|Year : 1961 | Volume
| Issue : 4 | Page : 91-93
Scleroma of the lacrymal SAC
BS Darbari, BP Saxena
Department of Pathology and Bacteriology, G. R. Medical College, Gwalior, India
|Date of Web Publication||7-Apr-2008|
B S Darbari
Department of Pathology and Bacteriology, G. R. Medical College, Gwalior
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Darbari B S, Saxena B P. Scleroma of the lacrymal SAC. Indian J Ophthalmol 1961;9:91-3
Scleroma is a disease of the "great unwashed" usually occurring in poor persons who live in insanitary surroundings in villages or slums of cities. From time to time cases of rhinoscleroma have been reported from this country (Castellani and Chalmers, 1919 and De and Chatterjee, 1935, quoted by Mohanty, 1945: Rao and Menon, 1941; Rege, 1951; Mohanty, Ghosh, 1945: Tulsidas and Chaddah, 1954; Goyal, Sarin and Naraynan, 1956; Wahi, Misra and Gupta, 1958; Sahgal, Sayed and Srinivasan, 1960). Wahi et al. observed 85 cases in a period of five years and collected information regarding the occurrence of this disease from various parts of the country. They suggested that the published records give a false impression that the disease is rare in our country when actually the disease appears to be common in certain parts of the country. A few cases of extranasal scleroma have also been reported from our country (Goyal et al; Wahi et al; Sahgal et al). However, scleroma of the lacrymal sac is very rare.
| Case Report|| |
A female K. B. aged 64 years was admitted with the complaints of watering from right eye of four months duration and pus discharge from the same eye of two months duration. She observed occasional swelling below the right eye. On pressure there was discharge from the right eye and some discharge from the nose too. She belonged to the poor class with poor personal hygiene. She was averagely built but poorly nourished. Orodental hygiene was poor. Ear, nose, throat and sinuses were normal. Vision was right eye 6/9 and left eye 6/12. Lids were normal. Conjunctivae were congested. There was regurgitation of pus on pressing the right lacrymal sac. Left lacrymal sac was normal. Systemic examination revealed no abnormality. Clinical diagnosis of chronic dacrocystitis was made and dacrocystectomy was performed.
The specimen received was a thick walled sac measuring 1.0 cm. x 0.5 cm.
Microscopic examination :-The lumen showed irregular dilatation and constriction and was filled with acute inflammatory exudate. The . epithelium showed formation of papillae due to hypertrophy of the epithelial lining [Figure - 1]. The submucosa was infiltrated with lymphocytes, plasma cells [Figure - 2] with a few Russel's bodies [Figure - 3] and occasional Mickulicz cells [Figure - 4]. There were areas of fibroblastic proliferation, new blood vessel formation and areas of patchy fibrosis.
| Discussion|| |
Gerhardt (1876) has been quoted by Cunning (1947) to report first a case of extra-nasal scleroma. It has now been realised that the disease is not restricted to the nose. At the International Congress of Otology, Rhinology and Laryngology at Madrid, in 1932 "Scleroma" was adopted at the designation for the disease in preference to "Rhinoscleroma". Scleroma of lacrymal sac is distinctly rare. Wahi et al. observed 2 cases of scleroma. Sahgal et al. observed one case of scleroma of the lacrymal sac. Wahi et al. suggested the possibility that the infection in these cases probably travels along the lacrymal duct.
In this case however, there was no visible lesion in the nasal cavity.
The etiology of scleroma is unknown. However, it is believed to be infective in origin. Klebsiella rhinoscleromatis is believed by some to be the etiological agent. Although the Koch's postulates have never been fulfilled the fact that serum of a high proportion of patients and of some contacts gives a positive complement fixation reaction with these organisms suggests that it may be casually related to the disease (Wilson and Miles, 1956).
| Summary|| |
A case of scleroma of the lacrymal sac in a female aged 64 years has been described. Scleroma is not as rare as it is made out.
| References|| |
Cunning, D. S., and Guerry, D., (1982), Arch. Otolaryng. 36, 662-678.
Ghosh, L. M., and Punja, D., (1945), Ind. Sled. Gazette, 80, 511.
Goyal, R. K., Sarin, J. C., and Naraynan, G., (1956), Ind. J. Otolaryng., 8, 120.
Mohanty, J. K., (1945), Ind. Med. Gazette, 80, 458.
Rao, B. T. and Merion, T. B., (1941), Ind. Med. Gazette, 76, 321-323.
Rege, R. S., (1951) , Ind. J. Otolaryng., 3, 69-86.
Sahagal, K. N., Saved, B. A., and Srinivasan, N., (1960), Ind. J. Otolaryng., 12, 115-121.
Tulsidas and Chaddah, M. R. (1954), Ind. J. Otolaryng., 6, 53 -
Wahi, A. L., Misra, R. N. and Gupta, N, P., (1958), Ind. J. Otolaryng., 10, 11-24.
Wilson, G. S. and Miles, A. A., (1956), E. Arnold (Publishers) Ltd., P. 2004.
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]