Reprinted from the 
University Medical Magazine, 
January, 1891. 
PYOKTANIN IN DACRYOCYSTITIS. 
In the December number of the Magazine, Dr. G. M. Gould records his 
experience with blue pyoktanin in the treatment of a variety of superficial ocu- 
lar inflammations, and lays particulal stress upon its value in dacryocystitis 
and lachrymal conjunctivitis. He states : 
" In chronically unhealthy conditions of the lachrymal excreting apparatus, I have 
found it to work like a charm in cleansing the channels and drying up the abnormal secre- 
tions. When the canaliculi or ducts are closed by constriction, they may be rendered patent 
by the usual methods, and with pyoktanin a quick cure thus effected. But there are many 
cases where the obstructed outflow is in part due to the inflammation and congestion caused 
by the presence of unhealthy tears and conjunctival disease, and in such cases, without 
other means, a drop of pyoktanin in the lower conjunctival sulcus, repeated twice a day for 
a few days, will work wonders. To the great diffusibility of the solution this effect is doubt- 
less in part due." 
My experience with the drug is in entire accord with the sentence just 
quoted from the paper of my colleague. I have used pyoktanin in a number of 
inflammatory affections of the cornea and conjunctiva with very indifferent 
success and often with disappointing effect, but in diseases of the lachrymal 
passages, especially when associated with accumulations of purulent or muco- 
purulent secretion in the tear sac, it is in many respects the most efficient 
remedy, in the rapidity of its curative influence, I have employed. Its value 
depends upon its pus-destroying properties and, as has been suggested, its great 
diffusibility. The latter quality is well illustrated by the following case : 
C. D., a boy aged 6, had from birth suppuration of the right lachrymal sac and clo- 
sure of the nasal duct. Pressure over the slightly bulging area of the tear-bag caused the 
exudation from both puncta of a thick, muco-purulent discharge. The lower canaliculus 
was slit and an endeavor made to pass a probe, which met with a firmly resisting stricture 
just beyond the lower part of the sac, or beginning of the nasal duct. The probe was not 
forced, neither was the stricture incised. Blue pyoktanin (i-iooo) was injected into the sac. 
The next day the suppuration had diminished considerably, and on the third day only a 
slightly tenacious, clear fluid exuded from the puncta. The pyoktanin injections were 
repeated for three days, when, although no change had taken place in the character of the 
obstruction and no probe had been passed, a little of the solution found its way into the 
inferior meatus of the nose. A naso-pharyngeal examination revealed an abnormal shape 
of the lower turbinated bone of the right nostril and evidences of a severe rhinitis during 
the past. Treatment of this condition was undertaken by Dr. Alexander MacCoy, and after 
a few days the stricture was incised, the probe passed and the usual treatment instituted 
with very rapid improvement. 
This case is interesting chiefly because, although an ordinary antiseptic 
solution like bichloride of mercury could not be forced through the stricture 
previous to its incision, the pyoktanin found a way. PYOKTANIN IN DACRYOCYSTITIS. 
2 
Rapid cessation of suppuration in the lachrymal passages under the influ- 
ence of this drug is illustrated by the following cases : 
Mrs. D., a woman aged 50, with long-standing, chronic dacryocystitis, suffering from 
an acute exacerbation, with free secretion of purulent matter from the left sac associated 
with blepharitis and some ectropion, received for three days a pyoktanin injection after slit- 
ting of the canaliculus. At the end of this time the purulent character of the secretion had 
ceased. The drug was now substituted by a solution of bichloride of mercury and the 
usual treatment continued, with very happy results. It may be stated that the blepharitis 
during the three days that the analine dye was used showed no improvement, but yielded 
rather speedily to an aristol salve. 
Mr. B., a gentleman over 80 years of age, had for many years obstruction of the left 
nasal duct and muco-purulent discharge from the tear sac of the same side. He had never 
permitted treatment until recently, when, as Ije was about to undergo a cataract extraction 
upon the opposite side, in which there was no suppuration in the lachrymal passages, but 
only a slight chronic conjunctivitis, the left canaliculus was slit, the nasal duct probed and the 
sac washed out with the pyoktanin solution, which passed freely into the nose. The next 
day there was marked improvement, the fourth day there was only a slight gummy discharge, 
and at the end of a week the abnormal secretion had absolutely dried up. 
The next case illustrates the point made by Dr. Gould and other observers, 
that in lachrymal conjunctivitis the drug often does good without its injection 
into the sac or nasal duct, simply by placing a drop or twyo of. it daily in the 
lower conjunctival sulcus. 
A hospital patient, aged 57, had upon the left side an old stricture of the nasal duct, 
which in times past had been probed, but which recently had not been treated. There was 
slight distichiasis with some pannus in the lower portion of the cornea. The eye was tear- 
soaked, and pressure over the right lachrymal sac caused the exudation of a few drops of 
muco-purulent discharge. Without reopening the stricture pyoktanin was dropped into 
the conjunctival cul-de-sac, with improvement in twenty-four hours, and with such marked 
benefit at the end of a week that a semi-luxated, cataractous lens was removed from that eye 
with rapid healing of the wound. The ultimate result of vision to this man was not very 
good, owing to considerable vitreous disease and patches of atrophic choroiditis, but there 
was no reaction from the operation and no more irritation than could be accounted for by the 
fact that the man had suffered from misplaced cilia, which rubbed against his cornea. This 
fault was corrected before the lens was extracted. 
These cases will suffice to show that the drug certainly exercises a very 
beneficial influence in drying up the abnormal secretions of the lachrymal pas- 
sages. Further than this, however, it does not appear to have marked effect, 
and it has been my practice, after the cessation of suppuration, to substitute for 
it one of the well-known antiseptics. In most of the cases blue pyoktanin has 
been used ; in a few treated with the yellow variety the result was not 30 good 
nor the application quite so free from irritation. However, my experience with 
the latter form of the remedy is very limited. Dilatation of the pupil follow- 
ing its use was not observed, neither was there any staining of the deeper 
structures. No particularly good effect occurred in eye affections other than 
those associated with the formation of pus, and in some cases ot corneal ulcer 
the disease was apparently aggravated by the applications of the ramedy. 
G. E. deSchweinttz, M.D., 
Ophthalmic Surgeon, Philadelphia and Children's Hospitals.