,无皮肤切口,颜面部不留瘢痕,不外露,不影响外观,费用低,操作简便。     

泪道探通联合硅胶管植入术治疗慢性化脓性泪囊炎的疗效观察

目的观察泪道探通联合硅胶管植入术治疗慢性化脓性泪囊炎的临床疗效。方法对30例(32眼)慢性化脓性泪囊炎患者行泪道探通联合硅胶管植入术,术后随访3-6个月。结果植入成功率100%。4眼于术后4～7d发生阻塞,及时行泪道冲洗后恢复通畅。硅胶管留置期间,其中溢泪、溢脓症状完全消除28眼,另外4眼仍有轻度溢泪。取出硅胶管后复发5眼占15%,治愈23眼,好转4眼,总有效率84%。结论应用硅胶管植入术治疗慢性化脓性泪囊炎手术时间短,出血少,安全性高,具有肯定的临床效果。值得推广。