|Year : 1963 | Volume
| Issue : 3 | Page : 55-57
Medicinal trials in chronic dacryocystitis
Gandhi Eye Hospital and M. U. Institute of Ophthalmology, Aligarh, India
|Date of Web Publication||28-Jan-2008|
Gandhi Eye Hospital and M. U. Institute of Ophthalmology, Aligarh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Dayal Y. Medicinal trials in chronic dacryocystitis. Indian J Ophthalmol 1963;11:55-7
Medicinal treatment of chronic dacryocystitis as an alternative to surgery has been recommended from early times, but on the whole, with a number of exceptions the results have not been good. During the last two decades many authors (Castelli, Redslob et al, Sorsby and others) have used sulphonamides, penicillin and other antibiotics systemically and locally with a limited success. Lately, Charamis and Topalis (1960) reported the use of alphachymotrypsin locally with good results, and Dayal (1962) suggested corticosteroids and fibrolysin in the prevention of lacrimal duct obstruction.
The present study is a further effort in this direction to try and assess the effects of antibiotics, corticosteroid and chymotrypsin separately and combined in syringing the lacrimal passages for treating cases of chronic dacryocystitis.
| Material|| |
A series of 80 cases of chronic, dacryocystitis of different types (catarrhal, suppurative including mucoceles) were studied at the Gandhi Eye Hospital, Aligarh during 1861-62.
The duration of the illness ranged from 2 months to 1 year and the age from 5 months to 38 years. The ratio of males to females was 1:3 (24 males and 56 females). 74 cases were unilateral (right eye affected in 4o and the left in 34), while 6 cases were bilateral. Thus in all 86 eyes were studied.
Each case complained of epiphora and revealed regurgitation through punctum when the sac area was pressed and syringing disclosed obstruction at the junction of the sac and the duct.
| Method|| |
The cases thus selected were grouped as below for the present study
Group I. - 2o cases (21 eyes) were syringed with antibiotics solution (penicillin with streptomycin) daily for two weeks.
Group II.- 20 cases (23 eyes) were syringed with a corticosteroid antibiotic solution (efcorlin with neomycin) daily for two weeks.
Group III.- 20 cases (22 eyes) were syringed with an antibiotic solution (penicillin with streptomycin) and chymotrypsin solution (Quimotrase) daily for two weeks. Syringing with antibiotics was done in the morning and that with chymotrypsin in the afternoon.
Group IV.- 20 cases (20 eyes) were syringed with a corticosteroid antibiotic solution (efcorlin with neomycin) and chymotrypsin solution (Quimotrase) daily for two weeks. Syringing with corticosteroid-antibiotic was done in the morning and that with chymotrypsin in the afternoon (as in group III).
In each group syringing was preceded by pressing firmly the sac area to express any contents from the sac and washing the eye with a sterile normal saline solution.
The drugs used were
I. Penicillin-Streptomycin Solution. Crystalline Penicillin G in 5,000 units per ml. and Streptomycin 2% in distilled water.
2. Corticosteroid-Antibiotic Solution. Efcorlin with Neomycin eye drops (Glaxo Laboratories, India) containing hydrocortisone acetate 1%, and Neomycin sulphate 0.5%
| Discussion|| |
Dacryocystitis is not only a common disease but also an unpleasant one, partly because of the troublesome and conspicuous symptoms it may cause and partly because it has little tendency to resolve while its adequate treatment presents problems some of which can hardly be said to have been solved.
In chronic dacryocystitis, whether catarrhal, suppurative or mucoceles, the clement of infection and inflammation with a tendency of fibrotic block at the site of obstruction are at work. Hence it is felt that any treatment which reduces these processes might prove beneficial in relieving the condition if not in all, atleast in some of the cases. As already stated, the use of sulphonamides, antibiotics astringents, styptics and chymotrypsin have already been reported with encouraging results. Corticosteroids and fibrolysin have been suggested by us for maintaining the patency of the duct following probing (Dayal, 1962).
Antibiotics when used locally control the infection very well, while the corticosteroid checks the inflammation and thereby prevents subsequent fibrosis. The enzyme alpha-chymotrypsin is another drug which has aroused interest in the recent past. It also is said to have an effective anti-inflammatory and fibrinolytic effect, probably by digesting the complex proteins into smaller easily absorbed carbon fragments and clearing the lymphatics and capillaries and thereby permitting the fluid to be withdrawn from the area of inflammation. Thus this enzyme also, by reducing the inflammatory response, can act as a secondary aid to the concentration of antibiotics at the site of inflammation.
The infective element is a primary factor in most of the cases of dacryocystitis causing mucosal oedema and thereby obstructing the narrow lumen of the duct. This leads to a vicious circle of further infection/inflammation and further obstruction. Hence it is felt that syringing the lacrimal passage with anti-infective and anti. inflammatory solutions may itself prove effective. The checking of infection and inflammation will permit separation of the oedematous mucosal walls that had begun to adhere, and shall clear away mucous obstruction.
The present study confirmed this view, though the results achieved could reveal a limited success only. When used singly, the medicines had been less effective, while in a combined therapy, the results had been n-ore encouraging, though not outstanding, as reported earlier by Charamis and Topalis (1960). Assessing the results according to the age of the patients as also the duration of the illness, it was observed that better success was achieved in cases of less age and of short duration, while aged cases and of long duration remained unaffected or only partly affected by this therapy (vide [Table - 2] and [Table - 3].
| Summary|| |
1. 80 cases of chronic dacryocystitis including catarrhal, suppurative and mucoceles treated by syringing with antibiotics, corticosteroid and chymotrypsin solutions separately and combined are reported.
2. The results of four different treatment schedules are compared and assessed.
3. The cure rate was maximum in combined therapy and minimum with antibiotics alone.
4. Better success was achieved in younger patients and where the duration of the disease was short.
I wish to thank the Chief 'Medical Officer. Gandhi Eye Hospital, Aligarh, for the facilities provided to undertake this study.
| References|| |
Charamis, J. and "lopalis, C. : (1960), Ann. ('ocul. 193: 687.
Dayal, Y.: (1962), Brit. 1. Ophthal., 46, 27.
Duke-Elder, S.: Text Book of ophthalmology, (1952), Vol, 5, p. 5300, Kimpton, London.
Fortier, E. G.: (1961), Amer. J. Ophthal. 51, 1o6.
Kara, G. B. : (1960) , Arch. Ophth., 63, 122.
Schwartz, B, and Schwartz, J. B (i 960), Tr. Am. Acad. Ophth. 64 : 17.
Venable, H. P. : (1960), J. Nat Med Ass., 52: 404,
[Table - 1], [Table - 2], [Table - 3]