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ARTICLE
Year : 1965  |  Volume : 13  |  Issue : 3  |  Page : 117-118

Dacryocystostomy-probing-treatment for blockage of naso-lacrimal duct


Depart. Of Ophthalmology, College Of Medical Sciences, Benares Hindu University, Varanasi, India

Date of Web Publication22-Feb-2008

Correspondence Address:
Krishna Swami Mehra
Depart. Of Ophthalmology, College Of Medical Sciences, Benares Hindu University, Varanasi
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Mehra KS. Dacryocystostomy-probing-treatment for blockage of naso-lacrimal duct. Indian J Ophthalmol 1965;13:117-8

How to cite this URL:
Mehra KS. Dacryocystostomy-probing-treatment for blockage of naso-lacrimal duct. Indian J Ophthalmol [serial online] 1965 [cited 2020 Aug 4];13:117-8. Available from: http://www.ijo.in/text.asp?1965/13/3/117/39230

Probing as a permanent cure, for the blockage of naso-lacrimal duct has been advocated in the past, but is not very popular today.

Duke Elder (1952) is of the opinion that syringing the lacrimal passage with antibiotics could result in a per­manent cure, Dayal (1962) has pro­duced better results by probing fol­lowed by syringing with corticoste­roids, antibiotics and proteolytic en­zyme. Mehra (1965) has claimed suc­cessful results with visine.

These various agents- antibiotics, corticosteroids, proteolytic enzyme and visine have been tried only when prob­ing was successful. When probing is not successful either a dacryocystec­tomy or a D.C.R. has to be done.

Probing of the nasolacrimal passages has fallen into disrepute, as it is a blind process, by which a false pass­age can easily be created. However Dayal (1962) and Mehra (1965) have reported successful cases of probing followed by syringing with antibiotics, zonulysin, hycine, visine and other agents. Stallard (1958) intubated an acrylic tube after probing. It was the object of the author to modify the technique of probing, by cutting down the sac wall and probing under direct vision, thus reducing the chances of a false passage, whilst at the same time obviating the necessity of the more drastic operations of D.C.R. or dacryo­cystectomy. It has the added advant­age, that it still leaves the door open to perform either of these two opera­tions, should the procedure under dis­cussion fail.


  Material and Methods Top


The patients in this series were be­tween the ages of 20-50 years and be­longed to both sexes. Their chief com­plaint was watering of the eye, the duration varying from five months to three years. The watering was due to blocked naso-lacrimal duct as con­firmed by syringing. In this series only those patients, who had no history of acute or subacute dacryocystitis were operated and in whom probing was unsuccessful through the puncta. Out of the ten cases four were admitted in the Hospital while the rest were treated as out-door patients.

Procedure: Two days before opera­tion the patients were given one injec­tion of penicillin and streptomycin daily which was continued for a week. One day before operation one ampoule of Clauden was given intramuscularly and another, one hour before the ope­ration. The cases were operated under local anaesthesia.

The incision was the same as that for dacryocystectomy, but was extended a little downwards, so as to expose the upper end of the naso-lacrimal duct. Skin, orbicularis muscle and lacrimal fascia were incised and the anterior surface of the sac defined. The junc­tion of sac and naso-lacrimal duct was also defined clearly. A mid line inci­sion 3 mm. long was made in the ante­rior sac wall, 3 or 4 mm. above the junction of the sac and naso-lacrimal duct. A lacrimal probe No. 3 or 4 was passed into the sac cavity through the incision in the sac wall. The probe was passed downwards, backwards and laterally in the direction of the naso­lacrimal duct. Some difficulty was felt in probing. With extra care and ap­plying some force the probe could be passed through the naso lacrimal duct thus opening up the duct. It was con­firmed by seeing the tip of the probe in the nasal cavity. The probe was left there for five minutes and then re­moved. Gentle syringing with the mix­ture of one c.c. of penicillin solution (5000 units per c.c.) + one c.c. of 1% streptomycine solution + one c.c. of hycin + one c.c. of zonulysin (1 in 5,000 freshly made sol.) + one c.c. of visine (0.05% sol.) was done through the sac wall incision into the naso­lacrimal duct. The incision of the sac wall was closed by two interrupted four zero catgut sutures. The skin in­cision was closed by interrupted silk sutures. The patient was put on Deca­doron tablets by mouth-2 tablets T.D.S. for three days, then one tablet T.D.S. for another three days and then half tablet T.D.S. for another three days-to lessen the fibrosis. The pa­tient was dressed daily with hycin + Visine drops. Skin stitches were re­moved on the seventh day. On the tenth day of operation syringing with normal saline was done, and the pa­tency of nasolacrimal duct was noted. Syringing with a mixture of penicillin + Streptomycine + hycin + zonulysin + visine was repeated on every alter­nate day for two weeks. Patients were called for a follow up every week or two weeks, and syringing with the same solution was done.

Out of 10 patients who were operat­ed and followed for 5 to 6 months in 6 watering from the eye was relieved and naso-lacrimal duct also remained patent and thus constituted 60% of our successful cases.

It appears that the four cases, which showed failure, most probably deve­loped fibrosis again in the naso-lacri­mal duct following the procedure.

In all these four patients, in whom this technique had failed, excision of the sac was done.

By this technique the patient is re­lieved of epiphora, which persists after sac excision and is saved the bothera­tion of undergoing a D.C.R. If prob­ing cannot be done after incising the sac wall, then the sac must be excised.[4]


  Summary Top


A technique in which probing is done by incising the wall of the lacri­mal sac, followed by syringing with penicillin + streptomycin + hycin + zonulysin + visine is described. In six patients out of ten the results were encouraging.

(The combination of penicillin + streptomycine + hycin + visine + zonulysin was used, as it has been shown by Mehra (1965), that there is synergistic action of all these drugs.)

 
  References Top

1.
Dayal Y. (1962) J. All-India Ophthal. Soc. 10: 61.  Back to cited text no. 1
    
2.
Duke Elder S.-1952, Text Book of Ophthalmology, Vol. 5, p. 5300, Kim- ton, London.  Back to cited text no. 2
    
3.
Mehra, K. S., (1965) Amer. J. of Oph­thal, 59:3  Back to cited text no. 3
    
4.
Stallard, H. B. (1951) Eye Surgery -third edition, p. 309, John Wright & Sons Ltd., Bristol.  Back to cited text no. 4
    




 

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