|Year : 1983 | Volume
| Issue : 1 | Page : 15-16
Management of chronic dacryocystitis by polythene intubation
DL Maria, VSK Ballurkar
Department of Ophthalmology, Medical College, Aurangabad, India
D L Maria
Civil Hospital Aurangabad, 431 001
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Maria D L, Ballurkar V. Management of chronic dacryocystitis by polythene intubation. Indian J Ophthalmol 1983;31:15-6
Probing which was advocated and practise (Bowman) in adults, usually fails in establishing its patency, endangers orbital cellulitis anc establishes fibrous stricture. Dacryocystorhinostomy is a time consuming process involving cutting of bones, nasal mucous membrane; though results are extremely encouraging. Polythene intubation was started by Summer skill. Intubation being a simpler process wa; tried in 80 cases of chronic dacryocystitis and followed up for it results.
| Material and methods|| |
80 patients of chronic dacryocystitis were picked up for this treatment. All patients were given a tablet of Calmpose one hour before the operation and nasal pack with xylocaine 4% and adrenaline 1 : 1000 half an hour before operation. Infiltration anaesthesia with 2% xylocaine with adrenaline was given. Sac was exposed by a standard method. Polythene tube 22 mm, long, 4mm, in diameter whose upper end was made funnel shaped by a heated punctum dialator, thoroughly
sterilized was introduced in each case through an incision on the anterior surface of lacrimal sac close to its junction with nasolacrimal duct. Wherever it was possible a stitch with 6 zero black silk was given to the mucous membrane of sac through the mushroomed end of tube. Sac was closed by 8 zero silk, followed by lacrimal facia, muscle and skin. Daily dressing was done and all patients were put on oral Sulfuno, Suganril and Incidal tablets for 5 days. First syringing was done on 2nd day and was repeated for 7 days. Most of the patients were followed upto 3 months.
| Observations|| |
The observations are tubulated [Table 1][Table 2][Table 3][Table 4][Table 5][Table 6]. We had patency of Nasolacrimal duct in 78% case, partial patency in 12 cases and failings in 10% cases. Expulsion of tube was noted in one case though nasolacrimal duct became patient. In 7 cases sac had to be reopened. The tube was not present. It must have been expelled. Intubation was repeated in 3 cases with successful results while sac was removed in remaining 4 cases. There was no reaction to the polythene tubing.
| Discussion|| |
No single method is fool proof in the management of chronic dacryocystitis. Mehra has mentioned dacryocystotomy probing as treatment for nasolacrimal duct block and got success in 80% cases. Attempts were made to keep metal tubes or styles in the duct since the last century but polythene tube was kept after exposing the sac recently (Summerskill, Singh & Garg).
Mukherjee et a1 used tube with one end funnel shaped by suturing it to the wall of sac in 44 cases. According to Stallard, acrylic tube of 3mm. diameter used by Summerskill might be successful, in 40% of cases if the infection was not very severe. If diameter of tube was less than 3mm. and infection was severe, failure was inevitable rate.
In our series the expulsion of the tube was in 8 cases (0%), while Mukherjee and Jair had in 6 8%, may be due to suturing of the tube with the sac wall. 63 cases (78%) had complete cure while in 9 cases (12%) nasal duct was partially patent whereas operation failed completely in 8 cases. Our results are in conformity with those of singh & Garg and Mukherjee & Jain.
The success rate of dacryocystorhinostomy operation varies from 80 to 97% (Stallard) while 8% suffer recurrence. In comparison to this intubation has less success rate, but because of simplicity of operation, less time consuming and even a junior surgeon can do it, intubation can be preferred to dacryocystorhinostomy. Intubation restores lacrimal passage. It can be repeated in recurrent cases or even dacryocystorhinostomy can be done.
| Summary|| |
Polythene tube was introduced in 80 cases of chronic dacryocystitis. Success rate was 78%, 12% had partial success while 10% failed completely.
| References|| |
Bowman, 1857, Quoted by Duke Elder, S. System of Ophthalmology', Vol. XIII Pt. 2, Page 715, Henry Kimpton, London, 1974.
Summerskill, 1952, : Quoted by Duke Elder, System of Ophthalmology Vol. XIII, Pt. 2, Page 715, Henry Kimpton, London, 1974.
Mehra, K., 1965, Ind. J. Ophthalmol. 13: 117.
Singh, D.S. and Garg, R.S., 1972 Brit. J. Ophthalmol., 56: 914.
Mukherjee, P.K., Jain P.C., 1972, Ind. J. Ophthalmol 20 : 16.
Stallard H.B. 1973, Eye surgery, 5th Ed., 267,