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ARTICLE
Year : 1961  |  Volume : 9  |  Issue : 4  |  Page : 91-93

Scleroma of the lacrymal SAC


Department of Pathology and Bacteriology, G. R. Medical College, Gwalior, India

Date of Web Publication7-Apr-2008

Correspondence Address:
B S Darbari
Department of Pathology and Bacteriology, G. R. Medical College, Gwalior
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Darbari B S, Saxena B P. Scleroma of the lacrymal SAC. Indian J Ophthalmol 1961;9:91-3

How to cite this URL:
Darbari B S, Saxena B P. Scleroma of the lacrymal SAC. Indian J Ophthalmol [serial online] 1961 [cited 2020 Jun 4];9:91-3. Available from: http://www.ijo.in/text.asp?1961/9/4/91/40283

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 Top


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 Top


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).[10]


  Summary Top


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 Top

1.
Cunning, D. S., and Guerry, D., (1982), Arch. Otolaryng. 36, 662-678.  Back to cited text no. 1
    
2.
Ghosh, L. M., and Punja, D., (1945), Ind. Sled. Gazette, 80, 511.  Back to cited text no. 2
    
3.
Goyal, R. K., Sarin, J. C., and Naraynan, G., (1956), Ind. J. Otolaryng., 8, 120.  Back to cited text no. 3
    
4.
Mohanty, J. K., (1945), Ind. Med. Gazette, 80, 458.  Back to cited text no. 4
    
5.
Rao, B. T. and Merion, T. B., (1941), Ind. Med. Gazette, 76, 321-323.  Back to cited text no. 5
    
6.
Rege, R. S., (1951) , Ind. J. Oto­laryng., 3, 69-86.  Back to cited text no. 6
    
7.
Sahagal, K. N., Saved, B. A., and Srinivasan, N., (1960), Ind. J. Otolaryng., 12, 115-121.  Back to cited text no. 7
    
8.
Tulsidas and Chaddah, M. R. (1954), Ind. J. Otolaryng., 6, 53 - 57.  Back to cited text no. 8
    
9.
Wahi, A. L., Misra, R. N. and Gupta, N, P., (1958), Ind. J. Otolaryng., 10, 11-24.  Back to cited text no. 9
    
10.
Wilson, G. S. and Miles, A. A., (1956), E. Arnold (Publishers) Ltd., P. 2004.  Back to cited text no. 10
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]



 

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