|Year : 1956 | Volume
| Issue : 2 | Page : 41-42
Purulent canaliculus infection probably of mycotic origin
|Date of Web Publication||19-May-2008|
B N Bhaduri
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bhaduri B N. Purulent canaliculus infection probably of mycotic origin. Indian J Ophthalmol 1956;4:41-2
In Bengal, primary infection of the lacrimal canaliculi is relatively rare though inflammation of the sac is common amongst the females specially in the rural areas.
According to Duke Elder (1952), cases of specific infections of canaliculus are more common than nonspecific and in the former mycotic infection is the commonest.
Almost invariably the fungus obtained is Actinomyces though exceptionally sporotrichosis (Fazakas 1936), Asperigillus Niger (Donahue 1949) and Favus (Tinea Schonlenii) Norkiewiez (1870) have been found.
Mycoctic infections of canaliculi are usually termed streptothrix in United States and some parts of Europe.
The lower canaliculus is usually involved and it is extremely rare to have mycotic inflammation of both canaliculi at the same time. Fazakas (1934) found fungi in the conjunctiva, palpebral margins and lacrimal passages in both normal and diseased eyes. His results showed the presence in 35.8°c of the diseased eyes and in 24.3% of the normal eyes. the common fungi being Penicillium and Torula. Locatcher-Khorazo (1954) isolated streptothrix (Nocardia) in 26 out of 5,055 cases of infection of the eyes at the Institute of Ophthalmology, New York.
| Case Report|| |
S. C. R., aged 73 years, an old patient of mine, consulted me for the complaints of discharge of pus on pressing on the lower lid margin near the inner angle of the right eye, redness of the eye close to it and swelling of the lower lid for two and a half months and epiphora for 1 year.
On examination of the right eye there was conjunctivitis localized near the inner angle of the eye. There was swelling of the lower lid margin from the inner angle upto the lower puncta. The lacrimal punctum itself was oedematous and dilated. On pressing over the site of lower canaliculus, copious quantity of purulent discharge came out through the lower punctum.
On passing a sterilized lacrimal probe of medium size which entered easily, an obstruction was felt within the canaliculus. A probable diagnosis of actinomyces infection of the lower canaliculus was given and surgical treatment was suggested.
A probable diagnosis of actinomyces infection of the lower canaliculus was given and surgical treatment was suggested.
The patient is a diabetic for more than 20 years. He was trephined for epidemic dropsy glaucoma in both eyes 14 years ago, and later for cataract successfully, with a corrected central vision of 6/6.
Treatment: Patient was using Terramycin ointment in the right eye since the appearance of discharge. Terramycin was stopped for a few days, discharge was examined on a smear preparation and cultured in blood agar and agar medium. Culture showed no growth after 72 hours and the microscopic examination of the slide
Underer local anesthesia, the lower canaliculus was probed and it was noticed that the thick end of a Weber's lacrimal probe passed into the canaliculus easily to a certain length but met a resistant mass inside the canal.
The canaliculus was slit up with a canaliculus knife and a large solid yellowish looking mass of cartilaginous consistency was removed with a curette. It was found to be broken into two pieces, one of which was put in Sabouraud's medium for culture and the other piece was kept in a sterile test tube. The canaliculus was roughly measured and found to be elongated to about 12 mm and the diameter of the canal was calculated from the diameter of the mass to be roughly 7 min. After carefully curetting the canaliculus, it was painted with iodine.
The patient made a quick recovery within 5 days though blood sugar was near about 200 mgm in 100 c.c. He was under insulin treatment.
There was no growth in Sabouraud's culture medium though incubated for one week. A portion of the mass on examination was found to be insoluble in strong acids (Hydrochloric, Nitric, Acetic etc.), but dissolved slowly in strong alkalies (KOH and NaOH) and the solution changed colour first to pink and then to red, indicating the pressence of amino acid tyrosine (Sakaguchi Test).
On paper chromatography test, it was found to be tryptophane.
| Comment|| |
It has been previously recorded that at times, it is impossible to grow the organism from the concretions removed (Viers. 1955) but in the present case the discharge and inner wall scrapings of the canaliculi were also negative both in smear and culture. The copious quantity of discharge from the canaliculus is the most characteristic feature of the present case. The quick formation of abundant discharge was observed by pressing the canaliculus region at every two or three hours intervals by the attending nurse. Though the mass removed from the canaliculus is large (12 x 7 mm), it is not hard enough to be called concretions as has been recorded in the literature by previous observers. The epiphora is found to be very much less though the canaliculus remained dilated for a long time.
| Summary|| |
A case is reported of purulent inflammation of the lower canaliculus only, in an old man aged 73 years. Though laboratory tests are all negative for the presence of fungi, the clinical feature of the case, that is a large solid mass of hard consistency is suggestive of mycotic infection.
My thanks are due to Dr. Karmakar of All India Institute of Hygiene for doing the paper chromatography test. My thanks are also due to D. C. Lahiri, Professor of Bacteriology and Pathology of the Tropical School of Medicine for advice and help.
| References|| |
Donahue (1949). Amer. J. Ophthal. 32, 207.
Duke-Elder (1957). Text Book of Ophthalmology. Volume V. (Henry Kimpton,London, p. 5295.
Fazakas (1934). Magyar Orvosi A.. 35, 325.
Fazakas (1936). Klin. M. Aug., 96, 227.
Locatcher-Khorazo, Deborah (1954): Exhibit at 17th International Congress ofOphthalmology, the Waldorf Astoria. New York N.Y. (Sept.) 1954.
Norkiewicz Jodko (1870). Klin. M. Aug.. 8, 78.
Viers. E. R. (1955). The Lacrinial System. Grune and Strattan, p. 61.
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