Different medical and surgical methods of restoring the patency of the obstructed lacrimal passages have been tried since ancient times. Medical treatment has no value in chronic dacryocystitis but surgical techniques have evolved from the drastic procedures of cauterizing the diseased tissue to the more refined conservative procedure ofdacryocystorhinostomy. This complicated and time-consuming operation has been further supplemented by intubation. A polyethylene tube is inserted permanently into the naso-lacrimal duct by exposing the lacrimal sac; the procedure is based on the method described by Summerskill (1952). Material and methodsThe study was carried out in the Ophthalmology Department of Rajendra Hospital, Patiala, in forty cases of chronic dacryocystitis who attended the hospital for treatment. Patients were selected who complained of epiphora, or who had regurgitation on pressure over the sac and on syringing with normal saline, indicating a block in the lower lacrimal passages. No patient with a negative regurgitation test was operated on by this technique. AnaesthesiaPatients below the age of I2 years were operated on under general anaesthesia and the rest under local anaesthesia. Technique(i) The site of the skin incision is marked with gentian violet solution.(2) The lacrimal sac is exposed through a straight skin incision about i cm. long along the lower part of the anterior lacrimal crest.(3) The soft tissue is separated below the intact medial palpebral ligament so as to expose the sac (Fig. I). (4) A vertical incision 4-5 mm. long is made in the lateral wall of the sac (Fig. 2). (5) The naso-lacrimal duct is probed and dilated as much as possible without fracturing the bone (Figs 3 and 4). (6) A Polyethylene tube of appropriate size and calibre is placed in the naso-lacrimal duct so that its flange rests at the bottom of the sac and the bevelled end lies in the inferior meatus of the nose (Figs 5 and 6). Polyethylene tubes of different lengths (i2, I5, I6, 17, and i8 mm.) and calibres (i, 2, and 3 mm.) are cut with one end bevelled while the other end is flanged about 4-5 mm. (This is done by warming the tube over a flame and quickly touching it against a smooth metallic surface.)
Introduction: Dacryocystitis is the inflammatory condition of the lacrimal sacwhich occur in acute and chronic form. Chronic dacryocystitis is commonly encountered, accounting for 87.1% of Epiphorawhich causes social embarrassment due to chronic watering from the eye. Understanding the antibiogram for micro organism causing inflammation of lacrimal sac can be useful in choosing the best antimicrobial. Hence the present study was done to evaluate the clinical profile and antibiogram of acute and chronic dacryocystitis. Method: A prospective observational study was done in patients with acute or chronic dacryocystitis attending ophthalmology OPD. Those fulfilling the eligibility criteria were enrolled in the study. Samples were collected from all the cases and were sent to microbiology lab for gram staining, culture and sensitivity. Result: 100 patients of dacryocystitis were enrolled, chronic dacryocystitis was found common than the acute dacryocystitis, along with a female (middle age group) preponderance. The main presenting symptom was watering (89%) followed by discharge (47%), swelling (34%), pain (23%) and tenderness (23%). Gram positive organisms (72.86%) were most commonly isolated. Among the Gram-positive organisms, Staph. aureus (37.14%) while Pseudomonas among Gram negative were the common isolate. Vancomycin and tobramycin are highly active against all Gram positive, tobramycin, gentamycin, fluoroquinolones and cephalosporins are found to be very active against Gram negative bacteria. Conclusion: The most common bacterial isolate in dacryocystitis, prevailing in this geographical area is Staphylococcus (Gram positive) followed by Pseudomonas, Pneumococcus and Staph epidermidis. Combination of Vancomycin and 3 rd generation cephalosporin can be used as empirical therapy when the culture reports are awaited.
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