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ARTICLES
Year : 1976  |  Volume : 24  |  Issue : 2  |  Page : 29-31

Dacryocystography and surgery in pseudo sac


Department of Ophthalmology, Medical College, Gwalior, India

Correspondence Address:
M L Agarwal
Department of Ophthalmology, Medical College, Gwalior
India
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Source of Support: None, Conflict of Interest: None


PMID: 1031392

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How to cite this article:
Agarwal M L, Gupta V K, Gandotra V K, Baijal G C. Dacryocystography and surgery in pseudo sac. Indian J Ophthalmol 1976;24:29-31

How to cite this URL:
Agarwal M L, Gupta V K, Gandotra V K, Baijal G C. Dacryocystography and surgery in pseudo sac. Indian J Ophthalmol [serial online] 1976 [cited 2021 Jan 22];24:29-31. Available from: https://www.ijo.in/text.asp?1976/24/2/29/31532

It is not unusual to come across a case showing recurrence of mucoid or mucopurulent discharge on regurgitation test following an operation of dacryocystectomy. This has been attributed to incomplete excision of sac. The only final treatment is removal of sac or an anastomatic operation.


  Material and Methods Top


In the present study six cases of pseudosac, have been visualised radiographically and surgery performed. All the cases were prepared for dacryocystorhinostomy and the technique described by Agarwal[2] was followed in all cases. Myodil has been used as contrast medium.


  Observations Top


All the cases were female ranging in age from 16 to 75 sears and had history of suffering from acute exacerbation prior to previous surgery.

Case No. D1

Dilated sac with thin wall fused with surrounding tissue could not be separated for flaps. Dacryocystectomy was done [Figure - 1].

Case No. D2

On operation table, an apparently big dila­ted sac, with thick wall and small cavity, adhesions around the sac was seen. After separating sac from these adhesions, flaps could be prepared and dacryocystorhinostomy was performed, [Figure - 2].

Case No. D3

There were adhesions around the sac at the mark of previous incision. Sac wall was thick. The sac was freed from adhesions; and the flaps could be prepared and dacryocystorhino­stomy performed. [Figure - 3]

Case No. D4

On operation sac was found to be dilated with thin friable wall, and could not be separat­ed. Dacryocystectomy was done. [Figure - 4]

Case No. D5

On operation table sac was dilated, and had a thin friable wall. The sac could not be sepa­rated. Dacryocystectomy was done. [Figure - 5]

Case No. D6

Sac was thick walled and had a smooth cavity. There were adhesions around the sac. Flaps could be prepared. Dacryocystorhino­stomy vas done. [Figure - 6]


  Discussion Top


The regeneration of lacrimal sac is thought to be a result of retained mucous membrane of the lacrimal sac following incomplete exci­sion. The cases where the mucous membrane is likely to be retained on an excision of sac are in whom the sac wall had developed pouches or had become fused with surrounding tissue or had developed fistula, internal or external along with adhesion! and fibrosis, following one or more attacks of acute exacerbations, prior to surgery.

In the present study, all the cases, who had developed a pseudo sac, had suffered from one or more acute attacks before excision of sac was undertaken.

Keith Lyle[3] states that the retained mucous membrane appears to continue secretion of mucous which not being absorbed becomes surrounded by a fibrous tissue capsule, the inner surface of which is lined by columnar epithelium. This pseudo sac is usually in continuity with inferior canaliculus and can be used instead of normal lacrimal sac in oper­ation of dacryocystorhinostomy.

In the present study, dacryocystography showed a dilated sac in all the cases. This pseudo sac had continuity with inferior canali­culus and therefore dacryocystorhinostomy could be performed in three cases (D l , D 3 , D s ).

A retained small degenerated piece of sac is not likely to secrete mucous. It is the dis­charge from surrounding tissue which has undergone inflammatory changes, and the tear fluid which get accumulated in the cavity after sac surgery is likely to excite a fibroblastic reaction in surrounding tissue resulting in a fibrous lining of a cavity.

The observations during surgery in all the 6 cases, have shown that the sac wall was fused with the surrounding tissues, thick in case Nos.

D 2 , D 3 and D s ; thin in case Nos. D l , D 4 and D 5 . In the cases (D 2 D 3 , D s ) with thick fibrous wall of pseudo sac, it could be dissected free from surrounding tissue, flaps prepared and dacryocystorhinostomy could be performed. In cases (D l , D A , D 5 ) with thin sac wall, it could not be dissected. So dacryocystectomy was done with care to remove all the tissue pertain­ing to sac under dissection.


  Summary and Conclusion Top


Six cases of recurrence (Pseudo sac) have been visualised radiographically and surgery performed. The clinical indication was dacry­ocystectomy in all the cases. On the table in three cases who had thick fibrous sac wall, which could be dissected free from surrounding tissue, an anastomotic operation was perform­ed. Dacryocystography has helped to assess and plan surgery pre-operatively in these cases of pseudo sac.

 
  References Top

1.
Agrawal, M. L., 1961, Amer. J. Ophth., 52,245.   Back to cited text no. 1
    
2.
Agrawal, M. L., 1970, J. All India Ophth. Soc., 18, 69.  Back to cited text no. 2
    
3.
Keith Lyle, 1946, Brit Jour. Ophth. 30, 102.  Back to cited text no. 3
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6]



 

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