Is a bacterial biofilm in the lacrimal sac the cause of chronic refractory dacryocystitis? – A pilot study

Figures & data

Table 1. Characteristics of the patients and their lacrimal sacs.

Patient	1	2	3	4	5	Control
Bacterial culture	Negative	Negative	Negative	Positive	Positive	Negative
Bacteria identified				Haemophilus influenzae, Streptococcus intermedius	Staphylococcus aureus
Scanning electron microscopy findings	Bacterial colonies and extracellular material	Bacterial colonies and extracellular material	Bacterial colonies and extracellular material	Bacterial colonies and extracellular material	Bacterial colonies and extracellular material	No bacteria
Gender	Male	Female	Female	Male	Female	Female
Age	57 years	57 years	46 years	68 years	96 years	70 years
Clinical symptoms	Epiphora	Epiphora	Dacryocystitis	Dacryocystitis	Dacryocystitis	Epiphora

Figure 1. Scanning electron microscopy of lacrimal sac biopsies revealed structures consistent with extracellular material (red arrows) adjacent to the bacterial colonies, indicating biofilm formation.

Figure 2. Bacteria were located not only on the luminal surface of the sacs, but also within the tissue of the sac (red arrows).

Figure 3. Sample from the lacrimal sac of the control patient. Neither bacteria nor biofilm were found. Red blood cells resulting from the surgery can be seen on the luminal part of the sac.