안와연조직염 및 안와농양의 수술적 치료 후 진단된 급성눈물주머니염 1예 = A Case of Acute Dacryocystitis Diagnosed after Surgical Treatment of Orbital Cellulitis and Orbital Abscess

다국어 초록 (Multilingual Abstract)

Purpose: We report a case of acute dacryocystitis diagnosed with abscess and rupture of lacrimal sac and fistula to posterior orbit during the operation.
Case summary: A 71-year-old woman visited our clinic with edema and pain in the eyelid from three days ago. For past four months, there was viscous of the left eye and tears. The patient had severe conjunctival chemosis and hyperemia, compared with the left eyelid edema and redness. Orbital CT scan showed orbital cellulitis, which was followed by systemic antibiotics and steroid therapy. On the 4th day of therapy, orbital abscess formation was observed in orbit MRI and surgical drainage was planned. During surgery, we found rupture of the posterior part of lacrimal sac and fistula to posterior orbit. Pseudomonas aeruginosa was identified in the bacterial cultures, and after the administration of appropriate antibiotics, the disease showed improved progress, and then additional dacryocystorhinostomy was performed.
Conclusions: In our case, acute dacryocystitis rarely spread in orbit, which may lead to delayed diagnosis, orbital cellulitis and abscess, resulting in serious complications of vision threat. So, we think that it is necessary to consider surgical treatment more actively in the stage of chronic dacryocysitis.

국문 초록 (Abstract)

목적: 안와연조직염을 치료하던 중 경과 악화 및 안와농양이 합병되어 수술 중 발견된 눈물주머니의 농양 및 파열과 뒤쪽 안와로 형성된 샛길을 확인하고 급성 눈물주머니염을 진단하였기에 보고하고자 한다.
증례요약: 71세 여자 환자가 3일 전부터 발생한 눈꺼풀의 부종과 통증을 주소로 내원하였다. 좌안 눈꺼풀부종과 발적에 비해 심한 결막 부종 및 충혈 소견을 보였으며, 안와전산화단층촬영상 안와연조직염 소견이 관찰되어 전신 항생제 및 스테로이드 치료를 하였으나 경과가 악화되었다. 치료 4일째 안와 자기공명영상촬영에서 안와농양이 관찰되어 수술적 배농술을 계획하였고, 수술 중 눈물주머니의 농양과 눈물주머니 뒷부분의 파열 및 안와로 형성된 샛길을 확인하였다. 세균배양검사상 녹농균이 동정되어 적절한 항생제 투여후 호전되었으며, 이후 눈물주머니코안연결술을 시행하였다.
결론: 본 증례와 같이 급성 눈물주머니염이 드물게 안와쪽으로 진행하는 경우에는 진단이 늦어지고 안와연조직염 및 안와농양이 합병되어 시력위협의 중대한 합병증이 발생할 수 있으므로 만성 눈물주머니염 단계에서 보다 적극적으로 수술적 치료를 고려하는 것이 필요하다고 생각된다.

참고문헌 (Reference)

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