硅胶鼻泪道支架植入治疗慢性汨囊炎疗效观察

目的探讨鼻泪道支架植入治疗鼻泪管阻塞、慢性泪囊炎的疗效。方法用硅胶管制成鼻泪道支架,在鼻粘膜表麻下经鼻腔植入泪道治疗鼻泔管阻塞及慢性泪囊炎26例（31只眼）。结果术后平均随诊7个月,溢泪症状消除,冲洗泪道通畅者26例（占83．37％）,溢泪、冲洗泪道通畅2例（占6．45％）,2只眼植入支架失败,1只眼1周后支架脱出,再次手术植入支架后冲洗通畅。总有效率90．32％。结论硅胶鼻泪道支架植入术是治疗鼻泪管阻塞、慢性泪囊炎的有效方法。     

Clinicopathological Study of Lacrimal Sac Specimens Obtained During DCR

Purpose: To determine the histopathologic characteristics of lacrimal sac specimens in adult patients undergoing external dacryocystorhinostomy (DCR) for acquired nasolacrimal duct obstruction.

Methods: A total of 471 lacrimal sac biopsies were obtained from 449 patients undergoing external DCR for symptoms or signs of acquired nasolacrimal duct obstruction and examined histopathologically.

Results: A total of 449 subjects including 283 (63%) female and 166 (37%) male subjects with mean age of 50.02 years underwent DCR and histopathologic examination of specimens. Presenting symptoms were epiphora in 411 patients (91%), history of acute dacryocystitis in 17 patients (4%) and obstruction revealed during ophthalmic examinations in 21 patients (5%). Histopathologic findings included: chronic inflammation in 450 patients (95.5%), fibrosis in 18 patients (3.8%), lymphoma in two patients (0.4%) and reactive lymphoid hyperplasia in one patient (0.2%). Lacrimal sac appearance during surgery was grossly abnormal in two cases: one case of lymphoma and one instance of reactive lymphoid hyperplasia.

Conclusions: Chronic inflammation and fibrosis are the most common histopathologic findings in lacrimal sac specimens obtained during DCR. Only two cases of lymphoma (0.4%) were encountered in the series, one of which had a suspicious lacrimal sac appearance during surgery while the other case (0.2% of all specimens) was unsuspected. The rate of malignant etiology for NLD obstruction is low enough to justify lacrimal sac biopsy only in suspicious cases.     

兔慢性泪囊炎动物模型建立的方法学研究

背景 慢性泪囊炎是一种常见的泪器感染性疾病,易复发,导致患者预后较差.目前关于在病变复发过程中究竟是感染因素还是泪道阻塞因素发挥主要作用仍存在争议,建立合理的动物模型有助于其发病机制的研究,但目前鲜见慢性泪囊炎的建立方法研究. 目的 探索建立兔慢性泪囊炎动物模型的方法,为慢性泪囊炎的临床诊疗研究提供实验依据.方法 采用随机数字表法将66只日本大耳白兔随机分为6个组,每组11只,均以右眼作为实验眼.暂时泪道阻塞组采用质量分数10％甲苯-2.4-二异氰酸酯(TDI)联合榄橄油溶液右鼻腔滴鼻诱导过敏性鼻炎造成暂时性泪道阻塞;永久泪道阻塞组由泪点注入0.15 ml甲基丙烯酸甲酯(MMA)和聚甲基丙烯酸甲酯(PMMA)聚合物;单纯细菌接种组由泪点注入1×107/ml金黄色葡萄球菌悬液0.3 ml;暂时泪道阻塞+细菌组和永久泪道阻塞+细菌组分别在造成暂时性泪道阻塞和永久性泪道阻塞后次日由泪点注入1×107/ml金黄色葡萄球菌悬液0.3 ml;正常对照组由兔泪点注入0.3 ml生理盐水.分别于术前、术后即刻及术后1d、7d观察动物出现慢性泪囊炎的眼部表现情况以判断造模成功率,行泪道冲洗观察泪道是否通畅,并行泪道CT造影检查是否发生泪道阻塞、阻塞部位以及阻塞程度;术后7d行泪道和泪囊黏膜的常规组织病理学检查. 结果 造模后3个月,暂时泪道阻塞组、单纯细菌接种组、暂时泪道阻塞+细菌组和正常对照组无一例出现慢性泪囊炎表现,永久泪道阻塞组和永久泪道阻塞+细菌组分别有8只眼和9只眼出现慢性泪囊炎的症状和体征.泪道冲洗结果提示,永久泪道阻塞组和永久泪道阻塞+细菌组的慢性泪囊炎眼泪道冲洗不通畅,液体完全返流;泪道CT造影检查显示,兔鼻泪管阻塞部位为鼻泪管的远端,即鼻泪管骨内段与鼻内段的转折部位,并可见鼻泪管完全阻塞,阻塞处近端可见明显的鼻泪管扩张,阻塞处远端无明显的造影剂充盈;永久泪道阻塞组模型眼标本可检出革兰阴性杆菌,永久泪道阻塞+细菌组模型眼金黄色葡萄球菌为优势菌.暂时泪道阻塞组、单纯细菌组、暂时泪道阻塞+细菌组和正常对照组兔眼泪囊和泪道黏膜病理组织学检查未发现异常,而永久泪道阻塞组和永久泪道阻塞+细菌组模型眼标本可见炎性细胞浸润和增生性改变.结论 泪道永久性阻塞是兔慢性泪囊炎动物模型建立的必要条件,在兔慢性泪囊炎的发生中起关键作用.     

Routine histopathologic evaluation of the lacrimal sac during dacryocystorhinostomy: how useful is it?

OBJECTIVE: To determine the usefulness of "routine" lacrimal sac biopsy to evaluate unsuspected neoplasm or systemic disease in patients with acquired nasolacrimal duct obstruction. DESIGN: Noncomparative, interventional case series with histopathologic correlation. PARTICIPANTS: Review of charts revealed histopathologic reports on 302 specimens from 258 patients who had undergone routine dacryocystorhinostomy for clinical acquired nasolacrimal duct obstruction. INTERVENTION: Dacryocystorhinostomy (DCR) with histopathologic evaluation of lacrimal sac. MAIN OUTCOME MEASURES: The following variables were extracted from the medical records: age, gender, presenting symptoms, history of predisposing conditions, lacrimal system abnormalities noted before surgery, dye disappearance test, dacryocystogram or dacryoscintillogram, appearance of the lacrimal sac during surgery, and histopathologic report of the lacrimal sac specimen. RESULTS: Findings of histopathologic evaluation of 302 lacrimal sac specimens from 170 females and 88 males who had undergone routine DCR were reviewed. Evidence of systemic disease or neoplasia involving the lacrimal sac was present in 10 specimens. All 10 positive specimens had a grossly abnormal appearing sac at the time of surgery (n = 8), a known preexisting history of systemic diseases (n = 6), or both. The remaining 292 specimens showed chronic inflammation, fibrosis, or normal mucosa. CONCLUSIONS: Only patients with known preexisting systemic disease or a grossly abnormal lacrimal sac had "positive" histopathologic findings. We recommend that lacrimal sac biopsy in patients undergoing DCR should be performed only in those with a positive history for systemic disease or an abnormal-appearing lacrimal sac during surgery.     

鼻内镜下泪囊鼻腔吻合术联合丝裂霉素C治疗鼻泪道阻塞

目的:探讨鼻内镜下泪囊鼻腔吻合术联合丝裂霉素C(MMC)治疗鼻泪道阻塞的疗效和安全性。方法:选择32例38眼鼻泪道阻塞(或伴泪囊炎、泪囊脓肿)患者,鼻内镜下鼻丘处制成骨孔,切开泪囊并充分翻转泪囊前后瓣,0.1g/L MMC棉球于泪囊吻合口保留48h后取出。结果:术后7d;3,6mo行鼻内镜检查并冲洗泪道。术后7d,治愈34眼,好转3眼,无效1眼,治疗好转率97.4%;术后3mo,治愈32眼,好转4眼,无效2眼,治愈好转率94.7%;术后6mo,治愈32眼,好转4眼,无效2眼,治疗好转率94.7%。所有病例,均未发生鼻出血和眼眶内并发症等术后并发症。结论:鼻内镜下泪囊鼻腔吻合术联合MMC治疗鼻泪道阻塞(或伴泪囊炎、泪囊脓肿)是一种安全有效的治疗方法。     

Nasolacrimal Duct Obstruction: Clinicopathologic Analysis of 205 Cases

Purpose: To investigate the histopathological results of lacrimal sac biopsies in patients with primary acquired nasolacrimal duct obstruction.

Methods: In this prospective non-comparative study, 205 consecutive patients, who were diagnosed as primary acquired nasolacrimal duct obstruction, were included. Patients with history of trauma and/ or surgery in the periorbital area, punctum or canalicular obstruction were excluded from the study. Patients were evaluated for age, gender, history, and presenting symptoms. Lacrimal drainage system abnormalities were assessed. Lacrimal system irrigation, dacryocystography, and in selected cases dacryoscintigraphy was performed. All patients underwent external dacryocystorhinostomy. Biopsy specimens were obtained from the posterior inferior flap and examined by the same pathologist.

Results: Forty-seven male and 158 females with age ranging from 6 to 81 years (mean 47.5?±?16.2 years) were included in the study. Only one patient had the diagnosis of chronic leukemia, others had no preexisting history of systemic disease. Pathologic examination revealed chronic inflammation (n= 178), fibrosis without inflammation (n= 19), normal mucosa (n= 4), and lymphoid hyperplasia (n= 1). Three patients had abnormal pathology: Lymphoproliferative disease in the patient with chronic leukemia, granulomatous inflammation, and basosquamous cell carcinoma.

Conclusion: In primary nasolacrimal duct obstruction, pathological examination of the lacrimal sac revealed chronic inflammatory changes in most patients. Even though rare, malignant or systemic disease in patients with neither specific history nor clinical or radiological finding might be observed in these cases. Thus, we recommend taking biopsy if any suspicion of abnormality of the lacrimal sac exists.     

正常泪道和泪道阻塞的CT检查

目的观察正常泪囊和鼻泪管以及泪道阻塞的CT表现。方法对32例正常泪道CT片及19例泪道阻塞患者CT表现进行观察分析。结果对正常泪道轴位软组织窗CT扫描图像进行分析:泪囊78.1%显影、21.9%不显影,鼻泪管均可显示;显影的泪囊和鼻泪管可分为双侧含气影、双侧黏膜影、一侧含气一侧黏膜影。4例泪道占位病变CT显示:泪囊区高密度影,鼻泪管扩张增粗,管内组织高密度。9例外伤后泪道阻塞CT显示:泪囊区软组织增厚,泪囊扩张或密度增高,泪囊区异常骨碎片影,鼻泪管骨折和阻塞。6例泪囊和鼻泪管炎症CT表现:泪囊区软组织增厚、密度增高,鼻泪管阻塞和密度增高。结论对正常泪道软组织窗轴位进行CT扫描:泪囊可显影或不显影;鼻泪管均可显影;显影的泪囊和鼻泪管表现为含气影或黏膜密度影。泪道占位、外伤和炎症均可在CT片上明确显示,利于诊断。     

Clinicopathologic analysis of 166 patients with primary acquired nasolacrimal duct obstruction.

OBJECTIVE: To determine the prevalence of lacrimal sac pathology in patients undergoing dacryocystorhinostomy (DCR) for primary acquired nasolacrimal duct obstruction (PANDO). DESIGN: Observational case series. PARTICIPANTS: One hundred sixty-six patients with symptoms of PANDO. METHODS: A total of 202 lacrimal sac biopsies were obtained from 166 patients undergoing external DCR procedures for symptoms of PANDO. MAIN OUTCOME MEASURES: Patient demographics, presenting symptoms and signs, relevant history, and assessment of the nasolacrimal system were recorded. All lacrimal biopsy specimens were examined histopathologically. RESULTS: A total of 118 patients (71%) were female and 48 patients (29%) were male. The mean age was 60.7 years (range, 21-93 years). All patients demonstrated epiphora, and 32 patients had dacryocystitis. Duration of symptoms ranged from 6 weeks to 50 years. No lacrimal sac tumors were detected. Sixty-five percent of specimens demonstrated chronic inflammation. CONCLUSIONS: No neoplasms were detected among 202 lacrimal sac specimens from 166 patients with symptoms of PANDO. Most lacrimal sac specimens demonstrated chronic inflammatory changes. We conclude that a lacrimal sac biopsy should be performed when there is suspicion of a neoplasm based on the clinical, historical, or intraoperative findings, rather than routine biopsy of all patients with PANDO.     

鼻内窥镜下鼻腔泪囊吻合置管治疗慢性泪囊炎合并鼻泪管阻塞

目的：探讨鼻内窥镜下鼻腔泪囊吻合置管治疗慢性泪囊炎合并鼻泪管阻塞的疗效。
　　方法：选取2011-12/2014-12我院收治的慢性泪囊炎合并鼻泪管阻塞患者70例70眼,随机分为对照组与研究组,对照组患者行鼻内窥镜下鼻腔泪囊吻合术治疗,研究组患者行鼻内窥镜下鼻腔泪囊吻合置管术治疗,对比两组患者术后1、6、12 mo时治疗总有效率及瘘口面积。
　　结果：术后1mo,对照组患者治疗总有效率97%与研究组100%,差异无统计学意义(P>0.05);术后6mo,研究组患者总有效率97%与对照组77%,差异有统计学意义( P<0.05);术后12mo,研究组总有效率94%明显高于对照组71%,差异有统计学意义(P<0.05)。两组患者术后1mo瘘口面积对比无统计学意义(P>0.05),研究组患者术后6、12 mo瘘口面积大于对照组,差异有统计学意义( P<0.05)。结论：慢性泪囊炎合并鼻泪管阻塞患者行鼻内窥镜下鼻腔泪囊吻合置管治疗的效果显著。     

泪囊鼻腔吻合术吻合方式选择的探讨

目的探讨泪囊鼻腔吻合术的吻合方式选择及手术技巧。方法通过对135例（152眼）慢性泪囊炎和单纯鼻泪管阻塞,术中根据泪囊的大小和泪囊与鼻黏膜距离分为3组,分别行3种不同的吻合方式。术后随访6—12个月,观察手术效果。结果治愈126眼（82．89％）,好转21眼（13．82％）,无效5眼（3．29％）。结论根据泪囊的大小和泪囊与鼻黏膜距离,选择泪囊鼻腔吻合术的吻合方式,更为合理有效。     

The pathogenesis and treatment of lacrimal obstruction: The value of lacrimal sac and bone analysis

INTRODUCTION . The cause of primary acquired nasolacrimal duct obstruction (NLDO) has not been fully elucidated. In an attempt to determine the role of an inflammatory etiology, the pathology of nasolacrimal sac and bone specimens was assessed and correlated with clinical lacrimal variables. MATERIALS AND METHODS . Lacrimal sac and bone tissues from patients with known NLDO were sampled at the time of external dacryocystorhinostomy (DCR). Histopathological analysis was carried out to determine the presence and degree of inflammatory changes present in the tissues, and to correlate them with the clinical presentation. RESULTS . Of 104 cases analyzed, bony inflammatory changes were seen in 14% and lacrimal sac inflammatory changes in 94%. All cases of bony inflammation had accompanying lacrimal sac inflammation. The inflammatory changes were independent of the following variables: gender, duration of symptoms, a history of dacryocystitis, the presence of a lacrimal sac mucocele, the location of obstruction, and the presence of lacrimal sac calculi. CONCLUSIONS . Inflammatory changes are almost invariably present in all patients with NLDO. Its occurrence in bone is probably secondary to lacrimal sac inflammation. Although attempts are made to perform DCR surgery only in the absence of lacrimal sac inflammation, almost all cases exhibit subclinical inflammation. This may suggest that bypassing this ‘critical area’ of the sac-duct junction, as in a dacryocystorhinostomy, would be more reasonable than to re-canalize through an inflammatory obstruction.     

The pathogenesis and treatment of lacrimal obstruction: The value of lacrimal sac and bone analysis

INTRODUCTION. The cause of primary acquired nasolacrimal duct obstruction (NLDO) has not been fully elucidated. In an attempt to determine the role of an inflammatory etiology, the pathology of nasolacrimal sac and bone specimens was assessed and correlated with clinical lacrimal variables. MATERIALS AND METHODS. Lacrimal sac and bone tissues from patients with known NLDO were sampled at the time of external dacryocystorhinostomy (DCR). Histopathological analysis was carried out to determine the presence and degree of inflammatory changes present in the tissues, and to correlate them with the clinical presentation. RESULTS. Of 104 cases analyzed, bony inflammatory changes were seen in 14% and lacrimal sac inflammatory changes in 94%. All cases of bony inflammation had accompanying lacrimal sac inflammation. The inflammatory changes were independent of the following variables: gender, duration of symptoms, a history of dacryocystitis, the presence of a lacrimal sac mucocele, the location of obstruction, and the presence of lacrimal sac calculi. CONCLUSIONS. Inflammatory changes are almost invariably present in all patients with NLDO. Its occurrence in bone is probably secondary to lacrimal sac inflammation. Although attempts are made to perform DCR surgery only in the absence of lacrimal sac inflammation, almost all cases exhibit subclinical inflammation. This may suggest that bypassing this 'critical area' of the sac-duct junction, as in a dacryocystorhinostomy, would be more reasonable than to re-canalize through an inflammatory obstruction.     

Oral and topical antibiotic therapy of complete, primary acquired nasolacrimal duct obstruction in adults.

PURPOSE: To determine whether patients with complete, acquired nasolacrimal duct obstruction may be treated with broad spectrum oral antibiotics and office lacrimal irrigation. METHODS: In a retrospective review, patients with complete, primary acquired nasolacrimal duct obstruction (NLDO) were divided by predominant symptoms and signs into two main groups: (a) those with tearing and/or mucous discharge and (b) those with previous acute dacryocystitis and/or lacrimal sac mucocele. All patients received a therapeutic trial of oral and topical antibiotics followed by lacrimal irrigation. RESULTS: Five of 55 patients with tearing and/or mucous discharge showed significant improvement after treatment with a mean follow-up of 16.5 months. A sixth patient with mucous and tearing had resolution of the mucous discharge but persistent tearing and blockage of the nasolacrimal system to irrigation. Two of 20 patients with lacrimal sac mucocele or history of acute dacryocystitis avoided surgery while 18 opted for early lacrimal surgical intervention. CONCLUSIONS: Conservative management of complete acquired NLDO consisting of oral and topical antibiotics and appropriately timed office lacrimal drainage system irrigation may be considered in selected patients.     

激光指示光引导鼻内镜下手术治疗外伤性鼻泪管阻塞伴泪囊移位

目的 观察通过激光指示光引导定位泪囊，行鼻内镜下泪囊鼻腔吻合手术治疗泪囊移位的方法。方法 对12例（12眼）经CT、MRI或泪囊造影后证实泪骨、鼻骨、或上颌骨鼻突骨折造成鼻泪管阻塞和泪囊移位，在局麻下激光指示光针于上或下泪小管进入泪囊，鼻内镜光源反复打开和关闭以观察指示光最靠近骨窗的最佳位置，切开相应鼻黏膜，做骨窗，然后顺势扩大鼻黏膜和骨窗口，准确找到泪囊后放入泪囊鼻腔引流支架。结果 12眼外伤性鼻泪管阻塞伴泪囊移位采用上述方法均顺利完成泪囊鼻腔吻合手术，术中大大减少了手术探查寻找泪囊带来的鼻黏膜和骨组织过多的损伤，术中患者痛苦少，术后恢复快，鼻腔换药次数减少。结论 激光指示光引导行鼻内镜下泪囊鼻腔吻合手术其定位准确，操作简单，组织损伤少，手术时间短。     

鼻泪管支架植入术125例临床观察

目的观察鼻泪管支架植入术治疗慢性泪囊炎和鼻泪管阻塞的效果。方法鼻泪管支架植入术125例（135眼）。术前诊断为慢性泪囊炎或鼻泪管阻塞等。采用中南大学湘雅二院研制的鼻泪管支架。以空心泪道探针经上泪小管、泪总管、泪囊、鼻泪管探通入下鼻道,将引导钢丝插入空心探针,从前鼻孔钩出,将鼻泪管扩张器、鼻泪管支架、支架推注器先后穿入钢丝,经鼻泪管开口逆行扩张鼻泪管及泪囊,将支架逆行推入鼻泪管及泪囊。术后定期冲洗泪道。结果随访6-19个月,治愈率91．85％。结论鼻泪管支架植入术疗效与鼻腔泪囊吻合术相当,且微创安全。术后定期泪道冲洗有助于减少支架阻塞的发生率。     

不同手术方法治疗鼻泪管阻塞继发泪囊炎的临床研究

目的：对比分析三种术式治疗鼻泪管阻塞继发泪囊炎的疗效以及安全性,探索临床治疗鼻泪管阻塞继发泪囊炎的最佳术式。方法：选取2010-01/2016-01我院收治的鼻泪管阻塞继发泪囊炎患者348例397眼作为研究对象,根据手术治疗方案不同分为3组：泪道激光组接受泪道激光成行术治疗130例152眼、鼻泪管组接受人工鼻内管支架植入术治疗113例127眼、鼻内镜组接受鼻内镜泪囊鼻腔吻合术治疗105例118眼,对比分析3组患者的治疗效果及不良反应发生率。结果：术后1mo,3组患眼治疗效果差异有统计学意义( P<0.05),泪道激光组治疗效果显著优于鼻泪管组、鼻内镜组(P<0.05),鼻泪管组与鼻内镜组治疗效果相比差异无统计学意义(P>0.05)。术后4mo,3组患眼治疗效果比较结果与术后1 mo完全一致,但是3组患者术后4 mo的治疗效果均显著变差,差异有统计学意义(P<0.05)。3组患者不良反应发生率差异有统计学意义(P<0.05),泪道激光组不良反应发生率显著低于鼻泪管组、鼻内镜组,差异有统计学意义(P<0.05),鼻泪管组与鼻内镜组不良反应发生率相比差异无统计学意义(P>0.05)。3组患眼复发
　　率比较差异无统计学意义(P>0.05)。结论：泪道激光成行术治疗鼻泪管阻塞继发泪囊炎的疗效与安全性均良好。     

Nasolacrimal duct obstruction associated with radioactive iodine therapy for thyroid carcinoma

A 50-year-old woman presented with a 5-year history of unilateral epiphora that began shortly after 131I therapy for thyroid carcinoma. A recent recombinant human thyroid-stimulating hormone (Thyrogen) scan had shown a focus of uptake adjacent to the right eye that was initially thought to be a possible metastasis. Probing and irrigation revealed complete blockage of the right nasolacrimal duct. The patient underwent a right dacryocystorhinostomy (DCR) and biopsy of the lacrimal sac. Histopathologic examination of the lacrimal sac and nasal mucosa revealed foreign-body reaction and fibrosis with no malignant cells. A repeat Thyrogen scan after DCR showed no residual focus of activity in the nose or near the lacrimal sac and confirmed reestablishment of lacrimal drainage on the right side. This case demonstrates that 131I therapy for thyroid carcinoma can be associated with nasolacrimal duct obstruction. The appearance of a focus of uptake near the lacrimal sac on Thyrogen scanning in a patient with a history of thyroid carcinoma may not be due to a new focus of metastasis and may indeed be due to pooling of 131I in the lacrimal sac due to nasolacrimal duct blockage.     

Pathological, immunohistochemical and microbiologicalal analysis of lacrimal sac biopsies in patients with chronic dacrocystitis

AIM:To analyze cases of obstruction of the nasolacrimal duct which creates a fertile environment for secondary bacterial infection and can result in dacryocystitis,which is a constant threat to cornea and orbital soft tissue and a potential source of endophthalmitis following intraocular surgery. The majority of obstructions of the lacrimal excretory outflow system are acquired ones occurring in adulthood and involving the distal parts of the system. Acquired obstruction may be primary/idiopathic or secondary to a wide variety of infectious, inflammatory, traumatic, mechanical, toxic or neoplastic causes mimicking idiopathic inflammation. These cases are treated by dacryocystorhinostomy (DCR).METHODS:The present study was conducted to determine the histopathologic, immunohistochemical and current microbiologic characteristics of lacrimal sac specimens in patients undergoing external dacryocystorhinostomy.RESULTS:Non-specific lacrimal sac pathology was present in all 33 cases and 81.8% of the cases showed moderate chronic inflammation with a chronic inflammatory score (CIS) ranging between 4 and 6, whereas 12.12% showed severe inflammatory changes with a CIS of 7. Mild degree of inflammation was seen in 6.06% with a CIS of 3. The total prevalence of gram-positive, gram-negative, and culture-negative samples were 59.4%, 37.5%, and 3% respectively.CONCLUSION:Non-specific chronic inflammation with fibrosis is indeed the most commonly reported histopathological finding in lacrimal sac wall biopsy specimens.     

Acute Dacryocystitis Associated with Epstein-Barr Virus Infection

Acute dacryocystitis is a rare complication of infectious mononucleosis with only three previous reports in the English literature. We present two further children with acute dacryocystitis and clinical and laboratory features of Epstein-Barr Virus related infectious mononucleosis. Both were treated with systemic antibiotics and one child additionally required surgical drainage of a lacrimal sac abscess. Both children made a complete recovery without any lacrimal symptoms. Acute dacryocystitis is uncommon in children without a history of congenital nasolacrimal duct obstruction, and an underlying systemic condition such as infectious mononucleosis should be suspected. In such patients, dacryocystitis can be expected to resolve without symptoms of nasolacrimal duct obstruction and dacryocystorhinostomy is seldom required.     

Acute dacryocystitis associated with epstein-barr virus infection

Acute dacryocystitis is a rare complication of infectious mononucleosis with only three previous reports in the English literature. We present two further children with acute dacryocystitis and clinical and laboratory features of Epstein-Barr Virus related infectious mononucleosis. Both were treated with systemic antibiotics and one child additionally required surgical drainage of a lacrimal sac abscess. Both children made a complete recovery without any lacrimal symptoms. Acute dacryocystitis is uncommon in children without a history of congenital nasolacrimal duct obstruction, and an underlying systemic condition such as infectious mononucleosis should be suspected. In such patients, dacryocystitis can be expected to resolve without symptoms of nasolacrimal duct obstruction and dacryocystorhinostomy is seldom required.