|Year : 1987 | Volume
| Issue : 4 | Page : 178-182
Dacryocystitis : Bacteriological study and its relation with nasal pathology
Rajeev N Bale
|Date of Web Publication||20-Dec-2008|
Rajeev N Bale
Source of Support: None, Conflict of Interest: None
A study of 100 consecutive cases of dacryocystitis, of which 43 were bilateral and 57 unilateral (total 143 eyes) was done It was found that the disease is more prevalent in females (57 per cent) than in males. The incidence of affection of left and right eyes is equal The disease has its commencement at 30 years age and maximum incidence in the 5th decade.
The common organisms are D pneumonae, c-ve staphylococci N catarrhalis, C + ve staphylococci and Klebsiella Mixed organism infection is not uncommon. It is also seen that the conjunctival sac is more commonly affected in lacrimal sac disease rather than in nasal disease or vice versa. There is no significance as far as organismal flora is concerned with nasal pathology in the cases of Dacryocystitis
|How to cite this article:|
Bale RN. Dacryocystitis : Bacteriological study and its relation with nasal pathology. Indian J Ophthalmol 1987;35:178-82
|How to cite this URL:|
Bale RN. Dacryocystitis : Bacteriological study and its relation with nasal pathology. Indian J Ophthalmol [serial online] 1987 [cited 2020 Apr 7];35:178-82. Available from: http://www.ijo.in/text.asp?1987/35/4/178/26188
| Introduction|| |
DACRYOCYSTITIS is a disease of common occurrence. Its symptoms are troublesome and conspicuous and treatment is unrewarding.
The normal mucosa of the lacrimal sac is highly resistant to infections and only unhealthy mucosae or other factors which reduce its resistance predisposes it to infection Stasis of Lacrimal fluid being one of the most important factor.
A diseased lacrimal sac forms a constant menace to the eye, especially cornea and its treatment forms a vital element However, inspite of its important role, little work was done on it in the past.
In view of the above, this study was undertaken, keeping in mind the following aims:
- To identify organisms in conjunctival sac in patients of dacryocystitis and its relation with organisms grown from lacrimal sac
- To estimate the frequency of organisms common to all the three, ie., cconjunctiva lacrimal sac and the Nostril ?
- Study of the flora of the nose and lacrimal sac in normal persons* and in persons with nasal pathology
(*Patients of Dacryocystitis without nasal pathology).
| Materials and methods|| |
This study was carried out in 100 consecutive patients of Dacrocystitis, the total number of eyes involved being 143. Such patients were sorted out from the general out patient department and the diagnosis was made on clinical presentation and sac syringing Under complete aseptic precautions, the swabs were taken from the lacrimal sac and from the nasal cavity close to the inferior turbinate. These swabs were immediately inoculated on 8-10% blood agar separately. In patients with involvement of both eyes, separate agars were maintained Minimal use of Anaesthetic or sterilizing chemical solutions was made to avoid any destruction of the organisms.
The blood agars thus inoculated were then kept in candle jar (Oxygen free) of incubation upto 24 hours at37° C At the end of this period the plates were examined and culture characteristics of the colonies, if any, were noted In case of absent or scanty growth, further incubation for 24 hours was done. The identification of the organisms from the colonies was made by usual standard tests.
| Results|| |
Out of the one hundred cases total number of affected eyes were 143, amongst which right eyes were affected in 70 and left in 73. The male : female ratio was 43: 57. Maximum patients were from the age group of 31 to 60 years, (63 per cent of the total number of cases).
Total number of429 cultures were done 143 each from conjunctival sac, lacrimal sac and nasal mucosae. In all 277, cultures were positive and 152 cases reports were sterile. The details of organisms cultured from all the three sites are given in [Table 1]. The Mixed culture reports from the three sites were also studied in detail. The Mixed flora from lacrimal sac is given in [Table 2] and that from Nostril in [Table 3]. The relationship between flora in the conjunctival sac, lacrimal sac and nasal mucosae is shown in [Table 4].
Out of the hundred cases in the present study, 27 were having nasal pathology accounting for a total number of 41 eyes The relationship between nasal obstructive/ infective pathology and dacryocystitis is given in [Table 5] and the details of these nasal pathologies are given in [Table 6]. It was observed that the flora of lacrimal sac and nasal mucosa was common in 20 eyes, whereas it was different in 21 eyes in the patients (41 eyes) suffering from nasal pathology [Table 7].
| Discussion|| |
Dacryocystitis is a disease manifesting rarely before the 3rd decade of life (leaving aside congenitial dacryocystitis). In the present study, nearly78% of cases were over the age of 30 years Amongst this the peak is at 51-60 years of age (26%). The incidence of Dacryocystitis in females had been recorded by Traquair  as83 percent by Summer Skill, W. Ft  as 73 per cent and Sood et al  as 63.3 percent In the present study itis57 per cent which is in conformity with earlier findings. The affection of side was found by Sood et at  as 50 each right and left and by Veris  as 66% in left in this series it was 51.04 per cent in left eye which is in agreement with earlier observations.
The direct inoculation on enriched media had been helpful in preventing the total or partial (structural) damage to the organisms by dessication during transportation and storage. Hence more promising results were obtained The absolutely sterile materials and methods used helped to minimise the chances of contamination. So also, only those organisms grown within the inoculated area were taken into consideration. Amongst the total429 cultures 277 (64.57%) showed growth of some organisms, i.e. positive culture reports; whereas 152 (35.43%) did not show any growth.
Growth from conjunctival sac : Swabs
48.95 percent of conjunctival reports were sterile. Amongst the remaining 51 per cent the organisms were D. Pneumonae (15.38%), coagulase negative staphylococcus (16.08%), coagulase positive organisms 6.29 per cent and N catarrhalis 5.59 per cent Only one case (0.69%) showed mixed flora (D. Pneumonae + C-ve staphylococci).
Growth from lacrimal sac fluid swab
Growth was observed in 90 eyes Out of which 84 eyes showed growth of one organism and 6 eyes showed mixed growth, whereas 53 eyes did not show organisms.
D. Pneumonae constituted the maximum, i.e., 18.88 per cent amongst all the culture reports (143), followed by C-ve staphylococci 13.98 per cent, N. Catarrhalis in 9.09 per cent and c + ve staphylococci in 7.69 per cent of total reports In mixed culture (4.19%) of the total reports two cases showed N catanhalis with Gve staphylococci and one each of N catarfialis with Klebsiella D Pneumonae with Klebsiella D Pneumonae + Cve staphylococci and E coli with Gve staphylococci Thus amongst the 6 mixed cultures Crve staphylococci was one of the two organisms in 3 cases and D pneumonae and Kiebsiella in 2 cases each. Pseudomonas was cultured in two cases
Growth from Nasal mucosa
As against the relative sterile reports of conjuctiva (48.95%), lacrimal sac (37.06%), nose had only 20.27 per cent sterile reports The total pure cultures were 104, 10 being mixed cultures amongst the total reports of 143 cases 19.58 per cent were D pneumonae, 20.27 per cent were coagulase -ve staphylococci and 11.88 per cent, N catarrhalis The next were C + ve staphylococci 6.99 per cent and same was true for mixed culture.
Amongst the mixed cultures (6.99%) pneumonae with C-ve staphylococci were seen in 3 cases, Neisseria catarrhalis was reported twice with, D pneumonae and C-ve staphylococci and once the staphylococcus albus and C + ve staphylococci Klebsiellawas seen with B Subtils once.
Emphasis was also given in the present study to find out the relationship between the three flora in all the cases It was observed that the organism growth were common to all the three in 30.06 per cent of cases whereas the conjunctival and lacrimal sac flora was same in 28.67 per cent as against the 13.28 per cent similarity amongst the lacrimal sac and nasal mucosal flora There had been no correlation amongst the three in 27.97% of cases.
A net similarity in conjunctival and lacrimal sac flora was seen in 84 cases and that of sac and Nostrilsin62 cases, Le., 58.74 percent and 43.35 per cent respectively. Thus it was seen that a conjunctival affection is more common in dacryocystitis rather than the affection of lacrimal sac in nostril pathology. However, the high incidence maybe attributed to the common habitates in the two and the communication of conjunctival sac and lacrimal sac through punctum.
A step further was taken regarding the relation of lacrimal sac and nostril flora Amongst the 143 cases studied, 41 (28.6%) cases had nasal pathology. 8 cases were affected by Deviated Nasal Septum, 9 by inferior turbinate hypertrophy. 10 by Rhinitis and 12 by Deviated nasal septum with inferior turbinate hypertrophy. The study of flora of sac and ipsilateral nostril amongst these cases revealed that in 48.78% of cases there was similarity in the flora from the two sites whereas in 51.21 % cases there was no correlation
Thus it can be said that there are only 50% chances of getting a involvement of sac and nostril by the same organism
| References|| |
Traquair (1940) Trans Ophthalm Society, UK, 60, 127.
Summer Skill, WA (1949) Trans Ophthalrn Soc, UK, 69,494.
Sood et aL (1967) All India Ophthal Soc, 15, 107.
Veris (1955) The Lacrimal system, Clinical applications, page 73, Grune & Stratton, New York
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]
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