Indian Journal of Ophthalmology

: 1990  |  Volume : 38  |  Issue : 4  |  Page : 189--190

Fungal flora in congenital dacryocystitis

Supriya Ghose, VM Mahajan 
 Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110 029, India

Correspondence Address:
Supriya Ghose
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110 029


In this study, 86 eyes in 66 cases (20 bilateral) of congenital dacryocystitis were analysed for fungal growth. Fungi alone were isolated in 12 eyes (13.95%) and in 14 eyes (16.28%) together with bacteria--a total of 26 positive for fungus in 86 eyes (30.23%). These 26 eyes yielded on fungal culture a total of 28 isolates (in 2 eyes, another fungus was isolated on repeat culture). 11 types of fungi were cultured--C. albicans and A. niger accounted for 5 each out of 28. To the best of our knowledge this is the first report in the literature of fungal flora analysed in congenital dacryocystitis--not surprisingly, more than 30% of eyes were positive for fungus. Systemic studies of fungal flora in dacryocystitis are very few, and hardly any literature on this subject exists in congenital dacryocystitis. This study is an attempt to determine the frequency and clinical significance of fungi isolated from cases of congenital dacryocystitis.

How to cite this article:
Ghose S, Mahajan V M. Fungal flora in congenital dacryocystitis.Indian J Ophthalmol 1990;38:189-190

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Ghose S, Mahajan V M. Fungal flora in congenital dacryocystitis. Indian J Ophthalmol [serial online] 1990 [cited 2021 Jan 15 ];38:189-190
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Eighty-six eyes in 66 cases(20 bilateral) of congenital dacryocystitis were examined, and the discharge imme­diately innoculated on Sabouraud's dextrose agar for culture. In those eyes whose initial culture % as positive for fungus, repeat cultures were run when& er possible. According to the mode of management adopted, the eyes were conveniently divided into 4 groups (G,roup I to IV).


Fungi alone were isolated in 13 eyes and together with bacteria in 13 more eyes, a total of 26 eyes (30.23%) positive for fungus, yielding a total number of 32 isolates including repeat cultures [Table 1]. In 3 eyes, the same fungus(Candida albicans) was recultured before topical therapy with 0.5% Amphotericin B. In 3 more eyes, another fungus of a different nature was isolated on repeat culture, without antifungal therapy - in 2 eyes of a patient, the initial Rhizopus in both eyes changed to flavus in the right eye, and A.niger in the left eye; in another eye, Alternaria changed to Rhizopus.

Two eyes (Group I), with an initial culture positive for both fungi and bacteria, responded excellently to con­servative therapy with topical antibiotics alone - a repeat culture later was negative for fungus.

Seven more eyes (Group II), all positive ini ially for fungus ( and 6 for bacteria too), were conservatively treated with topical antibiotics and 0.5% Amphotericin B - 5 responded very well, though 2 of these 5 yielded another fungus of a different nature on repeat culture before start of treatment, and 1 re-exhibited the same fungus (C.albicans) which could not be regrown after sucessful therapy. From the 2 eyes which only responded partly to treatment, the same fungus(­bicans) was recultured before initiating therapy.

Six other eyes (Group III) initially positive for fungus (and 1 for bacteria also) all responded excellently to probing and syringing and topical antibiotics - 3 of these eyes, where culture could be repeated later, were negative for fungus. One eye (Group IV) initially positive only for fungus, was cured by probing and syringing and Am­photericin B, and post-treatment culture was negative.

The remaining 10 of these 26 eyes initially positive for fungus could not unfortunately be followed up adequate­ly to definitely comment upon their therapeutic response


A chance observation in a couple of patients started us off on this study. We felt that a knowledge of the fungal flora in congenital dacryocystitis would be of obvious help to the ophthalmologist in guiding him on the use of topical antibiotics during conservative therapy of such cases, and on the use of antibiotics and/or steroids after probing, if probing is required. Fungi isolated in such cases probably represent fungal superinfections by saprophytic organisms, and not necessarily actual fun­gal dacryocystitis [2]. However it may indicate the use of topical antifungal agents along with conservative management, specially if probing is contemplated. If probing is carried out, the surgeon may decide on an antifungal solution on the table to irrigate the lacrimal passages after probing, and for instillations in the post operative period

In studies on healthy conjunctival sacs in newborns and children, fungus was positive in only 0.1 % to 4.8%. [3,4,5] The 30.23% incidence of fungal flora in our study is also definitely much higher than the 6% positive for fungus reported earlier from healthy conjunctival sacs in the same part of the country. [6]

The types of fungi isolated in our study on congenital dacryocystitis[Table 1] are almost similar to the fungal flora obtained in dacryocystitis in general spread over all age groups and mostly in adults. 1,2. The slightly higher incidence of fungus positive cases in these two studies, [1],[2]sub compared to ours may be explained on the basis of the observed rise of incidence of fungus even in healthy eyes with increasing age [3],[4],[5].

It seems that in diseases of the lacrimal sac, even in children, the rise of incidence of fungal flora is sig­nificant, probably aided by the continued and random use of broad-spectrum antibiotics, and presence of mucopurulent material. Topical steroids are not com­monly used in the routine conservative management of congenital dacryocystitis and are therefore, probably not a significant exciting factor in these cases.

The culture for fungus in the 26 eyes initially positive for fungus could not be repeated in 12 eyes for various reasons. In 3 of the 14 eyes where culture was repeated, topical antifungal drops had already been instilled (Group II), and in 4 more of those eyes, probing and syringing had already been done succcessfully (Group III and IV). All these 7 eyes were interestingly negative or repeat culture. It seems probable that the irrigation of the lacrimal passages after probing (Groups III and IV) played an important role in clearing away the fungus. The spontaneous resolution of the dacryocystitis on conservative treatment(Group I and II) cleans the sac of the discharge, and probably clears the fungus as well.

Still, of the 14 eyes subjected to a repeat culture for fungus, 6 eyes again were positive. In 3 of these eyes, the same fungus (C.albicans) was recultured, suggest­ing its definite role in the disease process. In 3 more eyes, where another fungus of a different nature was isolated on repeat culture, such a conclusion probably cannot be justified.

It is known that initially fungus positive normal eyes, when repeatedly recultured, may not yield any fungus4, thereby suggesting that fungus cultivable from the heal­thy conjunctival sac may be transitory contaminants rather than resident commensals. However, the ob­vious significance of fungi isolated in congenital dacryocystitis in this study cannot be underestimated.

Though further studies may be necessary before deriv­ing conclusions about the role of fungi in such cases, to the best of our knowledge, this is the first report in the literature of fungal flora systematically analysed in con­genital dacryocystitis - not surprisingly, more than 30% of eyes were positive for fungus.


The authors are highly indebted to Miss.Sushma Srivas­tava and Mr.D.K. Singh for their technical assistance.


1Rahi A.H.,Nath K., Sharma S.C., and Rahi S.L.1967, Proc. All India Ophth. Soc., 24:157.
2Thakur V. Nema H.V. and Mehra K.S.1968, Proc All India Ophth. Soc., 25:425.
3Hammeke J.C. and Ellis P.P.:1 960, Amer J. Ophthalmol 49:1174
4Williamson J., Gordon A.M., Wood D.R., McKdyer.A. and Yahaya O.A., 1968. Brit. J. Ophthalmol 52:127
5Locatcher-Khorazo D. and Seegal B.C.: 1972 "Microbiology of the Eye", C.V. Mosby Co., St. Louis, p.209 - 218
6Agarwal L.P. and Khosla, P.K.: 1963, Orient Arch. Ophthalmol, 1:145