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   Table of Contents      
ARTICLES
Year : 1978  |  Volume : 26  |  Issue : 2  |  Page : 5-8

Bacterial and fungal flora of the sockets


M. U. Institute of Ophthalmology and Premier Contact Lens Centre, Aligarh, India

Correspondence Address:
D Kumar
Premier Contact Lens Centre, Aligarh
India
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Source of Support: None, Conflict of Interest: None


PMID: 721246

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How to cite this article:
Nath K, Krishna G, Gogi R, Kumar D. Bacterial and fungal flora of the sockets. Indian J Ophthalmol 1978;26:5-8

How to cite this URL:
Nath K, Krishna G, Gogi R, Kumar D. Bacterial and fungal flora of the sockets. Indian J Ophthalmol [serial online] 1978 [cited 2020 Jun 3];26:5-8. Available from: http://www.ijo.in/text.asp?1978/26/2/5/31463

Table 9

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Table 9

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Table 8

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Table 8

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Table 5

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Table 2

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Table 1

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Table 1

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Use of prosthesis in the eye often results in the production of weeping mucous or an infec­ted socket which is a source of great discomfort and cosmetic dissatisfaction to the patient.

Our present concept of the normal bacterial flora is essentially the same as was first stated by Axenfeld[1] at the beginning of the century staphylococcus albus and corynebacteria consti­tute the major part of flora. Other organisms, such as staph. aureus, streptococci and gram negative bacilli may occur, but less frequently. In acute and chronic conjunctivitis bacterial and fungal flora of the conjunctiva may be altered.[2],[5],[13], 3 Relatively few authors have been interested in the bacterial and fungal flora of the sockets with ocular prostheses.[2],[3],[7],[8],[12], The bacteriological results gained from Gold­ frab and Turtz[3] indicate a higher incidence of streptococci and gram negative bacilli than is usually found in the normal conjunctival sac. Johnston et al[1] found that the sockets are particularly prone to bacterial contamination by S. aureus and E. coli. The use of contact lenses does not alter the pre existing flora.[15]

The present study was performed primarily to investigate the bacterial and fungal flora of the sockets with prostheses.


  Material and Methods Top


The present study includes 74 cases who used artificial eyes made of methyl acrylate and the work was carried out at the Institute of Ophthalmology, Aligarh. At the initial examination a detailed history was taken which included age, sex, ocular history regarding the reason and duration of loss of eye. Enquiries were made regarding the amount and character of discharge and earlier care of the socket that is, number of times the prosthesis was removed and how frequently clearing of lids and prosthesis was carried out. History of previous medication was also recorded.

Culture material was obtained from the lower fornix and tarsal conjunctiva with dry sterile cotton swab and inoculated on blood agar and Mac-Conkay's media. Organisms were studied after 48 hours for their cultural characteristics and their biochemical reactions. Simi­larly for mycological study, Sabouraud's glucose agar media was used and culture plates were examined upto six weeks for the appearance of any growth. The fungus was identified on the basis of the character of the colonies and their morphology.


  Observation Top


In a total of 74 cases, there were 52 males and 22 females, in the age group of 13 to 66 years with an overall average of 32 years. In 48 cases the left eye was involved. The time interval between the loss of eye and the present examination ranged from 28 days to 38 years [Table - 1]. No patient had used antibiotics, lubricants or other topical medicines in the recent past. Patients used to wash their pros­thesis with plain water twice or thrice a day (10 cases) or once daily (30 cases), biweekly (12 cases), once a week (10 cases) while in 12 cases, a vague history regarding the hygiene of the sockets was present [Table - 2].

In 44 patients there was history of long standing watery (14 cases), mucoid or muco­purulent discharge (30 cases) from the socket while 13 patients complained sticking of the cilia to the prosthesis, rest of the 17 patients had no complaints [Table - 3].

Culture examination of the socket in ques­tion revealed the presence of pure bacterial growth (36 cases), fungal growth (12 cases) while both bacteria and fungus were isolated in 6 cases. No growth was obtained in 20 cases. Similar examination of the fellow normal eye showed bacterial growth in 32 eyes whereas fungus was not isolated in any case [Table - 4][Table - 5][Table - 6][Table - 7].


  Comments Top


A wide range of organisms were isolated from the sockets (54 cases), such as staph. pyogens, staph. albus, diphtheroids, pseudo­monas, proteus, klebsiella, and moraxella. The presence of staph. albus had been reported by many workers. However, we come across some of the fungus not reported earlier, which are aspergillus and penicillium. In 32 cases the fellow eye also revealed positive in the form of staph. albus (12 cases), diphtheroids (12 cases), and staph. pyogens (8 cases) indicating that there is not much difference in the two eyes. In other words, use of prosthesis do not seem to alter the pre-existing normal conjunctival flora except in rare cases. Similar observations were made by Christiensen and Fahmy' but they feel that the gram negative rods and strict anae­robes were significantly more common in the sockets.

While correlating the clinical symptoms and culture reports [Table - 8], it is obvious that patients did complain of watering, mucoid or muco-purulent discharge and matting of the cilia, even when the culture findings were negative. On the contrary in the presence of one or other bacterial or fungal infections (12 cases), the sockets remain asymptomatic. Therefore, there appears to be little or no correlation between the cultures and subjective symptoms. It is well known that the pathogenic socket flora may be found in eyes without any signs of infection. Under favourable circum­stances these organisms induce inflammation leading to watering and discharge. The mecha­nical irritation caused by the prosthesis and decrease in the secretion of tears with its lysozyme and probably other factors helps to establish the inflammation.[2],[10]

Looking at the hygiene of the socket and frequency of pathogenic organisms detected [Table - 9], it is obvious that washing is no assurance against the micro-organisms in an oculo-orbital socket.


  Summary Top


The prosthesis wearers in general complain of watery or mucoid discharge. Our study has shown that although the eye socket with prosthesis is more prone to harbour bacteria and fungus there is no definite relationship to the subjective symptoms.

 
  References Top

1.
Axenfeld, T., 1907, Die Bacteriologie in der Augenheilkunde, 22, Gustav Fisher, Jena.  Back to cited text no. 1
    
2.
Christensen, J.N. and Fahmy, J.A., 1974, Acta Ophthal, 52,801.  Back to cited text no. 2
    
3.
Goldfarb, H.J. and Turtz, A.I., 1966, Amer. J. Ophthal., 61,1502.  Back to cited text no. 3
    
4.
Johnston, A.C. Shepherd, W.E. and Spencer, J.R.L., 1966, Cand. J. Ophthal., 1,317.  Back to cited text no. 4
    
5.
Kanski, J.J., 1965, Brit. J. Ophthal., 49,445.  Back to cited text no. 5
    
6.
Macivor, J., 1950, Amer J. Ophthal.. 33,1573.  Back to cited text no. 6
    
7.
Morgan, J.F. and Hill, J.C., 1964, Amer J. Ophthal., 758,167.  Back to cited text no. 7
    
8.
Miller, S.D., Smith, R.E., Dippe, D.W., Lacey, D.R. and Abel, M., 1976, Cand. J. Ophthal., 11,126.  Back to cited text no. 8
    
9.
Noble, R.I., Hill, J.C., Webb, C., 1964, Cand J. Ophthal., 8,59.  Back to cited text no. 9
    
10.
Norn, M.S., 1966, Acta Ophthal., 44,25.  Back to cited text no. 10
    
11.
Ralph, F.T., 1957, Amer J. Ophthal., 44:814.  Back to cited text no. 11
    
12.
Stone, W. Jr., 1952, Tran. Amer. Acad. Ophthal. Otolaryng., 56,35.  Back to cited text no. 12
    
13.
Sudama, 1974, Ind. J. Ophthal., 22,17.  Back to cited text no. 13
    
14.
Thygeson, P. and Kimura, S., 1963, Trans. Amer. Acad. Ophthal. Otolaryng., 67,494.  Back to cited text no. 14
    
15.
Winkler, C. H. and Dixon, J., 1967, Arch. Ophthal., 77,817.  Back to cited text no. 15
    



 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6], [Table - 7], [Table - 8], [Table - 9]



 

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