涙道内視鏡で巨大涙石を認めた2例

Two cases of giant dacryolith detected by dacryoendoscopy

要約　目的：涙道内視鏡で巨大な涙石が発見された2症例の報告。症例：症例は38歳と54歳の男性で，2年前から片側性の流涙と眼脂があった。所見：涙囊部に圧痛があり，通水試験で膿性貯留物が逆流した。涙道内視鏡で2症例とも涙石があり，鼻外法による涙囊鼻腔吻合術を行った。涙石の大きさはそれぞれ25mmと32mmで，1例には緑膿菌，他の1例には大腸菌が検出された。両症例とも術後の再発はない。結論：涙道内視鏡により，涙囊と鼻涙管の内部が観察でき，涙石を発見することができた。

Abstract.　Purpose：To report giant dacryolith in two cases of obstruction of nasolacrimal duct detected by dacryoendoscopic observation. Cases：Both were males aged 38 and 54 years respectively. Both had unilateral epiphora with discharge for 2 years. Findings：The lacrimal sac area showed tenderness and swelling. Forced irrigation showed backflow of putrid mass. Dacryolith was observed in the lacrimal sac by dacryoendoscopy. It was removed during extranasal dacryocystorhinostomy. Its diameter was 25 mm and 32 mm respectively. Pseudomonas aeruginosa was cultured in one case and Escherichia coli in the other. There has been no recurrence in the two cases. Conclusion：Dacryoendoscopy allows detailed observation of the lacrimal sac and nasolacrimal sac and may lead to detection of dacryolith located in the lacrimal sac.