The lacrimal apparatus includes the lacrimal gland and lacrimal ducts. The lacrimal gland is located in the upper outer part of the orbit. Tear fluid from the gland enters the upper fornix of the conjunctiva (under upper eyelid at the outer corner of the eye) and washes the entire anterior surface eyeball, covering the cornea from drying out.
- Colored tearfully- nasal test Vesta - allows you to determine functional state lacrimal ducts, starting from the lacrimal openings. A 2% fluorescein solution is instilled into the eye and the patient's head is tilted down. If the paint has been applied within 5 minutes, the test is positive (+); slow - 6-15 minutes; absence of paint in the nasal passage - test (-).
- Determination of indicators of total tear production - Schirmer test - carried out using a strip of graduated filter paper bent at an angle of 45°, which is placed behind the lower eyelid to the bottom of the lower fornix of the conjunctiva. Eyes closed. After 5 minutes, the length of wetting is measured. Normally it is 15 mm.
- Norn's Test - allows you to determine the stability of the precorneal film. After cleansing the conjunctival sac of mucus and pus, the patient is instilled with 1-2 drops of a 2% collargol solution twice with an interval of 0.5 minutes. The test is considered positive if collargol is completely absorbed within 2 minutes, and when pressing on the area of the lacrimal sac, a drop appears from the lacrimal punctum. If collargol is not released from the lacrimal openings, the test is considered negative.
- At the same time, a nasal collarhead test is checked.. To do this, under the bottom turbinate A cotton swab is inserted to a depth of 4 cm. If it is stained after 2-3 minutes, the test is considered positive, after 10 minutes - delayed, and if there is no coloring - negative.
- Lacrimal duct rinsing - performed after anesthesia of the conjunctiva with a three-fold installation of 0.25% dicaine solution. A conical Sichel probe is inserted into the inferior lacrimal punctum, first vertically and then horizontally, along the lacrimal canaliculus to the nasal bone. Then, using a syringe with a blunt needle or with a special cannula, a physiological or disinfectant solution is injected in the same way. The patient's head is tilted downwards, and when the lacrimal ducts are in a normal state, liquid flows out of the nose in a stream. In cases of narrowing of the nasolacrimal duct, the liquid flows out in drops, and in case of obstruction of the lacrimal ducts, it pours out through the upper lacrimal punctum.
- Probing the lacrimal ducts - performed after expansion of the inferior lacrimal punctum and canaliculus with a Sichel probe. Along this path, a Bauman probe No. 3 is passed to the nasal bone, after which the probe is turned vertically and, adhering to the bone, passes through the lacrimal sac into the nasolacrimal canal. Probing is used to localize strictures and widen the nasolacrimal ducts.
- To diagnose changes in the lacrimal ducts It is better to use radiography. After anesthesia of the conjunctival sac with dicain and dilation of the lacrimal punctum and canaliculi with a conical probe, 0.4 ml of an emulsion of bismuth nitrate in vaseline oil is injected into the lacrimal ducts with a syringe. Then, placing the patient in the chin-nasal position, a picture is taken. In this case, violations are easily detected normal structure lacrimal ducts. After radiography, the lacrimal ducts are washed with saline to remove the emulsion.
25-01-2014, 01:11
Description
External examination and palpation of the lacrimal gland, tubules and lacrimal sac
As with diseases of many other departments human body, in case of pathology of the lacrimal apparatus, external examination is the main method of examining the patient. Lacrimal gland Normally, it is accessible to inspection and palpation only to a very small extent, with the upper eyelid inverted and dislocated. In case of its diseases, examination, if not the gland itself, covering its eyelids, and most importantly palpation, brings a lot of data. The external one provides significantly greater opportunities when examining all parts of the lacrimal drainage apparatus, i.e. grooves, lacrimal duct, lacrimal lake, lacrimal caruncle and semilunar ligament of lacrimal openings, lacrimal canaliculi, lacrimal sac. When examining, you can use a Garcher's magnifying glass or a simple magnifying glass. Palpation of the lacrimal canaliculi and lacrimal sac, gentle at first, should be followed by forced palpation, trying to squeeze out the contents of the sac and canaliculi, if any are present.
External examination is supplemented by some special tests. Special attention deserve:
- Schirmer tests,
- capillary test,
- tubular and nasal tests,
- probing the lacrimal canaliculi,
- probing of the nasolacrimal canal,
- washing the lacrimal ducts,
- contrast and radiography of the lacrimal ducts.
The intended purpose of Schirmer tests, No. 1 and No. 2 comes down to trying to find out with their help the functional status of the lacrimal gland - whether there is hypofunction of the gland and what the condition is! its reactive secretion. The intended purpose of all other tests is topical diagnosis of the level of damage to the lacrimal tract, if any.
Schirmer test No. 1
is carried out as follows. The lower eyelids of both eyes are folded 0,5 cm long ends of narrow strips of filter or litmus paper 3,5 and width 0,5 cm. The other ends of the strips remain hanging freely over the eyelids. Gradually the strips are wetted from the ends placed behind the eyelids. Through 5 min, the length of the wetted part of the strips is measured. If not wetted 1,5 cm length of the paper strip, we can assume that there is no hypofunction of the lacrimal gland on the side being examined.
Schirmer test No. 2
serves to resolve the issue of the state of the reflex system of the tear-producing apparatus. After unilateral local anesthesia of the conjunct and the valvular sac, the end of a strip of filter paper is placed behind the edge of the eyelid. Then mechanical irritation of the nasal mucosa in the area of the middle concha is performed. By the length of time the filter paper becomes wet, one can judge whether the state of the reflex system is satisfactory or unsatisfactory.
Stream sample or capillary sample.
A drop of dye is placed into the conjunctival sac ( 1 % solution of flirescein or 3% solution of collargol). Through 10-15 sec pay attention to the tear stream: if it looks like a hair capillary, then it is not changed (Fig. 92).
However, the expansion of the stream, indicating pathology, may be so insignificant that it is not detected even by staining. In such cases, a comparison of the colored tear ducts on both sides is very revealing. If the capillary test does not reveal expansion of the stream, then the lacrimal drainage apparatus is functioning properly and lacrimation is caused by some other reason, for example, conjunctivitis. In the normal state of the lacrimal apparatus, while the eye moves in all directions, the colored hair capillary remains unchanged. In cases of pathology, when the patient looks up, the tear stream becomes wider. This symptom occurs in people of all ages and is associated with muscle atony Riolapa - a consequence of pulling back the lower eyelid when wiping away tears.
The capillary test reveals very early functional disorders in the lacrimal system (even before pathological atopic changes become clearly expressed).
Pokhisov evaluates the capillary test using a three-point system:
- it is normal when the tear stream looks like a hair capillary;
- the sample is indicated by a + sign when the tear duct is slightly dilated;
- the test is designated ++ when the tear stream is sharply expanded.
- The greatest advantage of the capillary test is that it is objective and allows one to judge how well-founded the patient’s complaints are.
Tubular and nasal tests
These tests are performed simultaneously and serve to determine the patency of the lacrimal canaliculi and nasolacrimal canal.
Into the conjunctival sac three times with an interval of 1-2 minutes let in the dye ( 1% - solution of fluorescent or 3% solution of collargol). If after one and a half to two minutes the solution disappears from the conjunctival sac, it means that fluid is being absorbed normally from the lacrimal lake - the ability of the tubules is preserved, and the reason lies somewhere further in the lacrimal ducts. In addition, in these cases, when pressing on the lacrimal canaliculi, drops of the dye solution come out through the points into the conjunctival sac.
If the dye remains in the conjunctival sac for more than two to five minutes and does not appear from the dots when pressing on the area of the lacrimal sac, the tubular test should be considered negative. However, experience shows that even under normal conditions, a tubular test can sometimes be negative. Thus, the diagnostic value of this test for lacrimation is low.
At the same time, a nasal test is performed to determine the narrowing in the nasolacrimal canal. The subject is asked to blow his nose or a tampon is inserted into the nose under the lower concha, alternately on each side. The appearance of paint in the nose after five minutes indicates good patency of the tear ducts. If there is no color in the nose or it appears later, then there is no patency or it is difficult.
It should be noted that even with normal conditions Collargol does not always appear in the nasal cavity after five minutes. This is explained by the fact that, in addition to pathological conditions9 in the lacrimal ducts, other factors also influence their patency. In particular, individual characteristics the structure of the nasolacrimal canal, excessive development of the Ashner valve, etc., may cause a delay in the appearance of paint in the nose, which, however, does not at all indicate a narrowing of the canal. Therefore, the nasal test cannot be considered reliable.
Probing of tear ducts
After anesthetizing the conjunctiva with a few drops 0,5-1 % - but a conical probe is inserted into the canaliculus through the lacrimal punctum, first vertically, then it is transferred to horizontal position and is brought to the lateral bone wall of the nose. After removing the conical probe, an ordinary zone of larger or smaller caliber is introduced. If a stricture is detected in the tubule, it is immediately dissected with a probe. Thus, this manipulation is not only diagnostic, but also an effective therapeutic measure for strictures, foreign bodies in the lacrimal canaliculi and other diseases.
After probing, it is necessary to drip a solution of some antiseptic used in ophthalmic practice into the conjunctival sac. Pokhnsov recommends letting it into the conjunctival sac after such an intervention 1-2 drops 1 % - a solution of lapis and 5% xeroform ointment, and bury it at home 3% -we are a solution of collargol or 30% - solution of albucid.
Probing of the nasolacrimal duct
This manipulation is also carried out with both diagnostic and therapeutic purpose, since it allows you not only to determine! the presence of narrowings and curvatures of the nasolacrimal canal, but in some cases it makes it possible to restore its normal patency.
Probing can be done either from top to bottom, i.e., through one of the lacrimal openings (usually through the lower one), or from bottom to top, from the side of the nasal passage (endonasally, or retrograde).
Probing consists of three points:
- insertion of the probe vertically through the lacrimal opening into the vertical surface of the lacrimal canaliculus;
- transferring the probe to a horizontal position and moving it along the canaliculus up to the nasal wall;
- moving the probe back into a vertical position and advancing it into the lacrimal sac and nasolacrimal canal.
Ophthalmologists probe primarily through the lacrimal openings with conical and then Bowman probes of varying thicknesses. Previously, the lacrimal canaliculi were split during probing, as they were not given any importance in the lacrimal drainage mechanism.
Golovin et al. (1923) used probing to force the expansion of the nasolacrimal canal.
Odintsov, Strakhov, Tikhomirov, Kolen and many others, attaching great importance to the lacrimal canaliculi in the mechanism of lacrimal drainage, spare them in every possible way. They first dilate the lacrimal canaliculi with conical probes and then probe them with thin Bowman probes.
Before probing, local anesthesia is administered by multiple installations into the conjunctival sac 0,5% -th dicaip solution. It is recommended to lubricate the probe with oil before insertion.
When probing, it is necessary to take into account the topographic structure of the entire lacrimal canal. You can’t rush, you need to insert it carefully, especially if there is an obstacle in the canal.
If probing fails, it should be postponed. Considering that the probing operation is sometimes very painful, in addition to dikaip installations, we can recommend infiltration for particularly sensitive patients 2% solution of novocaine with 3-4 drops of adrenaline under the lacrimal sac area. It is also necessary that the probes be polished, smooth, and without bending. They should be sterilized first.
If the probing technique and technique are incorrect or if probing is rough, complications may occur. Thus, rough penetration of the probe in the horizontal direction can lead to damage to the lacrimal bone and the probe entering the nasal cavity. It is also possible to rupture the wall of the lacrimal canal with the formation of a passage. There were even cases of bone wall fracture and the end of the probe getting into the maxillary cavity.
Other complications are also dangerous: nose bleed, phlegmon of the lacrimal sac, which developed as a result of the formation of a false passage, phlegmon of the orbit with inflammation of the optic nerve. The literature reports meningitis and orbital thrombophlebitis. Improper insertion of the probe can cause swelling and tissue swelling; after two or three days they usually disappear without a trace. It is dangerous to rinse the lacrimal ducts after probing if you are not sure of the correct placement of the probe. If there is a suspicion of a false passage (a feeling of bare bone and the appearance of two or three drops of blood from the lacrimal punctum after removing the probe), it is necessary to immediately perform an active massage of the lacrimal sac area from the bottom up towards the lacrimal punctum, thus freeing the canal from blood (so that prevent the formation of a hematoma) and apply a tight, damp bandage for one or two days. Sulfonamides are given internally. For a week after this, you should not probe through the lacrimal openings, you should be content with only endonasal probing.
Retrograde probing does not replace probing through the lacrimal tubules, but only complements it. It is an auxiliary intervention used in cases where probing from above is not effective enough,
The widespread opinion among ophthalmologists about the difficulty of mastering the retrograde sounding technique is unfounded. Thus, Arlt wrote in 1856 that it is easy to acquire the skill of retrograde insertion of a probe into the nasolacrimal canal. Pokhisov recommends the widespread use of retrograde probing as an independent intervention and as an auxiliary measure when probing through the lacrimal openings. He conducts it in both adults and children, even newborns.
Washing the tear ducts
Rinsing of the lacrimal ducts is done through the lower lacrimal punctum, and if the lower lacrimal canaliculus is narrowed, through the upper punctum. Anesthesia is required in advance - two or three times instillation into the conjunctival sac 0,5 - 1 % -n solution of dicaine, which is used to simultaneously extinguish the lacrimal opening. For rinsing, use a two-gram syringe, an Anel syringe or an injection needle with a blunt and rounded end. Washing for diagnostic purposes is performed 0,1 % rivanol solution or saline solution. The lacrimal punctum and canaliculus are pre-expanded with a conical probe. The needle is advanced along the lacrimal canaliculus, drawn outward and downward, while the head of the patient is tilted. Then the needle is slightly pulled back and the syringe is emptied by pressing on the plunger.
If the patency is normal, the flushing fluid flows out in copious streams. Slow fluid flow indicates a narrowing of the canal. With complete obstruction, fluid does not flow out of the nose, but flows out in a thin stream from the upper or lower lacrimal duct. When probing, it is necessary to take into account the topographic diatom of the lacrimal canal.
Probing is difficult in case of abnormal development of the lacrimal canal, atresin of the lacrimal punctum, cicatricial changes in the nasolacrimal canal, narrowing of the lacrimal punctum and canaliculus of a spastic nature.
The following complications of probing are possible: nosebleeds, swelling in the lower eyelid, phlegmon of the lacrimal sac, which developed as a result of the formation of a false passage, phlegmon of the orbit with inflammation of the optic nerve.
X-ray examination of the lacrimal ducts
If you inject the lacrimal ducts with a control mass that blocks X-rays, then it will fill all the smallest bends of the lacrimal sac, nasolacrimal canal and lacrimal canaliculi, forming an exact cast of them. Photographs taken in two mutually perpendicular planes will give a completely accurate and clear image of the cast, and with it an image of the cast themselves. tear ducts. Such images not only allow you to see the exact location and nature of the stenosis, but also indicate the topography of the pathological area, but also the size and degree of disorders,
In this regard, radiography of the lacrimal ducts is the most accurate method for determining the location of obstacles that cause their complete or partial obstruction.
The method of radiography of the lacrimal ducts was first used by Ewing in 1909. He injected the lacrimal ducts with a mast emulsion of bismuth nitrate and took photographs in the lateral position. Regardless of Ewing, the contrast method has been used since 1911 by Aubert, who developed a detailed methodology and detailed instructions on the diagnostic use of this method. However, in those years the contrasting method did not become widespread, and the works of these authors were forgotten. In 1914, he independently rediscovered this method, re-developing its technical and clinical aspects and, through persistent polarization, achieved its introduction into clinical practice.
Oxide on liquid paraffin, barium sulfate, podulyatrin, torotrost, podipin, sublipol can be used as a contrast mass.
The technique for injecting a contrast mass is as follows: after local linthesis (Sol. dicaini 0,5-1,0% ) with a conical probe, the lacrimal canaliculus is expanded and the lacrimal ducts are washed with some solution. Then, using a syringe, a contrast mass is very slowly injected through the lower lacrimal canaliculus into the lacrimal ducts until the patient feels its presence in the nose. In total, at least 0,3-0.4 ml. After this, the patient is quickly placed on the table and two x-ray- lateral and anteroposterior. If the nasolacrimal duct is passable, then the injected mass comes out on its own through 1-2 hours. Sometimes it is necessary to facilitate the release of mass light massage or washing. In case of complete obstruction, the contrast mass is delayed for several days.
Typically, the contrast mass is administered through the lower canaliculus. In cases of atresia of the inferior lacrimal punctum, the contrast mass can be injected through the superior lacrimal punctum.
Radiography of the lacrimal ducts has great scientific, theoretical and clinical and practical significance. This method makes it possible to study in situ the normal shape of the lacrimal duct with all the variations in its direction, bends, calibers, changes in the lumen at different levels, as well as its relationship to the surrounding sinuses, to the nasal cavity itself, etc.
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What is dacryocystitis?
Dacryocystitis- inflammation of the lacrimal sac. This bag is located near the inner corner of the eye in the so-called lacrimal fossa. Tear fluid passes through the nasolacrimal duct into the nasal cavity. If the outflow of tear fluid from the lacrimal sac is disrupted, pathogenic bacteria accumulate in it, which causes inflammation.Dacryocystitis can develop in both adults and children (including newborns).
There are acute and chronic forms of dacryocystitis.
Signs of dacryocystitis are:
- unilateral lesion (usually);
- pronounced, persistent lacrimation;
- swelling, redness and tenderness in the inner corner of the eye;
- discharge from the affected eye.
Causes
The immediate cause of dacryocystitis is obstruction of the nasolacrimal canal or blockage of one or both lacrimal openings, through which tears enter the nasolacrimal canal. The causes of obstruction of the nasolacrimal duct can be:- congenital anomaly or underdevelopment of the lacrimal ducts; congenital stenosis (narrowing) of the lacrimal ducts;
- trauma (including fracture of the upper jaw);
- inflammatory and infectious diseases of the eye and their consequences;
- rhinitis (runny nose); syphilitic lesion of the nose;
- inflammatory processes in maxillary sinus, in the bones surrounding the lacrimal sac;
- blepharitis (purulent inflammation of the eyelids);
- inflammation of the lacrimal gland;
- tuberculosis of the lacrimal sac;
Dacryocystitis in adults (chronic dacryocystitis)
Dacryocystitis in adults occurs in a chronic form of the disease. It can develop at any age, young or mature. Dacryocystitis occurs 7 times more often in women than in men. There are several clinical forms dacryocystitis:
- stenosing dacryocystitis;
- catarrhal dacryocystitis;
- phlegmon (suppuration) of the lacrimal sac;
- empyema (purulent lesion) of the lacrimal ducts.
The chronic form of dacryocystitis is manifested by swelling of the lacrimal sac and chronic lacrimation or suppuration. Often, there is a simultaneous manifestation of conjunctivitis (inflammation of the mucous membrane of the eyelids) and blepharitis (inflammation of the edges of the eyelids).
When you press on the area of the lacrimal sac (at the inner corner of the eye), purulent or mucopurulent fluid drains from the lacrimal openings. The eyelids are swollen. A nasal test or Vesta test with collargol or fluorescein is negative (the cotton swab in the nasal cavity is not stained). During diagnostic lavage, fluid does not enter the nasal cavity. With partial patency of the nasolacrimal canal, the mucopurulent contents of the lacrimal sac can be released into the nasal cavity.
With a long course of chronic dacryocystitis, the lacrimal sac can stretch to the size of a cherry and even to the size of a walnut. The mucous membrane of a stretched sac may atrophy and stop secreting pus and mucus. In this case, a somewhat viscous, transparent liquid accumulates in the cavity of the sac - hydrocele of the lacrimal sac develops. If left untreated, dacryocystitis can lead to complications (infection of the cornea, ulceration and subsequent visual impairment, including blindness).
The acute form of dacryocystitis in adults is most often a complication of chronic dacryocystitis. It manifests itself in the form of phlegmon or an abscess (ulcer) of the tissue surrounding the lacrimal sac. Very rarely, the acute form of dacryocystitis occurs primarily. In these cases, the inflammation on the fiber passes from the nasal mucosa or paranasal sinuses.
Clinical manifestations acute form Dacryocystitis is characterized by bright redness of the skin and pronounced painful swelling of the corresponding side of the nose and cheeks. The eyelids are swollen. The palpebral fissure is significantly narrowed or completely closed.
The resulting abscess may spontaneously open. As a result, the process may stop completely, or a fistula may remain with prolonged discharge of pus through it.
Dacryocystitis in adults requires mandatory consultation with an ophthalmologist and subsequent treatment. There is no self-healing of dacryocystitis in adults.
Dacryocystitis in children
IN childhood Dacryocystitis occurs quite often. They constitute, according to statistics, 7-14% of all eye diseases in children. There are primary dacryocystitis (in newborns) and secondary dacryocystitis (in children over 1 year old). This division of dacryocystitis is due to the fact that they differ in the reasons for their development and in the principles of treatment.
Based on age, dacryocystitis is divided into dacryocystitis of premature babies, newborns, infants, preschool and school-age children.
Dacryocystitis of newborns (primary dacryocystitis)
Dacryocystitis in newborns is caused by underdevelopment or abnormal development of the lacrimal ducts, when the nasolacrimal canal is partially or completely absent. In some cases, damage to the lacrimal ducts can occur when forceps are used during childbirth.Dacryocystitis of newborns is also called congenital dacryocystitis. It occurs in 5-7% of newborn babies and usually responds well to treatment. The disease manifests itself already in the first weeks of life, and sometimes even in the maternity hospital.
During the prenatal period of fetal development, a special gelatin plug or film is formed in the lower part of the nasolacrimal canal, which prevents amniotic fluid from entering the lungs (the canal is connected to the nasal cavity). At the first cry of a newborn baby, this film breaks through, and the nasolacrimal canal opens for tears. Sometimes the film breaks through a little later, during the first 2 weeks of life.
If the film does not break through, then the nasolacrimal canal becomes impassable for tears. If the baby's eyes are wet all the time, this may indicate an obstruction of the lacrimal ducts (partial or complete). Newborns cry without tears.
If tears appear (in one or both eyes), this may be the first manifestation of dacryocystitis. Tears stagnate and spill through the lower eyelid. Bacteria multiply well in stagnant tears. Inflammation of the canal develops, and then the lacrimal sac.
Much less frequently, dacryocystitis in newborns develops as a result of an abnormality in the structure of the nose or lacrimal ducts. Dacryocystitis in newborns due to infections is also rare.
Manifestations of dacryocystitis in newborns are mucous or mucopurulent discharge in the conjunctival cavity, mild redness of the conjunctiva and lacrimation - the main sign of the disease. After a night's sleep, “sourness” of the eye, especially one, can also be a symptom of dacryocystitis.
Sometimes these manifestations are regarded as conjunctivitis. But with conjunctivitis, both eyes are affected, and with dacryocystitis, as a rule, the lesion is one-sided. It is simple to distinguish dacryocystitis from conjunctivitis: when pressing on the area of the lacrimal sac, mucopurulent fluid is released from the lacrimal openings during dacryocystitis. The Vesta test (see section “diagnosis of dacryocystitis”) and diagnostic lavage of the lacrimal ducts will also help in diagnosing dacryocystitis.
You should not start treatment on your own; you should consult an ophthalmologist for advice. In the case of neonatal dacryocystitis, it is very important to start treatment as early as possible. This is a guarantee of cure. Chances of recovery will be significantly reduced if treatment is delayed or improper treatment. This may lead to the progression of the disease to chronic form or to severe complications (phlegmon of the lacrimal sac and the formation of a fistula of the lacrimal sac or phlegmon of the orbit).
Secondary dacryocystitis
The development of secondary dacryocystitis may be due to the following reasons:- improper treatment of primary dacryocystitis;
- descending inflammatory processes of the lacrimal sac from the conjunctival cavity or lacrimal canaliculi;
- inflammatory process in the nasal cavity and paranasal sinuses nose (sinusitis);
- injuries leading to compression or damage to the bony nasolacrimal canal;
- pathological processes in soft and bone tissue near the lacrimal ducts.
Inflammation of the lacrimal ducts can be caused by staphylococci, gonococci, coli and other pathogens. In order to determine the pathogen, a bacteriological examination is carried out.
Nasal test is negative; During diagnostic lavage, fluid also does not enter the nasal cavity. During diagnostic probing, the probe passes only to the bony part of the nasolacrimal canal.
With a long course of secondary dacryocystitis, ectasia (stretching) of the lacrimal sac cavity may occur; in this case, a protrusion will appear at the inner corner of the eye.
The use of Albucid in pediatrics is undesirable: firstly, it causes a pronounced burning sensation when instilled, and secondly, it is characterized by crystallization and compaction of the embryonic film.
If several drugs are prescribed, then the interval between instillations should be at least 15 minutes.
Massage of the lacrimal sac
As soon as parents notice manifestations of dacryocystitis, it is necessary to contact an ophthalmologist, because without a doctor it will not be possible to cope with this disease. An examination by a pediatrician and an ENT doctor is also scheduled. You should not hesitate to see a doctor, because... after 2-3 months, the gelatin film will turn into cellular tissue, and conservative treatment will become impossible. True, some doctors admit the possibility conservative treatment until the child is six months old.
Massage of the lacrimal sac plays a significant role in the treatment of dacryocystitis. But if there are the slightest signs inflammation, massage cannot be performed due to the danger of pus getting into the surrounding tissue of the lacrimal sac and the development of phlegmon.
The doctor must clearly show how to properly massage. Before starting the procedure, the mother should thoroughly wash and treat her hands with a special antiseptic solution or wear sterile gloves.
Before the massage, you should carefully squeeze out the contents of the lacrimal sac, clean the eyes of pus by rinsing with a solution of furatsilin. And only after this you can start the massage. It is best to massage immediately before feeding. The procedure is carried out at least 5 times a day (in the first 2 weeks up to 10 times a day).
Massage is carried out index finger: Gently press the area of the lacrimal sac 5 times, moving from top to bottom, and at the same time try to break through the gelatin film with sharp pushes.
If the massage is performed correctly, pus will be released from the canal. You can remove pus with a cotton ball soaked in freshly brewed broth. medicinal herb(chamomile, calendula, tea, etc.) or in a furatsilin solution at room temperature.
Purulent discharge can also be removed by rinsing the eyes using a pipette for rinsing. After removing the pus remedy washes off with warm boiled water. After the massage, antibacterial eye drops prescribed by your doctor should be placed in the eye.
During conservative treatment, you should visit your doctor 2 times a week.
After 2 weeks, the ophthalmologist will evaluate the effectiveness of the manipulations performed and, if necessary, adjust the treatment. Massage is effective only in the first months of a baby’s life. According to statistics, complete cure dacryocystitis in infants under three months of age – 60%; at the age of 3-6 months – only 10%; from 6 to 12 months – not higher than 2%. If the tear flow is not restored, the doctor will select other treatment methods. A specially trained physician may proceed to irrigate the tear ducts with a sterile saline solution containing an antibiotic. Before rinsing, an anesthetic is instilled into the eye - a 0.25% solution of dicaine.
Surgical methods of treatment
Probing the tear duct
Doctors' opinions on the timing of probing tear ducts are different. Proponents of conservative treatment methods believe that probing should be carried out no earlier than 4-6 months if there is no effect from massage. But there are also supporters of early use of probing - in the absence of effect from conservative treatment within 1-2 weeks.If massage does not give the desired effect in the first 2-3 months of the baby’s life, the ophthalmologist may prescribe probing of the tear ducts. This procedure is performed on an outpatient basis by a pediatric ophthalmologist. Under local anesthesia, a probe is inserted through the lacrimal opening into the nasolacrimal canal. A rigid probe allows you to break through the remaining film and expand the canal to ensure normal outflow of tears.
During probing, the child does not feel pain; the procedure is completed within a few minutes. The younger the baby is, the less discomfort he feels from probing. In 30% of cases, probing has to be repeated after a few days. It is possible to restore tear drainage using probing in 90% of cases and above. To prevent inflammation after probing, the child is prescribed antibacterial drops in the eye.
Bougienage of the tear duct
Bougienage is a fairly common method of treatment, more gentle than surgery. It consists of introducing a special probe into the tubules - a bougie, which will physically remove the obstacle and push apart and expand the narrowed walls of the nasolacrimal canal.The bougie is inserted through the lacrimal opening. The procedure is not painful, but there may be discomfort when carrying it out. Sometimes intravenous anesthesia is used. The procedure is completed within a few minutes. Sometimes several bougienages are required at intervals of several days.
In some cases, bougienage is performed with the introduction of synthetic elastic threads or hollow tubes.
Surgical treatment
Treatment depends on the patient's age, the form of dacryocystitis and its cause. Surgery dacryocystitis is indicated:- in the absence of effect from the treatment of primary dacryocystitis; with severe anomalies in the development of the lacrimal ducts;
- Treatment of secondary dacryocystitis, chronic dacryocystitis and its complications is carried out only surgically.
For primary dacryocystitis (in newborns), a less traumatic operation is used - laser dacryocystorhinostomy.
Surgical treatment of secondary dacryocystitis in children and chronic dacryocystitis in adults is carried out only surgically. In adults and children over 3 years of age, dacryocystorhinostomy is performed - an artificial nasolacrimal canal is created connecting the eye cavity with the nasal cavity. Removal of the lacrimal sac in adults with dacryocystitis is carried out in exceptional cases.
Before the operation, it is recommended to apply pressure to the area of the lacrimal sac 2 times a day; to remove purulent discharge, thoroughly wash the eyes with running water and instill anti-inflammatory antibacterial drops (20% sodium sulfacyl solution, 0.25% chloramphenicol solution, 0.5% gentamicin solution, 0.25% zinc sulfate solution with boric acid) 2-3 times a day.
There are two types of operational access: external and endonasal (through the nose). The advantage of the endonasal approach is that the operation is less traumatic and there is no scar on the face after surgery. The purpose of the operation is to create a wide opening between the nasal cavity and the lacrimal sac.
The operation is performed under local anesthesia with the patient sitting. As a result of surgical treatment with endonasal access, complete cure for chronic dacryocystitis is achieved in 98% of cases.
With dacryocystitis of newborns surgical treatment carried out when conservative treatment is ineffective. Before the operation, sufficient antibacterial therapy for the purpose of prevention infectious complications. Infectious complications pose a risk of brain abscess, because With venous blood, an infection from the area of the nasolacrimal ducts can enter the brain and cause the development of purulent inflammation of the brain or the formation of a brain abscess. During the operation under general anesthesia normal communication between the nasal cavity and the conjunctival cavity is restored.
For dacryocystitis, the cause of which is a congenital anomaly or a deviated nasal septum, surgical treatment is carried out at the age of 5-6 years.
Treatment with folk remedies
Many adult patients and mothers of sick children begin to treat dacryocystitis on their own, folk remedies. Sometimes such treatment takes an unforgivably long time, which leads to a protracted course of the disease or the development of complications.Rinsing the eyes with herbal decoctions and application eye drops can only temporarily reduce or eliminate the manifestations of the disease, but does not affect the cause that caused dacryocystitis. After some time, the symptoms of the disease reappear.
Folk remedies and methods of treating dacryocystitis can be used, but after consulting with an ophthalmologist:
- Compresses based on infusions of chamomile, mint, dill.
- Lotions: sachets with tea leaves should be briefly placed in hot water, let them cool slightly and apply them to your eyes, covering them with a towel on top.
- Lotions or drops of Kalanchoe juice
Spontaneous cure
Most of all, mothers are afraid of probing the nasolacrimal canals, as one of the methods of treating dacryocystitis. But not every dacryocystitis requires canal probing. In 80% of children with dacryocystitis, the embryonic gelatin film itself ruptures at 2-3 weeks of the baby’s life, i.e. self-healing occurs. Massaging the nasolacrimal canal will only help and speed up the rupture of the film.When detecting dacryocystitis in a newborn, ophthalmologists first of all suggest expectant management. Although ophthalmologists have different opinions about the waiting period: some suggest waiting up to 3 months, and some – up to 6 months of age. By this time, self-healing of congenital dacryocystitis may occur - as the nasolacrimal canal gradually matures, the gelatinous film covering the opening of the canal may rupture. Other ophthalmologists consider early probing of the lacrimal canal to be successful - after 2 weeks of massage, if the effect is not achieved.
When using a wait-and-see approach, it is necessary to ensure eye hygiene: instill drops recommended by an ophthalmologist into the eyes and rinse the eyes with warm, freshly brewed tea. Required condition is also providing a massage.
Self-healing will be indicated by the absence of manifestations of dacryocystitis. But even in this case, a repeated consultation with an ophthalmologist is necessary.
general information
To start working in the Vesta.Acceptance subsystem after authentication, in the window that appears, click on the link "Acceptance"(Fig. 1):
Rice. 1. List of available subsystems in the Vesta system
Colored icons located at the top above the button "Add sample"(Fig. 2) mean:
- Green- link to | official website of Rosselkhoznadzor;
- Blue- link to a website dedicated to the state information system in the field of veterinary medicine | "Vetis" ;
- Yellow- link to help system dedicated to the automated system "Vesta" .
Rice. 8. Form for searching for a counterparty in the Vesta.Acceptance subsystem (05/12/2015)
If the counterparty is not found, you can add it yourself by going to the tab "Add new".
The form of filling may vary depending on the type of counterparty; for an individual, the following fields are filled in (Fig. 8):
- Counterparty type- selection of counterparty type: Entity, Individual, Individual entrepreneur;
- Full name- indicate the full name of the counterparty;
- Passport- indicate the passport details of the counterparty;
- TIN- indicate the TIN of the counterparty, if any;
- A country- selection of the counterparty country;
- Region- region selection;
- Locality, Street, House, Structure, Office/Apartment.
After filling out the fields, click on the button "Add".
Rice. 8. Filling out the form for adding a new counterparty in the Vesta.Acceptance subsystem (05/12/2015)
Block "Sampling"
Contains the following fields (Fig. 9):
Rice. 9. Filling out the “Sampling” block in the “Vesta.Acceptance” subsystem (05/12/2015)
- Owner- the counterparty is indicated - the owner of the product or material from which the sample is taken. You must press the button with three white stripes;
- Selection act number- the number of the sampling report is indicated;
- Date of the selection report- the date of the sampling act is indicated;
- Package safe number- indicate the number of the safe package;
- Date and time of selection- the date and time of sampling is indicated;
- Place of selection- the location of sampling is indicated;
- Selection made- indicated executive, which carried out the sampling.
- In the presence- the persons in whose presence the samples were taken are indicated, if any.
- ND for sampling- indicated normative document regulating sampling;
- Number of samples- the number of samples taken is indicated, and the type of packaging of the product is also indicated;
- Sample weight/volume- the mass and units of measurement of the sample are indicated;
- Accompanying document- the accompanying document for the product is indicated, if any. This could be an invoice, inventory, label.
Block "Origin"
Contains the following fields to fill in (Fig. 10):
Rice. 10. Filling out the “Origin” block in the “Vesta.Acceptance” subsystem (05/12/2015)
- Manufacturer- the manufacturer of the product is indicated. You need to press the button with three white stripes.
Rice. 11. Adding a manufacturer in the “Vesta.Acceptance” subsystem (05/12/2015)
- Country of origin- country of origin is indicated;
- Region of origin- the region of the country of origin is indicated;
- Origin- a text field where you can enter information about the origin of the product;
- ND for product production- regulatory document for production;
- Fishing area.
Block “Information about the party”
Contains the following fields to fill in (Fig. 12):
Rice. 12. Filling out the “Batch Information” block in the “Vesta.Acceptance” subsystem
- Vet number document- number of the veterinary document accompanying the batch;
- Vet date document- date of the veterinary document accompanying the batch;
- Departure country- country of origin of the product (selected from the drop-down list);
- Departure region- region of the sending country (selected from the drop-down list);
- Point of departure- point of departure of products;
- Sender- name of the sender;
- Destination country- country of destination of the product (selected from the drop-down list);
- Destination region- region of the country receiving the product (selected from the drop-down list);
- Destination- the final destination where the product goes;
- Recipient- name of the recipient of the products;
- Marking- cargo marking;
- Batch weight/volume- mass/volume of the batch indicating the unit of measurement;
- Quantity per lot- quantity of products (material) indicating the unit of measurement;
- Production date;
- Best before date;
- Transport- you need to indicate the type of transport (select from the list) and indicate the number vehicle or name, then add to the batch information by clicking on the “plus” icon.
A team of 50 doctors from 25 specialties with over 15 years of experience who work well as a team. With such a team and a full range of modern equipment, we specialize in treating the most complex cases.
In our clinic you will find almost all possible pediatric specialists. What is especially important is that our entire team is very high level, and you can always get advice from a first-class specialist as soon as possible.
Play areas, a children's fitness room, tea, coffee, toys - children themselves ask their parents to come to us and do not want to leave!
We do not impose unnecessary tests and consultations, making only reasonable prescriptions. This is our policy - our prices for tests are equal to the cost of tests in an independent laboratory, and that’s all medical records must be checked by the Chief Warden
Modern scientists claim that an adult receives more than 70% of information about the world around him through vision. For newborns, this figure is approximately 90%. That is why, in case of problems with the eyes, you need to show the sick baby to a specialist - a pediatrician, pediatric ophthalmologist - as soon as possible and cure the inflammation.
Let's go along the teardrop route
To better understand all the intricacies of the disease called “dacryocystitis,” first of all, we suggest you delve into the anatomy.
The eye is washed with tears, which prevents it from drying out and prevents the proliferation of pathogenic bacteria. Normally, a person produces about 100 ml of tears every day. They are excreted from the body chemical substances, formed during nervous tension, stress, washed out foreign bodies(for example, an eyelash).
The tear is produced by the lacrimal gland and, having washed the eyeball, ends up in the inner (near the nose) corner of the eye. In this place on the upper and lower eyelids there are tear points (you will see them if you slightly pull the eyelid). Through these points, the tear enters the lacrimal sac, and then into the nasolacrimal duct, through which it flows into the nasal cavity (this is why, when a person cries, a runny nose appears!). But all this happens if there are no obstacles in the path of the tear. And since the tear ducts have a rather tortuous structure (there are also closed spaces - a kind of “dead ends”, and very narrow places), “congestions” often form here that block the outflow of tears. The narrow nasolacrimal duct prevents tears from entering the nasal cavity, and they accumulate in the lacrimal sac (located between the nose and the inner corner of the eyelid). The lacrimal sac stretches and overflows. Bacteria multiply in it, causing an inflammatory process - dacryocystitis, which without proper treatment can lead to serious complications.
Symptoms have causes
Some signs will tell you that your child has an inflamed lacrimal sac. In no case should they be ignored, because the later treatment is started, the greater the likelihood that conservative methods it won't be possible to get by.
l Permanent viral bacterial conjunctivitis. Moreover, they occur both against the background of acute respiratory infections, acute respiratory viral infections, and as a separate disease (often affecting one eye and then moving to the other).
l The eye is inflamed and red (the baby constantly rubs it).
l Excessive lacrimation (because tears cease to be absorbed at the lacrimal openings and stagnate in the eye) and leakage of tears and pus through the cilia. Often because of this they stick together, especially after a night or daytime sleep.
l When pressing on the area of the edematous lacrimal sac, the child experiences painful sensations, crying. Often a cloudy fluid (pus) is released.
Similar symptoms are observed in many newborns. But older children can also catch dacryocystitis, because the causes of the disease are associated not only with structural anomalies (underdevelopment of the lacrimal ducts).
Congenital
In infants, quite often the nasolacrimal duct becomes clogged with fetal mucus, which leads to tears beginning to stagnate. A so-called “gelatinous plug” appears. It happens that over time it resolves itself. But sometimes this doesn't happen. Then the traffic jam turns into connective tissue, becomes more rough. And this makes treatment very difficult!
Purchased
Foreign bodies caught in the eye, injuries, infectious and inflammatory diseases eyes, nose, paranasal sinuses (conjunctivitis, sinusitis, sinusitis) - all this serves as an impetus for inflammation of the lacrimal sac in older children.
We diagnose using the Vesta test
Symptoms of dacryocystitis are similar to other diseases. Therefore, making an accurate diagnosis is very problematic. To understand whether there are any obstacles in the path of the tear, experts often prescribe an x-ray contrast examination of the lacrimal sac (it can be used in children after two months).
There is a method that allows you to find out about the patency of the nasolacrimal duct at home. To do this, you need to conduct a Vesta test.
Insert a cotton pad into the baby's nostril (on the side of the sore eye). Drop a few drops of collargol into your sour eye (ask your doctor what its concentration should be). The test results are judged by the coloring of the cotton swab. The faster orange spots appear on it, the better the patency of the eye-nose path. Normally, this will happen within 2-3 minutes after you instill collargol (measure the time, remove the turunda from the nasal passage and evaluate the result).
A couple of minutes have passed, but the cotton swab is still white? Place it in the baby's nose again and wait some more time. If the baby has colored after 5-10 minutes, then a little later (let the baby rest!) the test should be repeated, since its result is in doubt.
Collargol did not appear for more than 10 minutes? Unfortunately, this indicates that the lacrimal ducts are obstructed or their patency is significantly impaired.
Can we do without surgery?
Of course, first they try to treat the disease conservatively. Fortunately, in 90 cases out of 100 such methods work great! True, there is a condition: therapy must be carried out comprehensively! And no amateur performances!
Massage
Using your fingers, lightly press (push) in the direction from the eye to the baby’s nose. Carry out a similar procedure at least 3 times a day for several minutes. But first, be sure to ask the doctor to show you a master class!
There is another type of massage: use your little finger to make circular movements at the inner corner of your eye (just try it on yourself first - this will help you calculate the force of pressure). You will know that you are doing everything correctly by the amount of purulent discharge. Does cloudy liquid flow out more when you move your fingers? This is good. This means that thanks to massage, the patency of the lacrimal ducts improves.
Washing
Disinfecting plant solutions and furatsilin solution make it possible to clean the eyes. The liquid is applied to a cotton pad and distributed throughout the palpebral fissure. After such washing and cleansing, other medications are instilled into the eyes.
Burying
Eye drops with an antimicrobial effect (Albucid, Oftadek) are usually prescribed. They prevent the growth of harmful bacteria.
Anti-inflammatory, antibacterial agents
Pharmacy medications help relieve inflammation and avoid severe infectious complications. Don't give up on using them. And don't worry! The doctor will prescribe these medications based on the child’s age. Conservative therapy alas, turned out to be powerless? This is not entirely true! After all, you can operate on the eye only after the acute inflammation has subsided (often this takes from three to six days) and the results of a general blood test (indicating its clotting time) are ready.
It is believed that one of the most simple ways surgical intervention, helping to restore the patency of the nasolacrimal duct - bougienage.
A special surgical instrument is used to pierce the plug or blockage and push apart the walls of the nasolacrimal duct, which have narrowed due to the inflammatory process. The procedure lasts only a couple of minutes, so the child doesn’t even have time to come to his senses! When the bougie (somewhat reminiscent of a wire) is removed, the patency of the lacrimal ducts is restored.
Obstruction of the lacrimal duct, according to medical statistics, is diagnosed in 5% of newborns. There is reason to believe that the pathology is much more common; it’s just that the problem may disappear before going to the doctor, without causing complications.
In all people, normally, the surface of the eyeball is regularly moistened by tear fluid when blinking. It is produced by the lacrimal gland, located under the upper eyelid, as well as by additional conjunctival glands. This liquid forms a film that protects the eye from drying out and becoming infected. Antibodies are present in tears and biologically active ingredients with high antibacterial activity. The liquid accumulates at the inner edge of the eye, after which it enters the lacrimal sac through special canaliculi, and from there it flows down the nasolacrimal duct into the nasal cavity.
Note: Since the baby cannot explain that he is experiencing discomfort, parents need to be able to recognize signs of the development of pathology.
Causes of tear duct obstruction in newborns
While the baby is in the womb, the tear ducts are protected from amniotic fluid entering them by a special membrane. Instead of a film, a plug may form in the canal, consisting of mucous secretion and dead cells.
When a newborn takes his very first breath, this membrane usually ruptures (the gelatinous plug is pushed out), and the organs of vision begin to function normally. In some cases, the unnecessary rudimentary film does not disappear, and the outflow of tear fluid is disrupted. When it stagnates and a bacterial infection occurs, purulent inflammation of the lacrimal sac develops. This pathology is called “dacryocystitis”.
Important: dacryocystitis of newborns is regarded by doctors as a borderline condition between congenital anomaly and acquired disease.
Quite often, parents are sure that their baby has developed conjunctivitis, and without prior consultation with a doctor, they begin to wash the baby’s eyes with antiseptic solutions and use eye drops with an antibacterial effect. These measures provide a visible positive effect for a short time, after which the symptoms increase again. The problem returns because the main cause of the pathology has not been eliminated.
Symptoms of blocked tear duct in newborns
Clinical signs of dacryocystitis and lacrimal duct obstruction in infants are:
Note: in most cases, unilateral obstruction of the lacrimal duct is diagnosed, but sometimes the pathology can affect both eyes of the newborn.
A characteristic symptom of this disease is the release of mucous or purulent contents of the lacrimal sac into the conjunctival cavity when pressing in its projection.
Signs of the development of a complication (progressive purulent inflammation) are restless behavior of the child, frequent crying and increased general temperature bodies.
Complications of lacrimal duct obstruction in newborns
Complication pathological process There may be stretching and hydrops of the lacrimal sac, accompanied by a clearly visible local protrusion of soft tissues. The addition of a bacterial infection often becomes the cause of purulent conjunctivitis. If adequate therapy is not started in a timely manner, the development of such a serious complication as phlegmon of the lacrimal sac is possible. In addition, if dacryocystitis is not treated, the formation of lacrimal sac fistulas is possible.
Diagnostics
The doctor makes a diagnosis of “obstruction of the lacrimal duct in a newborn” based on the medical history, characteristic clinical picture and the results of additional studies.
To detect obstruction tear ducts in infants the so-called collarhead test (Vest test). The diagnostic procedure is carried out as follows: the doctor inserts thin cotton wool into the child’s external nasal passages, and instills a harmless dye - a 3% solution of collargol - into the eyes (1 drop in each eye). The test is considered positive if after 10-15 minutes the cotton wool becomes colored. This means that the patency of the tear ducts is normal. If there is no staining, then the nasolacrimal duct is apparently closed and there is no outflow of fluid (Vest test is negative).
Note: The collarhead test can be considered positive if, after 2-3 minutes after instillation of the dye, the baby’s conjunctiva becomes lighter.
This diagnostic procedure does not allow us to objectively assess the severity of the pathology and the true cause of its development. If the test is negative, you must show the baby to an ENT doctor. It will help determine whether the cause of the outflow disturbance is swelling of the nasal mucosa (for example, with a runny nose due to a common cold).
Important: differential diagnosis carried out with conjunctivitis. Row clinical manifestations These diseases are similar to each other.
Treatment of lacrimal duct obstruction in newborns
By the third week after birth, in many babies, the rudimentary film in the canals disappears on its own, thanks to which the problem resolves itself.
Conservative treatment of tear duct blockage
First of all, the baby is shown local massage of the problem area (in the projection of the lacrimal canal). The procedure should be carried out by parents at home. Regular massaging helps to increase pressure in the nasolacrimal duct, which often helps to break through the rudimentary membrane and restore the normal outflow of tear fluid.
Massage for obstruction of the lacrimal canal
Before performing a massage, you should cut your nails as short as possible to avoid accidental damage to the delicate skin of the newborn. Hands must be washed thoroughly hot water with soap to prevent infection.
Pus is removed with a sterile cotton swab, generously moistened with an antiseptic - a decoction of chamomile, calendula or a solution of furatsilin 1:5000. The palpebral fissure must be cleared of secretions in the direction from the outer edge to the inner.
After antiseptic treatment, they begin to carefully perform massage. It is necessary to perform 5-10 jerky movements with your index finger in the projection of the lacrimal canal. In the inner corner of the child’s eye, you need to feel the tubercle and determine its highest and most distant point from the nose. You need to press it, and then move your finger from top to bottom to the baby’s nose 5-10 times, without taking a break between movements.
Pediatrician Dr. Komarovsky talks about how to cure blockage of the tear duct in newborns:
Note: according to Dr. E. O. Komarovsky, in 99% of cases a positive effect can be achieved conservatively.
When pressure is applied to the area of the lacrimal sac, purulent discharge may appear in the conjunctiva. It must be carefully removed with an antiseptic swab and massage continued. After the procedure, the baby should drop drops with antibacterial and anti-inflammatory effects (Vitabact or 0.25% solution of Levomycetin) into the eyes.
Before starting treatment for obstruction of the lacrimal canal and prescribing antibacterial drops, it is advisable to carry out bacteriological analysis discharged in order to identify the sensitivity (or resistance) of the pathogenic microflora that is the cause of the purulent process. It is undesirable to instill albucid into the eyes, since crystallization of the drug, which aggravates the course of the disease, is possible.
Manipulations are carried out 5-7 times a day for 2 or more weeks.
Surgical treatment of lacrimal duct obstruction
Often a child needs the help of a qualified ophthalmologist. If during the first six months of life it was not possible to restore it conservatively, the rudimentary film becomes denser. Eliminating it becomes much more difficult, and the risk of developing severe complications increases significantly.
Important: The operation is usually performed on a child at the age of 3.5 months.
Tear duct obstruction and ineffectiveness massage treatments are an indication for surgical manipulation– sounding (bougienage). This intervention is carried out on an outpatient basis (in an ophthalmology office, dressing room or small operating room) under local or general anesthesia. During treatment, the doctor moves a thin probe into the canal and with careful movements breaks through the pathological membrane. Total duration manipulation takes only a few minutes.
At the first stage, a short conical probe is inserted to widen the canal. A longer cylindrical Bowman probe is then used. It advances to the lacrimal bone, after which it turns in a perpendicular direction and goes down, mechanically removing the obstacle in the form of a film or plug. After removing the instrument, the canal is washed with an antiseptic solution. If the operation is successful, the solution begins to pour out through the nose or enters the nasopharynx (in this case, the baby makes a reflex swallowing movement).
After such a radical intervention, in most cases, patency is quickly restored. Eye drops are also prescribed to prevent the formation of adhesions and the development of relapse. The use of drugs containing an antibacterial component and glucocorticoids is indicated; they allow you to relieve swelling after the procedure. Child in postoperative period a course of local massage is also shown.
If pus continues to be released 1.5-2 months after probing, then a repeat procedure is necessary.
A positive effect can be achieved in 90% of cases of diagnosed neonatal dacryocystitis.
The ineffectiveness of bougienage is an absolute basis for carrying out additional examination. In such cases, it is necessary to establish whether the obstruction of the lacrimal canal is not a consequence of a deviated nasal septum or other developmental abnormalities of the newborn.
If the pathology is not diagnosed in a timely manner or insufficiently prescribed adequate treatment, then in the most severe cases, when the child reaches 5 years of age, a rather complex planned operation is performed - dacryocystorhinostomy.
It is important to remember that constant lacrimation, and, moreover, the appearance of purulent discharge in the eyes of an infant, is a good reason for immediately seeking medical care. There is no need to try to make diagnoses on your own or self-medicate to avoid serious complications.
Plisov Vladimir, medical observer
