The most important clinical features of canaliculitis include a red, swollen eyelid in the area of the affected canaliculus, a unilateral conjunctivitis, a mucopurulent discharge and in some cases dacryoliths visible in the lacrimal punctum. Conservative therapy was found to be little effective: only 10% of the patients could be cured, 40% showed a recurrence after conservative treatment. 20 patients (50%) were treated by canaliculotomy: 16 of these were cured by this surgical treatment, 4 patients complained of epiphora, although diagnostic syringing showed free lacrimal pathways. The surgical treatment of canaliculitis in combination with conservative therapy yields far better results than conservative therapy alone.

Aims-To evaluate the data for patients with basal cell carcinoma (BCC) in the eyelid region, to demonstrate histologically controlled tumour excision, and to prove the eYcacy of the treatment on the basis of long term observations. Methods-Retrospective analysis of 382 microscopically controlled BCC excisions in the eyelid apparatus (350 patients) in a follow up study over 5.7 (SD 1.1) years. Tumour location, tumour size, and histological results were recorded. The same procedure was followed for recurrences. Follow up examinations were carried out 1, 3, 6, and 12 months after the operation, and then annually for a further 4 years or longer. Results-A recurrence rate of 5.36% was observed after the primary operation. 60.3% of first recurrences occurred in the medial canthus, 41.2% showed in depth extension, and sclerosing types were overly represented at 35.3%. After the second operation the recurrence rate increased to 14.7% and reached 50% after a third and fourth operation. Conclusions-The greatest risk of recurrence exists for BCCs of the medial canthus with in depth extension, and for sclerosing types. The recurrence rate increases after every operation. For high risk cases, consideration should be given to adjuvant treatment such as radiotherapy. (Br J Ophthalmol 1999;83:85-88)

The dacryocystitis in adults is mainly caused by postsaccal stenosis of the lacrimal ducts. The banking up of the lacrimal fluid leads to an accumulation of germs and following infection. This report describes the clinical and microbiological findings in a large consecutive series of patients that presented at the outpatient clinic of the 2nd Department of Ophthalmology of the University of Vienna with the signs of acute, chronic recurrent or chronic infections of the lacrimal system between 1983 and the end of 1990. Within the bacterial genus Staphylococci (S. aureus, S. epidermidis and S. saprophyticus) were the most frequently isolated organisms (74 cultures = 50% out of samples with positive cultures). It was quite interesting that a significant number of gram-negative rods (37 = 25.5%) could be isolated. Of these microorganisms Escherichia coli was most frequently growing on special media (17 cases = 11.7%) when cultures were obtained from acute inflamed lacrimal sacs of patients who suffered from chronic recurrent infections. Conservative therapy of purulent dacryocystitis constitutes the last possible preparation for a necessary surgical intervention and therefore the authors want to point out the importance of microbiological examinations so as to optimize antibiotic therapy.

ABSTRACT.Aims: To determine the current bacteriology of mucopurulent discharge in congenital nasolacrimal duct obstruction (CNDO), the in vitro response to different antibiotics and clinical effectiveness of the antibiotics used to relieve babies from mucopurulent discharge. Methods: A clinical study evaluated the effectiveness of local antibiotic agents clinically and in vitro. 50 samples were obtained from the lacrimal sac in 47 young children with CNDO. The patients' mean age was 21.45∫17.09 months. The cultures were incubated and the infectious agents isolated. Sensitivity testing was performed in each case, testing 10 different local antibiotics. A control group of 10 babies expected for cataract surgery was constituted. Results: Cultures were positive for bacteria from 72.64% of the samples. 73 isolates were recovered from the 50 samples. The bacterial species most frequently cultured was Streptococcus pneumoniae, representing 35.4% of the isolates, followed by Haemophilus influencae (19.6%). The sensitivity testing revealed ofloxacin and tetracycline to be the most effective drugs as monotherapy. Clinically the combination of bacitracin and neomycin, primarily used in half of the patients as initial therapy, was successful in curing the dacryocystitis in 82.5% of all patients. Conclusion: Chronic dacryocystitis due to CNDO is associated with an equal proportion of Gram positive and negative bacteria, which can be treated with a high effectiveness by a combination drug of bacitracin and neomycin.

Aims-To determine the eYcacy of antegrade balloon dilatation of postsaccal lacrimal stenosis in adults. Methods-Balloon dilatation was performed in a series of 30 patients with complete nasolacrimal duct obstructions and epiphora. Obstruction was diagnosed by canalicular irrigation and transcanalicular endoscopic examination of the lacrimal pathway. Except for four cases in which general anaesthesia was applied, the procedure was performed under local anaesthesia. The Lacricath balloon catheter set was used. Silicone intubation was performed simultaneously. The time at which the tubes were removed depended on the findings at postoperative follow up but was, at the earliest, 3 months postoperatively. Results-Success was objectified by irrigation and was evaluated subjectively at each follow up examination according to Munk's scale. In all cases the procedure could be performed with subsequent silicone intubation. Three months postoperatively 89.9% of all cases were positive on simple irrigation, and subjective success was also registered (Munk's grade 0 or 1). At 6 months 70% of all cases were positive on irrigation, again with subjective success (Munk's grade 0 or 1). One year postoperatively 73.3% of all procedures showed subjective success (two successful redilatations would raise the success rate to 79.9%). Conclusion-Retrograde as well as antegrade dilatation has been reported to be more or less successful in partial nasolacrimal obstruction. Although the procedure is used as primary treatment in cases of complete obstruction, it can still be performed under local anaesthesia on an outpatient basis. Long term observation will be required to prove the sustained eVect of this procedure. (Br J Ophthalmol 2001;85:200-204)