Treatment of neonatal conjunctivitis

The effect of different treatment regimens on clinical and microbiologic cures of neonatal conjunctivitis was evaluated during a 32-day observation period. In 84 infants with mild to moderate conjunctivitis and no signs of dacryocystitis, clinical cures were achieved in more than 50% of the cases with lid hygiene only. Staphylococcus aureus was the most common organism (48%) isolated from these infants. Chlamydia trachomatis could not be isolated from eyes with mild to moderate conjunctivitis. Forty-four infants with severe conjunctivitis, with or without dacryocystitis, were randomly assigned to treatment with either topical chloramphenicol or oral erythromycin for 14 days. Chlamydia trachomatis was isolated from 19 (43%) of these infants. All infants with chlamydial conjunctivitis who were treated with 25 mg/kg of oral erythromycin ethylsuccinate twice daily for 14 days were clinically and microbiologically cured. In contrast, all treatment of chlamydial conjunctivitis with topical chloramphenicol failed clinically as well as microbiologically. Dacryocystitis was a common complication in neonatal conjunctivitis (17%). The clinical failures in neonatal nonchlamydial conjunctivitis were associated with persistent obstruction of the nasolacrimal duct.

[Paraffin granuloma of the lower lid]

A young man developed a solid tumor of the lower eyelid, which histological studies showed to be a paraffinoma. Two years before the first manifestation a dacryocystitis had been treated by probing and injection of antibiotic ointment into the lacrimal drainage system. Since paraffin is a constituent of most ointments, the possibility of a granulomatous reaction should be considered if the ointment containing paraffin is introduced into the subcutaneous tissue.

[Drug treatment of inflammatory and infectious endogenous inflammations of the eye]

In many cases antibiotic treatment is indicated; steroids are not always needed. In special cases of uveitis (Behcet's syndrome, sympathetic ophthalmia, anterior uveitis in children with JRA) cytostatic treatment seems justified. Inflammations of the optic disk and nerve require very extensive diagnostic evaluation. Medical treatment is usually limited to steroids, administered systemically and locally; however, its efficacy is still a matter of debate.

Canaliculitis caused by Enterobacter cloacae: report of a case

A 65-year-old man developed canaliculitis first of the left lower and later of the left upper lacrimal canaliculus. Mucoid material expressed from the upper canaliculus grew a pure culture of Enterobacter cloacae, the colonies of which had a stringy, tenacious, mucoid property consistent with the clinical findings. Treatment with topical chloramphenicol and oral ampicillin was followed by complete resolution.

Lacrimal gland enlargement in familial sarcoidosis

Familial sarcoidosis is rare. It is unusual for lacrimal gland enlargement to be the initial manifestation of sarcoidosis. Two sisters are described with lacrimal gland enlargement as the initial manifestation of sarcoidosis. Gallium-67 scan was a useful adjunct to lacrimal biopsy in sarcoidosis. Sarcoid dacryoadenitis responded dramatically to a short term course of low dose prednisone.

Bilateral Candida albicans dacryocystitis with facial cellulitis

Candida albicans rarely infects the lacrimal drainage system. This paper describes a case of bilateral C. albicans dacryocystitis following midfacial trauma. The patient presented with recurrent facial cellulitis and a fistula opening onto the cheek. The condition was controlled only after bilateral dacryocystorhinostomy along with amphotericin B therapy. This appears to be the first reported case in which the lacrimal sacs acted as a reservoir for microorganisms causing recurrent facial cellulitis.

Aetiology and treatment of acute bacterial infection of the external eye

The microbial flora of 738 patients with acute bacterial conjunctivitis, corneal ulceration, blepharitis, dacryocystitis, and discharging sockets has been investigated. Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae were the main pathogens isolated. Str. viridans was associated with conjunctivitis in patients aged under 1 year. moraxella sp. was isolated on only one occasion. Overall, 40% of specimens were associated with Staph. epidermidis or mixed skin flora, which also occurred with cultures of the normal eye. Clostridium welchii was isolated on 3 occasions but was not associated with bullae or gas gangrene. The least overall resistance, of 6%, was to chloramphenicol, but no one antibiotic was effective against all pathogens. Gentamicin remains the antibiotic of choice for Pseudomonas aeruginosa infection.

[The treatment of congenital obstructions of the lacrimal passages (author's transl)]

The Authors describe their method of treatment of congenital dacryocystitis. Up to 3-4 months of age the treatment consists in the use of antibiotic eye drops and message of the lacrimal sack. After this age and up to 8 months of age irrigation of the lacrimal passages is carried out. If this is unsuccessful or if the children are older a probing is performed. The Authors report the results of the probing in a series of 118 children (146 eyes). The best results are obtained when the probing is effectuated before 8 months of age. After this age the success decreases with the increase in age of the young children. There is no apprecciable difference between the unilateral and bilateral cases.

[Pharmakokinetic and clinical studies with azlocillin in paediatrics (author's transl)]

Azlocillin, an acylureido penicillin with bactericidal activity, is particularly effective against Pseudomonas, enterococci and Haemophilus influenzae. It is also very active against E. coli, various Proteus species and Bacteroides. Pharmacokinetic studies were carried out in 138 children of various ages (prematures, newborns, infants, schoolchildren) after administering 50-75-100 mg/kg/ body weight azlocillin via the i.v. or i.m. routes; The constant of elimination and the distribution volumes were calculated besides the serum levels. In prematures and newborns, therapeutically effective serum levels were obtained on administering 50 or 100 mg/kg body weight twice daily. Infants and older children required 100 or 75 mg/kg body weight t.i.d. Determination of azlocillin in the bronchial secretion after i.v. doses of 75 mg/kg body weight showed good elimination. Azlocillin was always identified up to the 5th hour post injectionem. Inspite of parenteral administration, azlocillin was identified in different concentrations in the meconium as well. 39 children were treated with azlocillin, 35 of whom had Pseudomonas infection. Very good results were obtained in infections of the urinary tract, wound infections, conjunctivitis, dacryocystitis and in one case of meningitis. Bronchopulmonary diseases did not take an equally good course, but in these cases the conditions had not been favourable. No serious side effects were revealed by testing several laboratory parameters.

Dacryolithiasis

The mechanism of dacryolith formation is obscure. Divisions of operative vs nonoperative, calcified vs fungal, and amino acid vs nonamino acid are reported but do nothing to elucidate their etiology. Jones' report on nonmycotic casts in northwestern climates, clearly points to more than one mechanism for formation. Fortunately, dacryolith formation is rare when compared to the incidence of lacrimal system inflammation. This case report is presented to emphasize the highly variable circumstances that surround dacryolithiasis.

Bilateral acute dacryocystitis in a premature infant

A premature infant with bilateral acute purulent dacryocystitis was presented. The possibility of a contamination before delivery was raised. Treatment with antibiotics proved to be helpful in curing the disease.

Granulomatous dacryoadenitis caused by Schistosoma haematobium

An 11-year-old boy from Sierra Leone developed a mass in the left lacrimal gland a year after trauma to the left side of the brow. Biopsy of the mass led to the diagnosis of schistosomiasis caused by Schistosoma haematobium, which had not been suspected previously. The initial occurrence in the orbit of such a rare, ectopic lesion in schistosomiasis and the possible relationship to previous trauma are features of special interest.

[Ophthalmic use of clindamycin-2-phosphate (author's transl)]

Bacterial and clinical experiments for ophthalmic use of clindamycin-2-phosphate (CLDM-2-P) were performed and the results were summarized as follows. 1. The distribution of sensitivity for 100 strains of Staphylococcus aureus isolated in 1975 was in the range of less than or equal to 0.19 approximately greater than or equal to 100 mug/ml, and majority of them (96.0%) were in less than or equal to 0.39 mug/ml. 2. The serum concentration by intramuscular injection of 300 mg and 600 mg CLDM-2-P in a single dose respecitvely reached the peak level after 2 hours and decreased gradually until 12 hours in both of them. 3. Ocular penetrations were examined in rabbit eyes. (1) After instillation of 1% CLDM-2-P solution, the aqueous level reached the highest after 1 hour and measurable after 6 hours. (2) After subconjunctival injection of 5 mg/0.5 ml CLDM-2-P, the aqueous level reached the highest after 2 hours and decreased until 6 hours. (3) After intramuscular injection of 100 mg/kg, the aqueous concentration was recognized from 1 to 8 hours, and peak was reached after 1 hour. 1 to 8 hours, and peak was reached after 1 hour. Aqueous-serum ratio in 1 hour was 37.13%. The ocular tissue concentrations at 2 hours showed relatively high levels in both of outer and inner parts of the eye. 4. The intramuscular injection of CLDM-2-P, 300 approximately 1800 mg daily, against suppurative ocular infections revealed excellent effects on cases of external hordeolum, acute chalazion, lid abscess, orbital phlegmone, corneal infiltration, corneal ulcer, and iridocyclitis purulenta. 5. Side effects: Two cases out of 22 cases complained of diarrhoea and bitter taste after injection, and able to be treated continuously by the drug. No abnormal findings in hepatic and renal tests were observed and no servere side effects like allergic reactions were recognized.