緑内障点眼アレルギー症状が涙囊鼻腔吻合術後に改善し点眼再開が可能となった1例

A case in which eye drop instillation became possible after DCR for eye drop allergy

要約　目的：緑内障点眼薬の副作用のため，継続した点眼治療に難渋することがある。緑内障点眼によると思われたアレルギー症状が涙囊鼻腔吻合術（DCR）を施行後に改善し，点眼再開が可能になった症例を1例経験したので報告する。

症例：68歳，女性。前医で両眼緑内障のため両眼点眼加療中，右眼にアレルギー症状および表層角膜炎が出現し，緑内障点眼薬の変更を繰り返していた。両眼トラボプロスト点眼に変更後も同症状のため右眼点眼中止となり，緑内障点眼治療に難渋し当科へ紹介となった。初診時，眼圧は右14mmHg，左12mmHgで，右眼に軽度表層角膜炎と瞼結膜充血を認め，前眼部，隅角に異常所見は認めなかった。涙液メニスカス高は正常であったが，涙囊洗浄検査で右通水不可，血性逆流と多量の膿の排出を認めた。涙囊造影CT検査を施行し，右拡張した涙囊が造影され，右慢性涙囊炎と診断した。右結膜炎の一因と考え，右DCR鼻内法を施行した。

結果：術後右涙囊洗浄検査で通水可能になり，眼症状も改善した。右眼トラボプロスト点眼を再開したが，再発なく経過している。

結論：点眼アレルギー症状のため緑内障点眼が継続困難な症例では，慢性涙囊炎も原因の1つとして考えられる。

Abstract　Purpose：Occasionally, due to the side effects of glaucoma eye drops, continuous eye drop treatment may be difficult. We report a case in which allergic symptoms thought to be caused by glaucoma eye drops treatment improved after dacryocystorhinostomy, following which resumption of eye drop treatment became possible.

Case：A 68-year-old woman, who had been taking eye drops to treat glaucoma, developed right eye allergic symptoms and superficial keratitis, and repeatedly changed glaucoma eye drops. Even after changing eye drops to travoprost, she had the same symptoms and had difficulty with her right eye glaucoma treatment, following which she was reffered to our department. At her first visit, she had a right intraocular pressure of 14 mmHg, a left intraocular pressure of 12 mmHg, right mild superficial keratitis and palpebral conjunctival hyperemia, and no abnormal findings in her anterior segment or angle. Her lacrimal meniscus height was normal, but her right lacrimal sac lavage examination revealed an inability to pass water, with bloody regurgitation and a large drainage of pus. She underwent a lacrimal contrast-enhanced computed tomography（CT）and her right dilated lacrimal sac was imaged, and she was diagnosed with right chronic dacryocystitis. It was thought to contribute to right conjunctivitis, and she underwent a right dacryocystorhinostomy.

Result：Postoperatively, a lavage examination of the right lacrimal sac made it possible to pass water, and the eye symptoms improved. The right eye drop treatment of travoprost was resumed, and eye symptoms had not recurred.

Conclusions：Chronic dacryocystitis is also considered to be one of the causes when it is difficult to continue glaucoma eye drops treatment due to eye drop allergic symptoms.