Therapie der Aktinomykose der ableitenden Tränenwege

Abstract

Canaliculitis is a rare disease of the lacrimal pathway, especially of the canaliculi. It is often not identified, therefore misdiagnosed and inadequately treated. It accounts 2 % of all lacrimal diseases. False diagnoses are usually conjunctivitis, blepharitis, dacryocystitis, hordeolum and chalazion. Besides viruses and fungi a variety of bacteria can cause a canaliculitis. Actinomyces is the most common pathogenic agent of canaliculitis. Its generic name was first described by Harz in 1877. In 1854 von Graefe as well as Kipp and others in 1883 identified actinomyces as the agent for intracanalicular dacryoliths. Although for years actinomyces has wrongly been attributed to ray fungi because of its filamentary and branched nature it actually belongs to facultative anaerobic, non-motile, non-spore-forming, non-acid-fast, pleomorphic bacilli. In the context of canaliculitis caused by actinomyces sulphur granules, also called plagues or actinomyces granules, can often be found in the affected canaliculi. Actinomyces can be identified by light microscopy, culture, biochemical and molecular biological procedures. The most appropriate treatment is to incise the lacrimal punctum, to perform a canaliculotomy and canalicular curettage and if necessary to perform a silicone intubation of the lacrimal system for prophylaxis of stenosis. A postoperative local therapy with a broad-spectrum antibiotic should be initiated for 1 - 2 weeks.