可能由放线菌感染导致的泪腺管炎

Objective:To describe the clinical characteristics and management of a group of patients who had chronic mucopurulent conjunctivitis that was probably due to Actinomyces infection of the lacrimal gland ductules. Design:A retrospective, interventional case series. Participants: Seven patients (2 male; 29%) between 34 and 52years of age (mean, 48.7years; median, 49years) who presented to the lacrimal clinic. Intervention:Surgical excision of the infective focus (6 cases) or fenestration and expression of infective debris (1 case) from the affected lacrimal gland ductule—typically the most inferolateral of the ductules. Main Outcome Measures: The clinical features of this previously unrecognized cause of chronic conjunctivitis and its response to treatment. Results: All cases settled rapidly after surgery. There was often a major delay in diagnosis, with the patients having symptoms for between 2 and 42months before referral (mean, 13.3months; median, 9months); 5 patients received prolonged or ineffectual topical medical therapy before referral. Conclusions: Infective lacrimal gland ductulitis, commonly from Actinomyces infection, should be considered in patients with unexplained chronic mucopurulent conjunctivitis; the condition settles rapidly with surgery (Figs 1 and 2). Figure 1: A, Palpebral lobe of the right lacrimal gland at surgery, showing a pyogenic granuloma at the discharging lowest lacrimal gland ductule (ringed). B, Excised lacrimal gland ductule showing purulent debris in its lumen. C, Bacterial debris in the inflamed excised tissues, the debris showing gram-positive bacilli compatible with Actinomyces spp. (Gram stain; original magnification, ×40.) (Reprinted from Hay-Smith G, Rose GE. Lacrimal gland ductulitis caused by probable Actinomyces infection. Ophthalmology. 2012;119:193-196, Copyright 2012, with permission from the American Academy of Ophthalmology.) Figure 2: (Case 7; Table 1) Patient referred with 9months of right ocular irritation, persistent temporal episcleritis (A), and marked chronic mucopurulent ocular discharge. B, The palpebral lobe of the right lacrimal gland is inflamed and the lowest ductule (arrow) has a large pyogenic granuloma prolapsing from a markedly dilated orifice. Mucoid, “stringy” purulent debris can be expressed with pressure over the affected lacrimal gland ductule. (Reprinted from Hay-Smith G, Rose GE. Lacrimal gland ductulitis caused by probable Actinomyces infection. Ophthalmology. 2012;119:193-196, Copyright 2012, with permission from the American Academy of Ophthalmology.)