|Year : 1967 | Volume
| Issue : 3 | Page : 107-110
Chronic dacryocystitis - a clinico-bacteriological study
NN Sood1, A Ratnaraj1, G Balaraman1, HN Madhavan2
1 Department of Ophthalmology, Jawaharlal Institute of Post-Graduate Medical Education and Research, Pondicherry, India
2 Department of Bacteriology, Jawaharlal Institute of Post-Graduate Medical Education and Research, Pondicherry, India
|Date of Web Publication||21-Jan-2008|
N N Sood
Department of Ophthalmology, Jawaharlal Institute of Post-Graduate Medical Education and Research, Pondicherry
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sood N N, Ratnaraj A, Balaraman G, Madhavan H N. Chronic dacryocystitis - a clinico-bacteriological study. Indian J Ophthalmol 1967;15:107-10
|How to cite this URL:|
Sood N N, Ratnaraj A, Balaraman G, Madhavan H N. Chronic dacryocystitis - a clinico-bacteriological study. Indian J Ophthalmol [serial online] 1967 [cited 2020 Jul 8];15:107-10. Available from: http://www.ijo.in/text.asp?1967/15/3/107/38697
Dacryocystitis as a disease entity is known since ancient times. A large number of clinical and clinico bacteriological studies have been done -Rollet and I3ussy (1923), Traquair (1948), Reddy & Reddy (1955), Prasad and Ram (1958). Rollet and Bussy found pure cultures in 100, mixed infections in 14 and no organism in 26, pneumococcus, staphylococcus, streptococcus and Pfeiffer's bacillus making the top four in pure cultures. Reddy and Reddy (1955), Prasad and Ram (1958) found staphylococci, streptococci, pneumococci and diphtheroids in the descending order of frequency. In vie\N of the extensive work on dacryocystitis it might perhaps appear superfluous to carry out further clinical and bacteriological studies. Our interest, however, was drawn while carrying out clinicobacteriological studies on corneal ulcers (to be published) on finding that the organisms cultured from the associated dacryocystitis were considerably different from the work already published.
| Methods and Materials|| |
This study was carried out on 139 consecutive cases of chronic dacryocystitis. A detailed ocular and nose and throat examination was done.
Mode of presentation of cases:
Fluid from the lacrimal sac was taken and inoculated onto 8-10% blood agar and on MacConkey's agar plates. One of the blood agar plates and MacConkey's agar were incubated anaerobically at 37°C for 18 - 24 hours. At the end of this period, the plates were examined and characteristics of the colonies if any were noted. The organisms isolated were identified by the usual standard tests.
Controls were provided by cultures from normal conjunctival sac (86 Cases) and from the nose (53 Cases).
| Results|| |
[Table - 1] -Shows the age and sex incidence.
Sixty eight patients presented with dacryocystitis of right eye and sixty five in left and in another six cases it was bilateral.
[Table - 2] gives the details of cultures for 146 cases with chronic dacryocystitis, conjunctival swabs from normal conjunctival sacs (86) and nasal swabs from 53 persons.
| Discussion|| |
Excluding congenital dacryocystitis, inflammation of the lacrimal sac is a disease of adults. Nearly 72% of our cases were over the age of 40 years. The high incidence of dacryocystitis in females has been stressed by many authors (Traquair-females 83%, Summerskill-females 70%). In this series there has been a lesser number of females (63.3%). As the number of cases was only 139, references were made to the cases with dacryocystitis seen in the six months period preceding the time of this study. Thus we had a total of 246 cases in which an incidence of 38% in males and 62% in females was found.
Veirs (1955) found dacryocystitis to be twice as often in the left than in the right eye. In our cases there has been an almost equal incidence on the two sides.
Epiphora was the presenting complaint in 49.3%. 17.1% of the patients attended with the complaint of regurgitation of pus on pressing over the inner canthus. Eleven of these patients had dacryocystectomies done elsewhere and sought advice for relief of regurgitant pus. On direct questioning, epiphora was present in all these cases. Acute exacerbation of chronic dacryocystitis accounted for 12.3%. In 11.6% the presence of dacryocystitis was only an incidental finding in cases with hypopyon ulcer. In 4.8% cases there were no symptoms and the condition was diagnosed on routine syringing carried out prior to cataract surgery. [Figure - 1]
Cultures of organisms from normal conjunctiva in 86 cases showed sterile cultures in (32.5%). Diphtheroids 29.4% and Staphylococci 27.9% accounted for the majority of pure cultures.
Mixed cultures from the conjunctival sac were found only in two cases (Staphylococcus albus and diphtheroids).
In the nasal swab, staphylococci (54.7%) pseudomonas aeruginosa (18.8%) accounted for majority of pure cultures.
The sac fluid in dacryocystitis cases yielded pure cultures in 97 (66.4%) mixed cultures in 22 (15.1%) and no growth in 27 (18.5%).
In contrast to the previously published reports, pseudomonas aeruginosa (21.9%) was the commonest organism obtained as pure cultures from cases with dacryocystitis. McCulloch (1943) studied the origin of pseudomonas in the conjunctiva in general and found that this organism may be present in the eye as a result of:
i) Contaminated solution used as drops
ii) as a part of flora of normal conjunctiva
iii) be associated with pseudomonas infections elsewhere in the body (Otitis media, nose, mouth, palate etc.).
To exclude the possibility of contaminated therapeutic preparations, solutions of penicillin, fluorescein, anethaine drops, cotton applicators used were cultured at various periods, but no pseudomonas aeruginosa was cultured.
Pseudomonas was cultured only twice from normal conjunctival sac but cultured on ten occasions from the nose. Perhaps the high incidence of pseudomonas infection in our cases resulted from nose. Only two cases of dacryocystitis had ear discharge and in both pseudomonas aeruginosa was grown.
Staphylococci accounted for 14.3%. Mima polymorpha was grown from sac fluid in 8.2% cases. This organism was grown from the normal conjunctival sac in 2.3% cases. This organism has been isolated previously from normal conjunctival sac (DeBoard, 1939, Brooke, 1951), persistent conjunctivitis (DeBoard, 1939, Moor, 1949, Burns and Florey, 1963). As far as we are aware this organism has not been reported previously from the sac fluid in cases with dacryocystitis.
As the organism is not often mentioned in ophthalmic literature, a short account of this organism would be pertinent.
The organism was first described by DeBord (1939) who suggested this name as these organisms resembled Neisseria morphologically. The characteristics of these organisms noticed in our cases included: (1) On solid media they showed diplococcal forms, but at the same time a few bacillary forms were always encountered. (2) On subcultures into liquid media a large number of organisms assumed coccobacillary forms. (3) They easily grew on ordinary media and gave rise to beta type of haemolysis on blood agar plates. (4) The colonies were mucoid in type. None of the strains showed any fermentative activity when tested for their action on glucose, lactose, sucrose, mannitol, xylose, raffinose, dextrin, aratunose after incubation at 37° C for one week. (5) None of them produced indole and H.S. (6) They also had no action on litmus milk. (7) None of them reduced nitrate and were negative for voges proskauer test and methyl red test. Eight strains were oxidase positive and three strains citrate positive.
Pneumococci were cultured in 6.8%. Streptocci and Diphtheroids were cultured in pure forms in 6.1% cases in which the sac fluid was examined.
Out of the 22 mixed cultures, pseudomonas headed the list along with other organisms in 17 cases. Obviously in our series pseudomonas was the commonest organism-the source of these organisms apart from the nose in some, is not known.
It may be that with the use of antibiotics some well known bacteria have become less important as causes of diseases but other organisms take their place, and the host parasite relationship seems to continue unabated.
| Summary|| |
Chronic dacryocystitis in 139 adults showed its incidence in a higher percentage of males (36.7%) than reported earlier. No significant difference in the involvement of the right or left lacrimal sacs was noticed. Pseudomonas aeruginosa, staphylococci, pneumococci, mima polymorpha and diphtheroids accounted for the majority of cultures. Mima polymorpha has been described from the cultures of lacrimal sac fluid for the first time.
| References|| |
Brooke M. S. (1951), Act Path. Microbiol. Scandanavia. 28: 338.
Burns P. and Florey, M. J.: (1963), Am. J. Ophthal., 56: 386.
DeBord, C. G.: (1939), J, Bact., 38: 119.
McCulloch: (1943) A.M.A. Arch. of Ophthal., 29: 924.
Moor, W. A.: (1949) Am. J. Ophth., 32: 1593.
Prasad B, Ram D. and Prasad. G. (1958) J. All India Ophth. Soc., 6: 68-70.
Reddy P. S. and Reddy, D. B.: (1955) Journal of I.M.A. 24: 413.
Rollet & Bossy -- Cited by Duke Elder S. Text book of Ophthalmology, Vol. V, Page 5317, Henry Kimpton. London, 1952.
Summer Skill. W. H.: (1949) Trans. Ophth. Soc.. U. Kingdom, 69: 494.
Tragnair, H. M. (1948) A.M.A. Arch. of Ophthal.. 26: 165.
VIERS. E. R.: The lacrimal system-Clinical application- Page 73. Grime & Stratton. New York, 1955.
[Figure - 1]
[Table - 1], [Table - 2]