容易误诊的疾病:放线菌性泪小管炎

作     者：Briscoe D. Edelstein E. Zacharopoulos I. 陈立军 

作者机构：Briscoe Department of Oph thalmology Sapir Medical Center Kfar Saba Israel 

出 版 物：《世界核心医学期刊文摘（眼科学分册）》 (Digest of the World Core Medical Journals:Ophthalmology)

年 卷 期：2005年第1卷第2期

页      面：28-29页

学科分类：1002[医学-临床医学] 100212[医学-眼科学] 10[医学] 

主　　题：泪小管炎 泪管 泪道结石 血培养瓶 眼分泌物 涂片检查 慢性结膜炎 凝结物 溢泪 症状体征 

摘      要：Background: To review the diagnosis and management of seven cases of Actinomyc es canaliculitis. Methods: Culture of dischargewas performed in six of seven pat ients with Actinomyces canaliculitis using a PD Plus/F blood culture bottle. All patients were treated by canaliculotomy with curettage of dacryoliths, followed by treatment with systemic penicillin and Sulphacetamide drops over a period of 3-6 months. Part of the curetted concretions was fixed on a glass slide and pa rt was sent to the laboratory for culture. Results: Four patients were women and three men with age ranging between 43 and 90 years. The average time lapse betw een onset of symptoms until diagnosis was 3 years. All cases presented with epip hora, chronic conjunctivitis, palpably thickened canaliculus, and yellow punctal discharge. Diagnosis was achieved by culture of discharge in three of six cases , culture of concretions in three of five cases, and staining of dacryoliths in all seven cases. Follow-up ranged between 12 and 48 months. The canaliculitis r esolved completely and all patients have patent canalicula. Conclusions: Actinom yces canaliculitis presents with epiphora, chronic purulent conjunctivitis, a pa lpably thickened canaliculus, and yellow punctual discharge. In suspect cases ca nuliculotomy and curettage should be performed, although canalicular reconstruct ion is generally unnecessary. Culture of discharge and concretions using PD Plus /F blood culture medium gave improved results over accepted norms. Fixation of s meared concretions on a slide in alcohol is simple and is diagnostic of the dise ase. We recommend long-term systemic penicillin treatment in Actinomyces canali culitis.