Clinicobacteriological study of chronic dacryocystitis in adults.
ABSTRACT Chronic dacryocystitis is the inflammation of lacrimal sac, frequently caused by bacteria. Obstruction of nasolacrimal duct converts the lacrimal sac a reservoir of infection. It is a constant threat to cornea and orbital soft tissue. Moreover, it causes social embarrassment due to chronic watering from the eye. This study was conducted to find out the current clinicobacteriological profile of chronic dacryocystitis in adults. A total of 56 adult patients were selected from ophthalmology OPD. Detail history and clinical examinations were carried out. All patients underwent either dacryocystorhinostomy or dacryocystectomy. A part of the sac was collected for culture and sensitivity. This study revealed that chronic dacryocystitis is more common in females and left eye is more frequently involved than right eye. It is common among lower socioeconomic strata with habit of pond-bathing. Some form of nasal pathology like hypertrophied inferior turbinate, deviated nasal septum, nasal polyp and allergic rhinitis werefound in 19.6% of the patients. Complications of chronic dacryocystitis like conjunctivitis, corneal ulcer, acute on chronic dacryocystitis, lacrimal abscess and fistula were seen in 25.0% of these patients; 53.6% of the culture samples were positive for bacterial growth. Gram-positive organisms were most common isolate. Unlike other studies, Staphylococcus aureus (40.0%) was found to be most common Gram-positive organism, followed by Staphylococcus epidermidis (10.0%) and Steptococcus pneumoniae (10.0%). Among the Gram-negative organisms, Pseudomonas aeruginosa (16.6%) was the most common, followed by Klebsiella pneumoniae (6.6%) and Haemophilus influenzae (6.6%). Antibiotic sensitivity tests were done. Most of the organisms were resistant to penicillin. Chloramphenicol was effective against most of the Gram-positive organisms. Aminoglycosides, tobramycin in particular, was effective against Staphylococcus epidermidis. Fluoroquinolones, namely ciprofloxacin and ofloxacin were effective against Pseudomonas aeruginosa and Klebsiella pneumoniae.
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ABSTRACT: Aims and objectives: The aim of this study was to identify the organisms responsible and to determine the antibiotic susceptibility pattern of the bacterial isolates from conjunctiva and nasal mucosa in cases of chronic dacryocystitis and comparing with lacrimal sac specimen. Design: Prospective longitudinal study. Methods: A prospective analysis of 44 lacrimal sac contents of patients with chronic dacryocystitis conducted during the period from April 2012 to March 2013. Material was obtained directly from the lacrimal sac while making sac flap during external dacryocystorhinostomy for chronic dacryocystitis. Samples were also collected from ipsilateral conjunctiva and inferior meatus of nose. The specimens were cultured and results analyzed. Statistical Analysis: The results were analyzed by using Chi-square (χ(2)) test. Results: All the patients were in age group of 30 and above. Gram positive bacteria i.e., Coagulase negative staphylococci and Staphylococcus aureus were the most common isolates (71% and 14% respectively). Vancomycin, amikacin, 3(rd) generation cephalosporins and amoxyclav were most sensitive antibiotics (100%, 89%, 83%, and 78% respectively). Comparison between lacrimal and nasal/conjunctival isolates showed high degree of identicalness between the isolates of two sites (p< 0.05). Conclusion: Majority of the chronic dacryocystitis cases are caused by Coagulase negative Staphylococci and Staphylococcus aureus. Amoxyclav and 3(rd) generation cephalosporins can be used to treat chronic dacryocystitis. Commensal flora of nose and conjunctiva have a direct role in pathogenesis of chronic dacryocystitis.Journal of clinical and diagnostic research : JCDR. 11/2013; 7(11):2502-4.
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ABSTRACT: Aims: To evaluate a new approach for recanalization (RC) of nasolacrimal duct obstruction in the treatment of the symptomatic nasolacrimal duct obstruction (NLDO). Materials and Methods: A prospective, interventional, comparative study in 302 eyes of 209 patients of symptomatic nontraumatic NLDO. Eyes with previous failed surgery were excluded. One hundred and fifty-one eyes underwent RC with 20 G endodiathermy bipolar probe connected to a 7 W diathermy followed by bicanalicular intubation under direct visualization. One hundred and fifty-one eyes underwent standard external dacryocystorhinostomy (DCR). Follow-up was for 24 months and evaluation was done on basis of change in symptoms and lacrimal syringing. Data was analyzed by Chi-square test and unpaired t-test. P value < 0.05 was considered statistically significant. Results: Success defined as an asymptomatic patient or freely patent syringing was 92.7% (140 eyes) in RC group and 83.44% (126 eyes) in DCR group. Success was significantly more ( P ≤ 0.01) in RC than DCR group. Surgical time was significantly less in RC than DCR ( P ≤ 0.001). In RC group, RC could not be performed in three eyes and had to be later taken up for DCR. Intubation after RC was not achieved in four eyes; however these eyes had a patent pathway till 24 months. Twenty-two eyes had a premature extrusion of the tube; but the success rate in these (20 eyes) was comparable to the others within the group (P > 0.05). Two eyes in RC and one in DCR group had complications. Conclusions: RC with 20 G endodiathermy bipolar probe is a quick, simple, and effective alternative to standard external DCR.Indian Journal of Ophthalmology 11/2013; · 1.02 Impact Factor
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ABSTRACT: Objective. To compare pre- and postoperative characteristics and surgical success rates of patients with and without previous episodes of dacryocystitis, who underwent external dacryocystorhinostomy (DCR) for nasolacrimal duct obstruction (NLDO). Methods. The medical files of all patients who underwent external DCR between 2006 and 2011 in our institution were reviewed. The retrieved data of patients with and without previous episodes of dacryocystitis were compared. Surgical success was determined by postoperative followup of at least 6 months. Results. A total of 185 patients with NLDO underwent external DCR of whom 152 (100 females and 52 males, mean age 67 ± 15 years) met the inclusion criteria. Sixty had previous episodes of dacryocystitis and 92 did not. Left-side obstruction was more common than right-side obstruction among patients with previous episodes of dacryocystitis (48.3% versus 31.7%, resp., P = 0.031). Glaucoma patients were significantly more likely to develop dacryocystitis than patients without glaucoma (P = 0.002). The success rate of external DCR was 94.4% for patients with previous episodes of dacryocystitis and 86.7% for patients without (P = 0.337). Conclusions. The surgical outcomes of external DCR in patients with or without a previous episode of dacryocystitis were similar. Patients with glaucoma and NLDO had a significantly higher risk of developing dacryocystitis.Journal of Ophthalmology 01/2013; 2013:287524. · 1.37 Impact Factor
AIOC 2010 PROCEEDINGS
Dr. JYOTI BHUYAN: M.B.B.S. (1983), Gawahati Medical College, Assam; M.S (1988), RIO,
Gawahati Medical College, Assam. Presently Associatate Professor.
A Clinicobacteriological Study on Chronic Dacryocystitis
Dr. Jyoti Bhuyan, Dr. Subhajit Das
(Presenting Author: Dr. Jyoti Bhuyan)
and conspicuous symptoms it may cause, partly
because it has little tendency to resolve. This
study was carried out in RIO Guwahati with the
objectives of: 1) Identifying the causative bacteria,
2) Studying the antibiotic sensitivity of these
bacterias to commonly used antibiotics and 3)
occupation and socioeconomic status.
Materials and Methods
Sixty cases of clinically established chronic
Dacryocystitis, who attended and were treated in
RIO, GMCH during the period from July 2008 to
June 2009 were selected for this study. Cases that
did not use any antibiotic drop previously or
stopped using antibiotic eye drop at least one
week before attending the hospital were taken for
this study irrespective of age, sex, occupation and
social status. Sterile swab sticks were used for
collection of regurgitated material. For bacterial
1. Stain – Gram’s Stain, KOH (10%).
2. Culture medium – Blood Agar, Mc Conky`s
Agar, Nutrient Agar, Chocolate Agar were used.
Three swabs were collected at a time. First for the
KOH smear, second for the Gram staining and
hronic Dacryocystitis is an unpleasant
disease, partly because of the troublesome
last swab for culture in medias. Swabs were sent
to Microbiology department for study.
Different results were observed in this study.
Table-1: Shows age Distribution
Age Groups (yrs)
Table 1 shows that the max. number of patients
are in the 4th decade (23.33%) followed by 5th
decade( 21.66). The present study shows that out
of 60 patients 46(76.66%) are females and 14
(23.33%) are males in the ratio of 3.28:1.
Our study shows that out of 60 patients 38
(63.33%) are housewives, 10 (16.66%) are farmers,
4(6.67%) are service holders, 4(6.67%) are
students, 3(5%) are shopkeepers and 1(1.67%) are
No. of Cases
Our study shows that out of 60 patients
29(21.66%) belong to upper class and 31 (78.33%)
belong to lower class.
Regarding presenting symptoms our study
shows that watering is present in all cases (100%),
while mucopurulent discharge is present in
25(41.66%) cases and swelling over lacrimal sac
region is seen in 10(16.66%) cases.
It has been observed that out of 60 patients of
chronic dacryocystitis clear fluid regurgitation is
found in 29(48.33%) patients, followed by
mucopurulent fluid regurgitation in 23(38.33%)
and purulent regurgitation in 8(13.33%) patients
Table-2: Bacteriological Examination
No of Cases
Table 2 shows that the commonest organism is
staphylococcus aureus (28.33%), followed by
streptococcus pneumoniae (23.33%).
Regarding sensitivity test our study shows that
Staph. Aureus is most commonly sensitive
against ciprofloxacin and gentamycin. Strep.
Pneumoniae is sensitive against ciprofloxacin
and Ampicillin. Overall sensitivity testing shows
that most effective antibiotic against all bacteria is
ciprofloxacin (80.76%) followed by Gatifloxacin
(46.15%), Chloramphenicol (42.30%), Tetracyclin
(44.23%), and Cloxacillin (32.69%).
The observations made in this study was more or
less similar to those of other previous authors. In
our study of 60 cases maximum number of
patients were in the 4th decade (23.33%) followed
by 5th decade (21.66%) & 3rd decade (20%) of
life. Sood et al 1 in 1967 and Visootr Chayakul et
al 2 in 1984 reported similar result. In this study
females 76.66 %( 46) were affected more than the
males 23.33 % ( 14). Duke-Elder (1974) 3 and
Trevor Roper et al 4 in 1974 made the similar
observation. The incidence of dacryocystitis was
more among housewives (63.33%) in our study.
Similar result was observed by Duke-Elder (1974)
3. Regarding social status our observation of
class(78.33%) was similar to that of Duke-
Elder(1974) 3 and Visootr Chayakul et al 2 in
observation was similar to Khurana AK 5 in 1996.
Predominant organism in our study was
Staphylococcus aureus (28.33%) followed by
Streptococcus pneumoniae (23.33%). Similar
results were stated by Prasad et al 6 (1958), Sood
et al 1 (1967) & D.V.Seal et al 7 (1982). While
examining the sensitivity test we found that the
most sensitive antibiotics were Ciprofloxacin
(69.23%), Gentamycin (67.30) & Tobramycin
(61.5%). Similar results were observed by Seal
D.V.et al 7 in 1982, Jain M.R. 8 in 1992 and
Mahajan VM et al 9 in 1987.
We conclude by saying that the present study
tried to find out the commonly involved
causative organism in chronic dacryocystitis and
helped to treat the patients with proper
antibiotics. It also studied local and general
predisposing factors causing dacryocystitis.
1.Sood NN, Ratnaraj A, Balaraman G, Madhavan HN,
study, Indian J Ophthalmol 1967; 15:107-10.
Visootr Chayakul: Studies on dacryocystitis and
dacryocytorhinostomy. X Congress APAO; 183-185,
Duke-Elder, 1974: System of Ophthalmology, edited
by Duke-Elder, Vol-13, part 2, 700-714, 1974.
Trevor Roper: A Clinico-bacteriological study of
chronic dacryocystitis, Ophthalmology; 83 (2): 275-
A K Khurana, Comprehensive Ophthalmology 2007
B Prasad, D Ram, G Prasad. Histological changes
Ophthalmology; vol: 6(4); P: 71-77 Year 1958.
D.V.Seal, J.I.Mcgeal: Etiology and treatment of
bacterial infections of external eye. : British Journal
of Oph. 66:357-370.,1982
Jain M.R.,: Clinical evaluation of Ciprofloxacin
drops in bacterial keratitis
MahajanVM, Bareja U. Prakash K.: Pneumococci in
ocular disease of children and their treatment.
Annals of Tropical Paediatrics.7:270-273, 1987.