Year : 1985 | Volume
: 33 | Issue : 4 | Page : 251--253
An observation on pathological changes of lacrimal sac in chronic dacryocystitis
Dept of Ophthalmology, Rajendra Medical College and Hospital, Ranchi, India
Dept of Ophthalmology, Rajendra Medical College and Hospital, Ranchi
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Thakur S. An observation on pathological changes of lacrimal sac in chronic dacryocystitis.Indian J Ophthalmol 1985;33:251-253
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Thakur S. An observation on pathological changes of lacrimal sac in chronic dacryocystitis. Indian J Ophthalmol [serial online] 1985 [cited 2021 Jun 21 ];33:251-253
Available from: https://www.ijo.in/text.asp?1985/33/4/251/30803
The presence of inflammation and pus in the lacrimal sac for a variable period due to neglect, may cause histo-pathological changes of variable degree in different patients which may be of some interest to ophthalmologist.
The object of present study is to assess the evolution of dacryocystitis over a number of years and co-relate it with the induced pathological changes.
MATERIALS AND METHODS
40 patients of chronic dacryocystitis were taken into this study. A thorough clinical examination was made which was followed by surgery. Histo-pathological examination of the lacrimal sac, so removed, were carried out.
(A) Macroscopic appearance:-It is apparent from our study, that there were two types of changes that occurred in the lacrimal sac as seen in naked eye appearance
Type I-Enlarged sac with thick wall and soft feel 42.5%.
Type II-Shrivelled up sac with thin walls 57.5%.
(B) Microscopic appearance :-Histopathologically the lacrimal sac was divided in the following types :
I. Non-specific chronic dacryocystitis-
Almost normal epithelial wall and epithelium was heavily infiltrated with chronic inflammatory cells [Figure 1].
II. Chronic catarrhal type -Pseudostratified epithelium heavily infiltrated with chronic inflammatory cells, proliferation of fibroblast [Figure 1]b.
III. Hyperplastic type - Characterised by hyperplasia of epithelium was multiplied more than two layers. In some cases hyperplasia of goblet cells. Wall infiltrated with chronic inflammatory cells [Figure 1]c.
IV. Dacryocystitis pseudoglandularis - Epithelium dipped into the submucosa and the wall. Some had contact with lumen and some were independent lumen, infiltrated with chronic inflammatory cells [Figure l]a.
V. Fibrotic type-Atrophy or shedding of the epithelium as well as the sac wall. Every tissue was replaced by dence fibrosis [Figure 2]a.
VI. Follicular type-Lymphocytic aggregation in the lymph node fashion in the submucosal layer of the wall. Epithelium was normal or hyperplastic. There was infiltration of the chronic inflammatory cells [Figure 2]b.
In the present series of 40 cases the follicular changes were found in 35%, hyperplastic changes in 32.5%, fibrotic changes in 12.5%, dacryocystitis pseudoglandularis in 10%, non specific chronic dacryocystitis in 7.5% and chronic catarrhal in 2.5%.
In 17 cases of Type I, the preponderating group of 76.5% has hyperplastic changes whereas 23.5% were dacryocystitis pseudogland ularis.
In 23 cases of Type II, 60.9% were characterised by subepithelial follicular hyperplasia whereas 21.7% were characterised by fibrotic, 13.1 % non-specific chronic dacryocystitis and 4.3% chronic catarrhal type.
In our study we found hyperplasia of the epithelium is commonly associated with the thickening of the wall whereas follicles formation in wall is associated with shrivelled up appearance. This type of observation is not reported in the available literatures.
Rahi et al examined 304 lacrimal sacs excised in cases of chronic dacryocystitis in which hyperplastic type was 35%, follicular type 27%, dacryocystitis pseudoglandularis 18% fibrotic type 12% chronic catarrhal type 7% and suppurative type 1%.
Sharma et a1 studied 25 cases of chronic dacryocystitis and observed the hyperplasia and denudation of the epithelium with chronic inflammatory cells infiltration.
In the present observation, follicular type of changes is more common than the other type whereas Rahi et al found hyperplastic changes more common than others. In our study 7.5% cases have non-specific changes in the sac whereas these changes were not found by Rahi. Rest of the changes almost confirm with those of Rahi et al observation. This type of variation may be due to some geographical distribution of the disease and the number of cases observed.
As regards the duration of illness, the follicular and hyperplastic changes in the lacrimal sac were more frequent in small duration of illness whereas fibrotic changes was frequent in prolonged duration of illness [Table 1].
It may be concluded that hyperplastic changes in the epithelium is more frequent if the duration of illness is less whereas if the disease is neglected for pretty long time fibrotic changes in the lacrimal Sac Supervenes.
In a study of 40 cases of dacryocystitis, the duration of disease macroscophic appearance and histopathology findings of excised lacrimal sac correlated.
I express my thanks to Dr. Shreemohan Mishra, and Dr. A. B. Khan for the valuable help and guidance for conducting this study.
|1||Rahi, A. H, Rahi, S. L. Ahuja, 0 P. and Shukla, B. B. 1967, Ind. J Ophthalmol : 15 : 159.|
|2||Sharma, J. L., Chaudhary, B. S. Parmar, I P.S and Arya R K 1972, Orient Arch Ophthalmol 10: 246.|