Fungal canaliculitis: diagnostics, treatment, prevention

Up to 2.4 % of primary patients seeking ophthalmological care are cases of canaliculitis. Purpose: to systematize the methods of diagnosing, treatment and relapse prevention of fungal canaliculitis on the basis of the authors’ experience. Material and methods. The results of diagnosing, treatment and relapse prevention are systematized based on the analysis of examination of 57 patients aged 46 to 89 with tear duct disorders of micotic origin. Results. Canaliculitises of fungal etiology are characterized by chronic course of the disease and complications caused by late diagnosis and prolonged inadequate treatment. Practical ophthalmologists should be aware of the fact that this pathology develops primarily in senior females suffering from chronic conjunctivitis and inflammatory disorders of ocular adnexa within the tear duct area that are resistant to antibiotics. A plan of diagnostic examination is recommended based on the analysis of the clinical picture, determination of patency of lacrimal passages during washing and probing, and canalicular and nasolacrimal assays. We also used bacteriological methods of study and X-ray contrasting of tear ducts. The main technique of treatment of fungal canaliculitis is surgical dissection of lacrimal canaliculi, removal of their content with subsequent instillations and washing of tear ducts with antiseptics and antifugal preparations. In the follow-up period spanning 2 months to 5 years no relapses of the process were observed. Conclusion. The use of special diagnostic methods based on the analysis of clinical picture and surgical treatment combined with antimicotic preparations is necessary for relapse prevention and rehabilitation of patients with fungal diseases of lacrimal canaliculi // Russian Ophthalmological Journal, 2016; 4: 74-9. doi: 10.21516/2072-0076-2016-9-4-74-79

Cases of Undiagnosed Open Eye Injury: Clinical Features, Diagnosis and Surgical Treatment

Open eye injury (OTG), in the structure of eye damage is up to 35.0–85.0 %, the level of disability among the working part of the male population from 26 to 55 years ranges from 25.0–47.5 %, and the removal of the eyeball due to traumatic pathology is 6.5–26.3 % of cases. The aim of the work is to demonstrate the consequences of undiagnosed cases of open injury, successfully treated in the Department of traumatology and reconstructive surgery. Attention is focused on some diagnostic techniques that contribute to the correct diagnosis, especially in undiagnosed and unoperated timely sub — conjunctival sclera ruptures that occur in 1.0–2.6 % of cases of OTG. This pathology leads to the development of severe complications with a persistent decrease in visual functions, detachment of the inner shells, with the formation of staphylomatous, cystic changes, as a rule, along the upper limb in 0.5–1.0 mm from it. There are 3 clinical cases with the description of surgical restoration of the integrity of the scleral capsule in combination with intraocular surgery, which led to good anatomical, cosmetic and functional results. In the first case, the patient with the consequence of injury with wooden shavings 6 months ago was performed a delayed revision of vascular staphyloma after separation of the conjunctiva and plastic defect sclera cadaver scleral flap. Visual acuity of OD increased from 0.4 to 0.8. The second case is the consequences of an open eye injury, dislocation of the lens under the conjunctiva. The patient underwent a delayed revision of the scleral wound with removal of the lens, microinvasive vitrectomy with removal of hemophthalmos, iris plasty and secondary IOL implantation. Visual acuity improved with pr.l.certae up to 0.7. The third case is a patient with the consequences of open trauma, staphyloma vascular, complete coloboma of the iris, traumatic cataract. Were facoaspiration traumatic cataract with IOL implantation and plasticity of the iris, delayed revision of the scleral wound plasty of the defect cadaverous sclera. Visual acuity improved with pr.l.certae to 0.2 n/K. Conclusion. Thus, thanks to the use of clinical and diagnostic methods of research and high-tech surgical technique of treatment, it was possible to achieve optimal anatomical, cosmetic results in patients with long-term consequences of complicated open eye injury. Despite the severe anatomical consequences, good functional results were obtained in all cases. In our opinion, this can be explained by the absence of damage to the choroid during the injury, which, according to the literature, mainly leads to massive bleeding into the inner shells and cavities of the eye, the development of ischemia and is the trigger for the development of vitreoretinal proliferation