Lacrimal Duct Occlusion Is Associated with Infectious Keratitis

Abstract

Background: To explore the prevalence of lacrimal duct obstruction in patients with infectious keratitis, and the necessity of lacrimal duct dredge in the treatment of human infectious keratitis.Methodology/Principle Findings: The design is prospective, non-control case series. Thirty-one eyes from twenty-eight continuous patients with infectious keratitis were included in this study. The presence/absence of lacrimal duct obstruction was determined by the lacrimal duct irrigation test. The diagnosis of infectious keratitis was made based on clinical manifestations, cornea scraping microscopic examination and bacterial/fungus culture. Diagnosis of viral keratitis was set up based on the recurrent history, deep neovascularization and typical outlook of the cornea scar. The treatment of keratitis included drugs, eye drops or surgery, while treatment of chronic dacryocystitis was lacrimal duct dredging with supporting tube implantation surgery. In the thirty-one eyes with infectious keratitis, fifteen suffered from fungal keratitis (48%), two bacterial keratitis (6%), and fourteen viral keratitis (45%). Eleven eyes (35%) from ten patients with infectious keratitis also suffered from lacrimal duct obstruction. In those cases, six eyes also suffered from lower canalicular obstruction, three nasolacrimal duct obstruction and chronic dacryocystitis, one a combination of upper and lower canalicular obstruction, one upper canalicular obstruction. After local and systemic applications of anti-bacterial, anti-viral, anti-fungal and anti-inflammatory drugs, twenty-eight eyes (90%) recovered within three weeks, while the ulceration of three patients required the lacrimal duct dredging and supporting tube implantation surgery for the healing.Conclusions: Herein, we first report that the prevalence of infectious keratitis is closely correlated to the occurrence of lacrimal duct obstruction. When both confirmed, simultaneous treatment of keratitis and lacrimal duct obstruction promptly is required. Further evaluation of mechanism, prevention and control of the diseases are warranted.

Factors Associated and Management of Functional Failure after External Dacryocystorhinostomy at Zonal Tertiary Hospital

“…The success of external DCR in the literature has been described to lie between 80% and 99%. [16,[18][19][20][21][22] equaling the success of external DCR surgery could be a difficult task since numerous studies use totally different success standards [23]. Proof of anatomic patency to irrigation doesn't give any information regarding the physiologic function [3,24].…”

Fungal Keratitis: Recent Advances in Diagnosis and Treatment

“…The common risk factors for fungal keratitis are trauma with vegetative matter or objects contaminated with soil, contact lenses, ocular surface disease, lacrimal duct occlusion, fungal skin infections, long-term use of antibiotics or steroids locally or systemically [2,[13][14][15][16][17]. Other relatively rare risk factors include history of eye surgery, herpes simplex virus keratitis, eyelid abnormalities, etc.…”

Nasal Inflammation and Ulceration Secondary to Repeated Use of an Intranasal Delivery Device in Rabbits

“…This is especially true for studies performed in rabbits, where the nasal anatomy is more complex making rabbits more susceptible to nasolacrimal obstruction and infection, which may result in ocular infection. 16 –18 This case emphasizes the need to properly explore the cause of each of the findings and not to exclude the possibility of safe use in human because of tissue damage seen in rabbits.…”

“…16 Obstruction and stasis of the lacrimal duct can result in secondary infection of the duct that can eventually spread to the ocular surface, and in addition can cause overflow of tears to the ocular surface, which contributes to the occurrence of infection. 17,18 The nasal inflammation was seen in both the vehicle-and test drug-treated animals, and therefore, these changes were not attributed to the test drug itself or even the drug-device combination product, but rather to the repeated traumatic procedure. The nature of the changes in the nose, being focal, unilateral, hemorrhagic, ulcerative, and localized to the mucosa and underlying submucosa, suggests a mechanical puncture/ scratch trauma, as was previously shown by our group in the case of subcutaneous injection of saline.…”

“…16 Obstruction and stasis of the lacrimal duct can result in secondary infection of the duct that can eventually spread to the ocular surface, and in addition can cause overflow of tears to the ocular surface, which contributes to the occurrence of infection. 17,18…”