|Year : 1962 | Volume
| Issue : 3 | Page : 61-63
Corticosteroid and enzyme therapy in the treatment of epiphora
Gandhi Eye Hospital & M. U. Institute of Ophthalmology, Aligarh, India
|Date of Web Publication||18-Mar-2008|
Gandhi Eye Hospital & M. U. Institute of Ophthalmology, Aligarh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Dayal Y. Corticosteroid and enzyme therapy in the treatment of epiphora. Indian J Ophthalmol 1962;10:61-3
|How to cite this URL:|
Dayal Y. Corticosteroid and enzyme therapy in the treatment of epiphora. Indian J Ophthalmol [serial online] 1962 [cited 2019 Nov 20];10:61-3. Available from: http://www.ijo.in/text.asp?1962/10/3/61/39560
Epiphora due to obstruction of the naso-lacrimal duct is a very common condition of the lacrimal pathway in this country. The first conventional treatment of such a condition consisted of a judicious and restrained probing but the permanent success from this procedure has been small due to the recurrence of the block. In the last decade sulphonamides and antibiotics have been used along with syringing and probing, and have shown to cure some cases without surgical intervention (Duke-Elder, 1952). Recently in addition to the antibiotics, use of corticosteroids and fibrolysin have been suggested following probing to maintain the patency of the duct (Dayal, 1962).
The present study is a further effort in that direction to try another drug-Chymotrypsin (a proteolytic enzyme well known for its fibrinolytic and anti-inflammatory effect) vis a vis the corticosteroids and antibiotics to assess their usefulness separately and combined in preventing reblockage of the duct following probing.
| Material|| |
A series of 85 cases of epiphora due to blocked naso-lacrimal duct were studied at the Gandhi Eye Hospital, Aligarh during 1960 and 1961.
The duration of the complaint varied from 3 months to 10 months. The cases were mostly middle-aged adults between 14 to 49 years. [Table - 1].
The females outnumbered males in proportion of 5: 2 (59 females and 26 males).
78 cases were unilateral (right eye affected in 43 and the left in 35), while 7 cases were bilateral. Thus in all 92 subjects were studied.
| Method|| |
In each case the site of the obstruction was confirmed by syringing, and before including in the present series, a smear and culture was done to exclude any evidence of inflammation or infection. The cases thus selected were studied in four separate groups as below :
Group I of 18 cases (19 eyes) were probed and then syringed with an antibiotic solution daily for two weeks.
Group II of 20 cases (22 eyes) were probed and then syringed with a corticosteroid-antibiotic solution daily for two weeks.
Group III of 24 cases (25 eyes) were probed and then syringed with both an antibiotic solution and an enzyme solution daily for two weeks. Syringing with the antibiotic solution was done in the morning and that with the enzyme solution in the afternoon.
Group IV of 23 cases (26 eyes) were probed and then syringed with a corticosteroid-antibiotic solution (as in Group II) and an enzyme solution (as in Group III) daily in the mornings and afternoons respectively, for a period of two weeks.
Only patients in whom probing was successful were followed by syringing as enumerated above while the cases where probing failed were left over from the subsequent study at this stage.
The following drugs were used:
After following the syringing for two weeks, the results were noted and the patients were discharged from the hospital with instructions to report after 6 weeks for check-up when recurrence of epiphora, if any was noted and the patency of the naso-lacrimal duct was confirmed by syringing.
| Results|| |
Percentage success rate was lowest in Group I and highest in Group IV.
No side effects locally or systemically were reported at any stage.
| Discussion|| |
Inspite of controlling the infection by syringing with antibiotics, there are many recurrences after successful probing, probably because of the post-traumatic inflammation of the mucosa and subsequent cicatrization. It is felt that by controlling this post probing inflammation and cicatrization, recurrences could be checked in most of the cases and thus save many from undergoing the hazardous surgery.
Apart from the antibiotics which check the infection, the value of corticosteroids in controlling the inflammatory and allergic reactions that so often accompany in these patients, is very well known. Harrenschwand (1954) used 1 cortisone ointment in some cases to increase the elasticity of the punctum, but its use as a syringing solution was first mentioned by Dayal (1952). Combined corticosteroid and antibiotics for syringing had the desired anti-inflammatory and anti-infectve effect and used in combination with fibrolysin the process of cicatrization was prevented as well.
Lately enzyme therapy has received widespread attention. Clinically one of the most useful group of enzymes has been the proteolytic one and of these trypsin and chymotrypsin are best known. Chymotrypsin is derived from the pancreas and is known to be a potent anti-inflammatory agent. It hastens the absorption of oedema and exudates and minimizes the tissue reaction in an apparently safe manner Fortier (1931). By reducing the inflammatory response, the enzyme is a secondary aid to the concentration of antibiotics at the site of injury and inflammation.
In Ophthalmology, apart from its use in zonulysis, chymotrypsin has been reported in uveitis, hyphaema, vitreous haemorrhage and retinal haemorrhage. In orbital trauma and squint surgery, swelling and echymosis are rapidly reduced with systematic chymotrypsin Fortier (19S l ). Charamis and Tonalis (1960) reported their observations on a preliminary study in lesions of lacrimal passages with good results.
The present study was confined to cases with lacrimal obstruction alone as post-operative adjuvant to probing. Those in which probing was successful were syringed daily for two weeks with antibiotics, corticosteroids and chymotrypsin solutions separately and combined to maintain the patency of the nasolacrimal duct. This combined therapy was designed to control the three processes of infection, post-traumatic inflammation and subsequent cicatrization. The results on the whole have been quite encouraging. Of course compared to antibiotics and corticosteroids, its use has not been found better in any way, but in a combined therapy the results have been more successful as revealed from the present study in Group IV (See Table). Probably the two drugs supplement the effects of each other giving an additive anti-inflammatory response. Still as compared to the combined therapy using corticosteroid and fibrolysin in which the success rate was 84 per cent Dayal (1962), it has proved less efficacious (success rate 67 per cen). Still the results have been quite interesting to stimulate further study in this direction.
| Summary|| |
1. 85 cases of epiphora due to blocked naso-lacrimal duct treated by probing and followed by syringing with antibiotics, corticosteroid and chymotrypsin separately and combined are reported.
2. The results of four different treatment schedules are compared.
3. The cure rate was maximum in combined therapy and least with antibiotics alone.
| References|| |
Charamis, J. and Topalis, C., (1960), Ann. d'Ocul. 193, 687-689.
Daval, Y., (1962), Brit. J. Ophthal., 46, 27-30.
Duke-Elder, S., (1952), Text-book of Ophthalmology, Vol. 5, p. 5300, Kimpton, .London.
Fortier, E. G., (1961), Am. J. Ophthal. 51.
Kara, G. B., (1960), Arch. Ophth., 122.
Schwartz, B. and Schwartz, J. B., (196o), Tr. Am. Acad. Ophth., 64, 17-24.
[Table - 1], [Table - 2]