Clinicobacteriological study of chronic dacryocystitis in adults.

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.

Treatment of pterygium with conjunctival limbal autograft and mitomycin C--a comparative study.

A total of 60 eyes with primary progressive pterygium were selected. They were randomly divided into two groups ie, group A and group B each consisting of 30 eyes. Group A patients were treated with pteryglum excision with ipsilateral conjunctival-limbal autografting. Group B patients were treated with pterygium excision followed by mitomycin C 0.02% for two minutes. Both groups were followed up for one year postoperatively to document recurrence rates and postoperative complications. In group A recurrence rate was 3.0% with minimal ocular complication after one year follow-up. But in group B recurrence rate was high as 10.0% and ocular complications were significant after the same period of postoperative follow-up. Both conjunctival-limbal autograft and intra-operative mitomycin use are effective method of surgical treatment of pterygium but considering the rate of recurrence and other postoperative ocular morbidity conjunctival-limbal autografting seems to be the best method of pterygium treatment.

Bacteriological profile in chronic dacryocystitis.

A study was conducted to see the bacteriological profile in 172 cases of chronic dacryocystitis attending eye outpatients department of Midnapore Medical College and Hospital and NRS Medical College and Hospital, Kolkata. The patients underwent clinical examination of the eyes and lacrimal system, with particular attention to drainage system. The culture and sensitivity test was done from the material, which regurgitated through the punctum following pressure on sac. Out of 172 cases, 66(38.4%) were found with epiphora, 44 cases (25.9%) of epiphora with mass, 8 cases (4.6%) with epiphora mass with cellulitis and in 54 (31.4%) with chronic conjunctivitis. Bactriologically, 142 patients (82.5%) were revealed with pure culture, mixed culture in 18 cases (10.5%) and no growth of organism in 12 cases (7.0%). Staphylococcus aureus was found primary pathogen in disease process. Candida albicans were seen in 4 cases (2.3%).

Xerophthalmia: a study among malnourished children of West Mednipur District.

To study the correlation of stages of xerophthalmia in different grades of malnutrition, having 200 children clinically diagnosed having malnutrition as per criteria laid down by the Indian Academy of Pediatrics (IAP) were examined to detect the dinical stages of xerophthalmia as proposed by World Health Organisation (WHO). Out of 200 cases with different grades of malnutrition 81 (40.5%), 78 (39.0%), 22 (11.0%) and 19 (9.5%) were found malnourished in grades I, II, III, and IV respectively. Night blindness was earliest feature and seen in 97 cases (48.5%). All the 97 cases of night blindness fell in group of X(N) in which one case had corneal scar and falls in the group of X(S) in clinical staging of xerophthalmia. Thirty-nine (40.2%), 35 (36.1%), 19 (19.6%), 3 (3.1%) and (1.1%) were in clinical stages of xerophthalmia of X(1A), X(1B), X2, X(3A), X(3B)respectively. Severity of xerophthalmia was found directly proportional to severity of malnutrition.

Malignant melanoma of conjunctiva--a case report.

A 65-year-old male patient presented with a rapidly increasing mass in his left eye. It did not show any intra-ocular extension as examined by slit lamp, gonioscopy, indirect ophthalmoscopy and ultrasonography, nor there was any sign of systemic metastasis. The mass was excised completely. Buccal mucous membrane grafting was done to cover up the lower forniceal area and conjunctival autograft taken from right eye and placed over upper fornix and bulbar area. Postoperative radiotherapy was suggested. Histopathological examination of the mass revealed the diagnosis of malignant melanoma of conjunctiva.

Rheumatoid arthritis and ocular involvement.

To study the occurrence and incidence of different ocular manifestations in rheumatoid arthritis a random cross-sectional study was carried out among 54 patients with active rheumatoid arthritis. The patients were examined thoroughly to detect any ocular disease associated with rheumatoid arthritis. Complete ocular examination with special emphasis on anterior segment evaluation and tearfilm study was done. Two-thirds of the patients examined had some kind of visual problem at presentation. Three patients (5.55%) had marked dry eye with another 20 (37.03%) having borderline tear deficiency. Two cases ( 3.70% ) of episcleritis were also seen. No cases of scleritis or retinopathy were found. The most common ocular association with rheumatoid arthritis was secondary Sjogren's syndrome. Other conditions include episcleritis and marginal keratitis.

Clinical pattern of ocular manifestations in vitiligo.

To study the ocular abnormalities in cases of vitiligo, 100 patients were examined who underwent a series of investigations e.g., complete haemogram, urine analysis, blood biochemistry and chest x-ray and 70 cases were taken as control. Patients with systemic diseases such as diabetes mellitus, thyroid and auto-immune disorders were excluded. Detailed ocular examinations including recording of vision, slit-lamp biomicroscopy, gonioscopy, ophthalmoscopy and examination of fundus by 90 D lens were done. Of 100 vitiligo patients, 23% showed hypopigmented sports on the iris, 18% pigmentation on anterior chamber, 9% retinal pigment epithelium hypopigmentation, 5% uveitis, 11% had chorioretinal degeneration and 34% had no ocular findings. There lies a strong association of ocular disorder in patients with vitiligo.

Association of diabetic maculopathy with diabetic nephropathy--a study.

A total number of 100 patients were examined over a period of one year to find out any correlation between diabetic maculopathy and diabetic nephropathy. Twenty-two belonged to insulin dependent diabetes mellitus group and 78 patients were in the non-insulin dependent diabetes mellitus group who were suffering from diabetes over a period of 0-25 years and more. Another group comprising 6 patients were chosen from these 100 patients who were suffering from nephropathy diagnosed clinically and on pathological investigations. Background and proliferative--both types of diabetic retinopathy were found with increased incidence with the persistence of the disease in both types of diabetes mellitus. Nine patients had diabetic maculopathy, out of which 6 patients (66.66%) were suffering from diabetic nephropathy. Proliferative diabetic retinopathy is more common in insulin dependent diabetes mellitus than in non-insulin dependent diabetes mellitus of more than 25 years of duration. Maculopathy is more common in non-insulin dependent diabetes mellitus and there is strong correlation between diabetic maculopathy and diabetic nephropathy.