Congenital Lacrimal-Cutaneous Fistula-Induced Facial Cellulitis-a Case Report and Review

先天性淚囊瘻管引致之臉部蜂窩性組織炎－病例報告及文獻回顧

梁怡珈(I-Chia Liang) ； 蒲啟明(Chi-Ming Pu) ； 黃世鴻(Shih-Hung Huang) ； 林均昶(Chun-Chang Lin) ； 林素玲(Shun-Ling Lin)

《中華民國眼科醫學會雜誌》 49卷3期 (2010/09) Pp. 377-381

https://doi.org/10.30048/ACTASOS.201009.0018

摘要

目的：報告一先天性淚囊瘻管引致臉部蜂窩組織炎之病例。
方法：病例報告及文獻回顧。
結果：一名十歲男孩因右側眼瞼紅痛三天而求診。該患者於四歲時偶然被發現右眼內眥鼻側下方有一淚囊瘻管，但一直沒有症狀。檢查可見淚囊瘻管處有膿樣分泌物。淚囊沖洗發現排淚系統通暢。細菌培養為coagulase-negative Staphylococcus。口服Cepha-lexin五天後，紅痛範圍擴大至臉頰。患者入院接受靜脈Vancomycin治療。做切開及刮除手術可見大量結石，細菌培養為Viridans Streptococcus。感染緩解後，瘻管切除手術發現一瘻管連接至排淚系統。術後十二個月無復發。
結論：無症狀之淚囊瘻管通常不會進展且不需治療。由此病例，我們發現此類淚囊瘻管仍可能因角質及上皮沈積引起細菌生長及感染。因此，對此類病患應告知有感染風險存在。

並列摘要

Purpose: To report a case of previously asymptomatic congenital lacrimalcutaneous fistula complicated with facial cellulitis.
Methods: Case report and literature review.
Result: An 11-year-old boy sought treatment for a 3-day history of progressive painful redness and swelling at his right medial upper and lower eyelids. At presentation, ocular examinations were normal except that right medial upper and lower eyelids adjacent to the cheek were swollen and erythematous. A lacrimal-cutaneous fistula infranasal to the medial canthus was noticed, and some purulent material could be expressed from the orifice. Irrigation through the right upper lacrimal canaliculus revealed patency of the lacrimal drainage system. Bacterial culture of the pus showed the presence of coagulase-negative Staphylococcus. Despite oral Cephalexin treatment, the infection status worsened at outpatient department follow-up 5 days later. The patient was admitted and treated with parenteral Vancomycin immediately. Incision and curettage was performed and profuse concretions were also curetted out. Bacterial culture of the curetted substance revealed Viridans Streptococcus. After the infection subsided, fistulectomy was done and the lacrimal fistula was found to be connected to the lacrimal drainage system with an infected diverticulum. The patient has remained asymptomatic postoperatively for 12 months.
Conclusions: Asymptomatic congenital lacrimal-cutaneous fistulas are usually non-progressive and require no treatment. In this case, we found that a silent fistula can still have keratin squamae deposited inside, further propagates bacteria and induces cellulitis. Therefore, we suggest informing patients of the possible risk of such infection.

並列關鍵字

congenital lacrimal fistula ； cellulitis