|Year : 1967 | Volume
| Issue : 3 | Page : 98-99
College of Medical Sciences, Varanasi, India
|Date of Web Publication||21-Jan-2008|
K S Mehra
College of Medical Sciences, Varanasi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mehra K S. Dacryocystostomy-probing. Indian J Ophthalmol 1967;15:98-9
Probing as a permanent cure, for the blockage of naso-lacrimal duct has been advocated in the past, but is not very popular to-day.
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 dacryocystorhinostomy (D.C.R.) has to be done.
Probing of the naso-lacrimal 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 this worker to modify the technique of probing, by cutting down on 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 sac excision. 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|| |
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, 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 dicrysticin 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 anesthesia.
The incision was the same as that for dacryo-cystectomy, but was extended a little downwards, so as to expose the upper end of naso-lacrimal duct. Skin, orbicularis muscle and lacrimal fascia were incised and the anterior surface of sac defined. The junction of sac and naso-lacrimal duct was also defined clearly. A midline 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 of the size of 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 naso-lacrimal duct. Some difficulty was felt in probing. With extra care and by 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 5 minutes and then removed. Gentle syringing with the mixture* of 1 cc each of penicillin and streptomycine solutions with Zonulysin Hycin and Visine was done through the sac wall incision into the nasolacrimal duct. The incision of the sac wall was closed by two interrupted 0000 catgut sutures. Skin incision was closed by interrupted silk sutures. The patient was put on a course of dexamethasonet by mouth starting with 2 tablets thrice a day, tapering down to end the course after 10 days, in order to lessen fibrosis. The patient was dressed daily with hycin and 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, hycine, visine and zonulysin was repeated 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.
Those cases, whose watering from the eye was relieved and nasolacrimal duct remarried patent, were labelled as successful cases. Out of the 10 cases so treated, 6 were successful and 4 unsuccessful, which were treated subsequently by a D.C.R. or excision of the sac. One case of failure had not taken the full treatment as advised. It appears that in the cases that failed most probably fibrosis developed in the nasolacrimal duct following oedema, as a result of operative interference. A combination of the five different solutions is used because of the report by Mehra (1955) that there is a synergistic action of these drugs when combined.
By this technique the patient is relieved of epiphora, which persists after a sac excision and is saved the botheration of undergoing a D.C.R. If probing is not possible after incising the sac wall, then the sac may be removed.
| Summary|| |
A technique in which probing is done by incising the wall of the lacrimal sac, followed by syringing with a mixture of penicillin, streptomycin, hycin, zonulysin and visine is described. In 6 patients out of 10 the results were successful.
| References|| |
Dayal, Y. (1962), J. All India Ophthal Soc. 10: 61-63.
Duke Elder S. (1952), Text Book of Ophthalmology, Vol. 5, p. 5300, Kimpton.
Mehra. K. S. (1965). Amer. J. of Ophthal. 59: 3.
Stallard. H. B. (1958), Eye Surgery, Third Edition, p. 309, John Wright and Sons Ltd., Bristol.