The role of bacteriologic infection in the etiology of nasolacrimal duct obstruction

Background: In patients with nasolacrimal duct obstruction, the inflammatio n and fibrosis may be secondary to coexisting infectious colonization withi n the lumen of the lacrimal sac, We examined the bacterial flora within the lacrimal sac at the sac-duct junction to explore the possibility of a prim ary bacteriologic etiology of the inflammatory response. Methods: The study included 114 consecutive patients (132 sides) with epiph ora undergoing routine external dacryocystorhinostomy (DCR) at a tertiary c are hospital in Toronto between November 1999 and April 2000, A lacrimal sa c tissue biopsy specimen was acquired intraoperatively from the inferior po sterior lacrimal sac near the sac-duct junction. Microbiologic analysis was carried out to determine the presence and identification of infectious org anisms. Results: Culture gave positive results in 51 patients (44.7%) (41.7% of spe cimens). A total of 65 isolates were cultured, of which 78.5% were gram-pos itive bacteria and 21.5% gram-negative bacteria. Of the gram-positive organ isms 76.5% were Staphylococcus sp, The presence of a positive culture resul t was independent of a history of dacryocystitis or the presence of a mucoc ele. Interpretation: Using direct biopsy methods, we found culture-positive lacr imal sac specimens in a large proportion of patients undergoing DCR surgery . These organisms were found to be present in patients with and without a h istory of infection.