泪小管炎的临床诊断和治疗

Diagnosis and treatment of canaliculitis

研究泪小管炎的主要致病菌及药物敏感性,探索泪小管炎治愈率高、损伤小、依从性好的治疗方法。方法选取西安市第一医院就诊的泪小管炎患者32例(32只眼),取泪小管分泌物行细菌培养及药敏试验;泪小管内排除的硫磺颗粒碾开涂片;用搔刮泪小管+挤压泪小管排出硫磺颗粒+抗生素凝胶注入泪小管+敏感抗生素点眼联合方法进行治疗。结果 32例泪小管炎患者中,有31例挤压泪小管见硫磺颗粒经泪点排出,取硫磺颗粒涂片均见放线菌。32例患者取泪小管分泌物进行细菌培养,31例为阳性,共培养出菌株37株,主要为表皮葡萄球菌、草绿色链球菌和肺炎球菌,其他菌种少见。药物敏感性试验结果显示:利福平、头孢西丁、氯霉素、美洛西林等药物敏感性较高。用泪小管搔刮+挤压排出硫磺颗粒+抗生素凝胶注入泪小管+敏感抗生素点眼联合方法治疗泪小管炎,治愈率可达84%以上。结论放线菌为泪小管炎的主要致病菌,且大部分存在与其他细菌的合并感染。利福平、头孢西丁、氯霉素、美洛西林等药治疗泪小管炎敏感性高。用联合方法治疗泪小管炎治愈率高,且损伤小,患者依从性高。

Objective To investigate major pathogens and drug susceptibility in patients with canaliculitis, and to find out an optimal treatment strategy with high cure rate, less complication, and good compliance.Methods Thirty-two patients （32 eyes） with canaliculitis were enrolled in this study.Canaliculus secretion was collected and used for culture and drug susceptibility tests.Sulfur granules were sampled by squeezing the canalicular and were used for bacterial smear. A combination of antibiotics was tropically administered as treatment.Results Sulfur granules were sampled in 31 pa-tients, and actinomycetes was found in all smears.Bacterial culture of canalicular secretions was positive in 31 patients. Major pathogens were Staphylococcus epidermidis, Streptococcus viridans and pneumococcus.Drug susceptibility test Re-sults showed sensitivity to rifampicin, cefoxitin, chloramphenicol, and mezlocillin.The cure rate of combined antibiotics was 84%.Conclusions Actinomycetes was the main pathogen in canaliculitis.In most cases, the infection was superim-posed with other bacteria.Combination of rifampin, cefoxitin, chloramphenicol, and mezlocillin are effective to treat canal-iculitis.