Alternative names: color test Vesta, fluoroscein test, nasal test.
Colored nasolacrimal test is one of the research methods in ophthalmology, which consists in assessing the active patency of the paths along which tears flow from the eye into nasal cavity. During the test, the doctor measures the time it takes for dye instilled into the conjunctival cavity to travel from the conjunctival cavity into the nasal passage.
The purpose of this technique is to provide an integrative assessment of the active conductivity of tear fluid along the entire lacrimal duct.
This research method is the most popular method for diagnosing diseases of the lacrimal duct due to the ease of its implementation and complete absence side effects and complications.
Preparing for the test. No special preparation is required. The test can be carried out at any time of the day.
How is the color nasolacrimal test performed?
The patient sits and one drop of dye (1% sodium fluoroscein solution or 3% collargol solution) is instilled into the conjunctival cavity using a pipette. After this, the doctor asks the patient to tilt his head forward and blink a little. After 3 and 5 minutes, the patient is asked to blow his nose into a wet tissue using each nostril separately. If necessary, the doctor inserts under the lower turbinate a button probe tightly wrapped with damp cotton wool or a bandage. Based on the presence of dye on a napkin or bandage, the results are interpreted.
Interpretation of results
With normal patency of the lacrimal ducts, the dye enters the nasal cavity no later than 5 minutes. In this case, the sample is considered positive.
Staining a napkin or turunda from 6 to 20 minutes after the introduction of the dye is regarded as a delayed test. This fact may indicate stenosis of one of the sections of the lacrimal ducts.
If the dye appears later than 20 minutes or does not appear at all, the sample is considered negative. This may occur when the tear ducts or nasolacrimal duct are completely obstructed.
Indications
The main indications for color testing nasolacrimal test- This is lacrimation and lacrimation. Also, this test can be carried out as part of a comprehensive examination of the organ of vision during preventive examinations.
Contraindications for the test
The only contraindication for the test is individual intolerance to the dye (collargol or fluorescein). Considering that these substances do not have cross-allergy, when allergic reaction One drug can be tested through another.
Complications
No complications were noted.
additional information
This test is highly specific, but in some cases it is possible to obtain false results. This happens in following cases: with severe inflammation of the nasal mucosa (rhinitis) or when squeezing dye onto the skin during blepharospasm (involuntary contraction of the orbicularis oculi muscle). In these cases, it is advisable to postpone the procedure.
The color nasolacrimal test is the most accessible method for studying the active patency of the lacrimal ducts. The only more accurate alternative method is scintigraphy of the lacrimal ducts, which is based on monitoring the passage of a radiopharmaceutical containing the technetium-99 isotope through the tracts using a gamma camera. This study allows us to assess the degree of stenosis of the tubules and canal. However, due to the complexity of carrying out this study it doesn't find wide application in clinical practice.
Based on the results of a color nasolacrimal test, the question of the need for other examination methods is most often decided: diagnostic lavage and probing of the lacrimal ducts, radiography of the lacrimal ducts. Comprehensive examination allows you to make the correct diagnosis and decide on treatment tactics.
Literature:
- Ophthalmology: National leadership. Ed. S.E. Avetisova, E.A. Egorova, L.K. Moshetova, V.V. Neroeva, Kh.P. Takhchidi. - M.: GEOTAR-Media, 2008. - 944 p.
- Cherkunov B.F. Diseases lacrimal organs. – Samara: Perspective, 2001. – 296 p.
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 it will not be possible to manage with conservative methods.
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 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: do it with your little finger circular movements at the inner corner of the eye (just try it on yourself first - this will help 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
Usually prescribed eye drops with an antimicrobial effect (“Albucid”, “Oftadek”). 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 subsides (often this takes from three to six days) and the results are ready general analysis blood (indicating its clotting time).
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 break through 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 data 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 upper eyelid, as well as 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 the entry of amniotic fluid into 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 joining occurs bacterial infection, 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 a congenital anomaly and an 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 development of complications (progressive purulent inflammation) are the child's restless behavior, frequent crying and increased general body temperature.
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 tissue. 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 a harmless dye is instilled into the eyes - a 3% solution of collargol (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. Required index finger 5-10 jerky movements 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 conduct a bacteriological analysis of the discharge in order to identify sensitivity (or resistance) pathogenic microflora, which 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 it was not possible to restore it conservatively during the first six months of life, 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 in outpatient setting(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 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 insufficient adequate treatment, then in the most severe cases, when the child reaches 5 years of age, a rather complex elective surgery– 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
In the human lacrimal apparatus, two sections are distinguished: the tear-producing (lacrimal gland, Krause's glands) and the lacrimal drainage (lacrimal openings, lacrimal canaliculi, lacrimal sac and nasolacrimal duct). Pathology of the lacrimal apparatus is most often manifested by inflammatory processes and anomalies in the development of the lacrimal ducts and very rarely by pathology of the lacrimal glands.
Most constant symptom These diseases cause persistent lacrimation (epiphora).
One of the main causes of lacrimation is obstruction of the lacrimal ducts, which can occur in any area.
To diagnose the patency of the lacrimal ducts, the following are carried out: collarhead test, washing, probing and radiography of the lacrimal ducts.
In order to objectively assess the functional state of the lacrimal openings and canaliculi, a collar canalicular test (Vest test) is used. 1 drop of a 3% solution of collargol is instilled into the conjunctival cavity with the patient sitting with his head slightly thrown back. It is suggested to make light but frequent blinking movements. The evacuation of a colored solution from the conjunctival cavity into the lacrimal sac is judged by the discoloration of the conjunctival cavity. The test is considered positive if discoloration of the conjunctival cavity occurs within 5 minutes, delayed - 6-10 minutes, negative - if after 10 minutes collargol is retained in the conjunctival cavity at least partially.
At the same time, a collarhead nasal test is performed to assess the patency of the entire lacrimal duct. A cotton swab is inserted under the inferior turbinate to a depth of 4 cm. Collarhead nasal test is considered positive if the dye appears on the swab after 5 minutes, delayed - 6-10 minutes, negative - if there is no dye on the swab at all.
A slow or negative tubular test indicates a mechanical obstruction along the lacrimal openings or tubules or their functional failure. A negative or delayed nasal test with a positive canalicular test indicates a difficulty in the outflow of tears from the lacrimal sac into the nose due to inflammatory or scarring changes.
In cases of delayed or negative collarhead test, they are washed to determine the patency of the lacrimal ducts. A 0.5% solution of dicaine is instilled into the conjunctival cavity. The lacrimal punctum is expanded with a conical probe, after which a blunt needle, attached to a two-milliliter syringe with a solution of furatsilin diluted 1:5000, is inserted into the lacrimal canaliculus 5-6 mm. By slowly pressing the piston, the liquid is injected into the lacrimal ducts. The patient's head is slightly tilted forward, and he holds the tray with his hand near his chin.
When washing, the following may occur:
- a) washing liquid flows out of the nose in a stream - the patency of the lacrimal ducts is good; flows out in drops - narrowing of the tear ducts;
- b) the washing liquid does not pass into the nose at all, but comes out in a stream through the upper lacrimal punctum - the lumen of the lacrimal ducts is completely blocked, the level of which can be determined radiographically.
For radiography of the lacrimal ducts, they are filled with a contrast agent (30% iodolipol solution, verografin solution).
Probing of the lacrimal ducts is usually carried out with therapeutic purpose with dacryocystitis of newborns, to restore patency of the tract.
T. Birich, L. Marchenko, A. Chekina
“Diseases of the lacrimal organs, lacrimation, diagnosis” article from the section
Thank you
The site provides background information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!
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);
- severe, 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 V 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. Nasal test or the Vesta test with collargol or fluorescein is negative (the cotton swab in the nasal cavity does not stain). 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 the 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 - hydrops 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).
The massage is carried out with the 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 dipped 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 regarding the timing of probing the tear ducts vary. Supporters conservative methods treatment, it is believed 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 carried out 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 rinse 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 once 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 preventing infectious complications. Infectious complications pose a risk of developing a 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.
The lacrimal apparatus includes the lacrimal gland and lacrimal ducts. Lacrimal gland located in the upper outer part of the orbit. The tear fluid from the gland enters the upper fornix of the conjunctiva (under the upper eyelid at the outer corner of the eye) and washes the entire anterior surface of the eyeball, covering the cornea from drying out.
- Vesta color nasolacrimal test - 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, a cotton swab is inserted under the inferior nasal concha 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 with Dicaine of the conjunctival sac and expansion of the lacrimal opening and canaliculus with a conical probe tear ducts 0.4 ml of bismuth nitrate emulsion in petroleum jelly is injected with a syringe. Then, placing the patient in the chin-nasal position, a picture is taken. In this case, disturbances in the normal structure of the lacrimal ducts are easily detected. After radiography, the lacrimal ducts are washed with saline to remove the emulsion.
