Eye ducts. Instructional video for checking the patency of the lacrimal duct

The operation on the lacrimal canal of the eye involves clearing or expanding the duct in order to eliminate its blockage. This pathology is called dacryocystitis and requires immediate treatment. If you delay this, the inflammatory process will intensify, and then probing alone will not be enough.

Reasons for the development of dacryocystitis

Dacryocystitis often occurs in infants as a congenital pathology. The tear ducts of newly born babies may be clogged due to abnormal development of the skull, intrauterine infections or cystic abnormalities. In 80% of cases, the problem is solved by itself when the baby starts to cry, because the tears clear the ducts. But if the pathology is more serious, the help of doctors is required.

In adults, inflammation of the tear duct often develops in eye diseases, especially glaucoma. Also cause blockage tear ducts can become independent use eye drops(without a doctor's prescription) or by-effect from taking anticancer drugs based on docetaxel. If a person receives a facial injury, then blockage of the lacrimal canal can be triggered by displacement or deformation facial bones skulls.

By the way! Women who are fond of beauty injections and circular suspenders, also often become victims of dacryocystitis. The tear ducts of the eye are clogged with materials used for procedures, or blockage occurs due to narrowing of the ducts caused by another cosmetic manipulation.

Symptoms of the manifestation of pathology

It is not difficult to determine dacryocystitis, especially if it occurs in an acute form. The skin around the eyes turns red, painful swelling appears, the eyelid swells, and the palpebral fissure narrows. Outwardly, it looks as if a person was bitten by bees, because swelling severe inflammation can spread to the cheek, and even to the nose. At the same time, the patient himself experiences pain when pressing or touching the eye, jerking spasms. He may have a headache and a fever that indicates an infection.

In chronic dacryocystitis, there are no sharp painful manifestations. This flow is different outward signs: the skin around the eye becomes thinner and becomes bluish. Also often chronic inflammation lacrimal canal leads to infection and nearby membranes of the eye. So comorbidities are blepharitis, keratitis, conjunctivitis.

By the way! The appearance of an eyesore (a white film that impairs vision and looks unaesthetic) can also be due to chronic dacryocystitis, which occurs without obvious painful symptoms.

In newborns, the pathology is manifested by a visible narrowing of the palpebral fissures. The baby cannot open his eyes due to swelling. And when he starts to cry, there are no tears. If this mild form disease, there are no other symptoms. In severe dacryocystitis, hyperemia around the eyes and noticeable swelling can be observed.

How are lacrimal duct pathologies diagnosed?

Sometimes to determine dacryocystitis alone is not enough clinical manifestations. It is possible to clarify the diagnosis and check how much the inflammation of the lacrimal canal is running using diagnostic methods.

Color tests

A white swab is inserted into the nasal passage. A dye solution is instilled into the eye. If after 2 minutes the swab remains clean (does not stain), then the patient has problems with blockage of the tear ducts. But they can be dealt with conservatively. If the tampon does not stain even after 8-10 minutes, then the pathology is running, and it is necessary surgical intervention.

Sometimes a simpler method is used without a tampon. A dye solution is dripped into the eye and the patient is asked to blink. By how quickly the dye ceases to be visible to the eye (flows down the tear ducts), the doctor determines the degree of dacryocystitis.

Dacryocystography

This diagnostic method allows not only to detect the presence of cysts in the lacrimal ducts, but also to determine their location, as well as the force of gravity on tear drainage. The patient is first introduced into the lacrimal canal contrast agent(for example, lipiodol), and then take pictures in several projections on special equipment.

Biomicroscopy

It is carried out with suspicion not only of inflammation of the lacrimal duct, but also of other eye pathologies associated with developmental anomalies or loss of vision due to the same dacryocystitis. Often, biomicroscopy helps to highlight eye diseases that the patient did not even know about.

Bakposev

For bacteriological culture the microflora needs a morning smear. The patient is asked to come to the appointment immediately after waking up, without washing. A special loop is used to take a smear from the fold of the lower eyelid. If it is revealed pathogenic microflora will require antibiotic treatment.

Conservative treatment of dacryocystitis in newborns

If the situation is not critical, and there is no obvious inflammation, infants are tried to be treated conservatively. But it is necessary to start therapy as early as possible so as not to miss the moment and not start dacryocystitis.

Massage

The simplest and most gentle method that even moms and dads themselves can handle. Lacrimal canal massage is performed on newborns to soften cystic formations and bringing them out. Parents are taught a simple technique, and then they themselves try to cope with the problem. The main thing is that everything is sterile so that an infection does not develop in the tear ducts.

Attention! Massage of the lacrimal canal with dacryocystitis is prescribed only if it is certain that this is not purulent inflammation! Otherwise, pus can spread to nearby tissues and provoke phlegmon.

If a newborn has a purulent obstruction of the lacrimal canal, antibiotic treatment is required first, and only then massage or other procedures.

sounding

Or bougienage of the lacrimal canal. The procedure is performed on an outpatient basis under local anesthesia. A special probe is inserted through the lacrimal opening, which breaks through all the obstacles and expands the duct. All this only takes a few minutes. The only discomfort for the baby is the inability to move the head, because it is held in order to avoid injury to the finest tissues. Otherwise, newborns calmly tolerate probing of the lacrimal canal.

If the baby starts crying during the procedure, this is even a plus. Because this way the doctor can immediately assess the effectiveness of the intervention. If necessary, probing is repeated after 2-3 weeks. After such an operation, the child must be prescribed eye antibiotics.

Surgical treatment of dacryocystitis in newborns

Surgery is indicated for infants if conservative methods treatment does not show positive results in dynamics, and the disease progresses. There are two types surgical treatment blockage of tear ducts:

• using laser technology;
• the classic way.

Laser dacryocystorhinostomy is more modern and less traumatic. Therefore, when possible, such an intervention is used. An endoscope with a laser is inserted into the tear duct, beams of which reach the obstruction and destroy it. The operation is considered minimally invasive, there is almost no bleeding, and healing is fast. Another important plus: you can perform laser dacryocystorhinostomy under local anesthesia. The main disadvantage is the high price (from 30 thousand rubles)

The standard intervention for blockage of the lacrimal ducts in newborns is carried out in two ways: externally or through the nose (endonasal). The purpose of the intervention: to create a wide mouth between the lacrimal sac and the nasal cavity. Classical dacryocystorhinostomy requires general anesthesia. The operation is dangerous due to its complications (infection), as well as damage to nearby tissues and leaving scars.

After any operation, it is required to wash the lacrimal canal with special solutions (antibacterial, physiological) for 7-10 days. Therefore, the newborn has to stay in the hospital for some time.

For the treatment of blockage of the tear duct in an adult, the same conservative and surgical methods: probing or operation to expand the channel. If the pathology is running, sometimes it is necessary to carry out the plastic of the lacrimal sac with the removal of the formed tumor.

Also, the treatment of dacryocystitis in adults involves another type of operation: balloon dacryocytoplasty. It consists in introducing a thin conductor equipped with a microscopic balloon into the lacrimal duct. The latter is filled with liquid, swells and thereby expands the channel. Then the balloon is removed, and the patient is prescribed a course of antibiotic therapy.

Prevention of blocked tear ducts

In the case of newborns, it is difficult to predict whether a baby will be born with or without a pathology. Although even healthy children may develop dacryocystitis over time if the mother does not follow basic hygiene. The child's eyes should be washed daily, using lint-free cotton pads dipped in warm water. boiled water. And at the first suspicion, you should immediately contact your pediatrician.

Washing the lacrimal canal is an ophthalmic procedure, the essence of which is the introduction of a special liquid with moderate pressure into the nasolacrimal canal. used in therapeutic and diagnostic purposes. Can be performed at any age, in infants and adults.

The procedure is performed under anesthesia with special eye drops. Washing the lacrimal canal in newborns helps to remove the plug that prevents the outflow of intraocular fluid. Such a blockage occurs quite often in the first two months of a baby's life.

Canal blockage in adults occurs due to complications of inflammatory processes or tumors different nature. Washing is also necessary after eye injuries.

Canal lavage for diagnostic purposes is prescribed if children or adults have profuse tearing. And also with a high concentration of intraocular fluid. For therapy, the event is used for such pathologies:

• Dacryocystitis in infants. In the event that massage does not help the child;
• Inflammatory process or stenosis in the canals;
• Partial obstruction of the canal.

The procedure can not be performed with purulent or watery formations in the lacrimal sac. If this is not taken into account, serious consequences can follow.

Probing of the lacrimal ducts

Probing is used for diagnosis and therapy. Thanks to this event, the place where the cork has formed is determined. For the procedure, a special probe is used, which is carefully and smoothly inserted into the lacrimal duct. The operation does not take long. Used as an anesthetic eye drops.

The procedure is usually given to young children. If you use this event in relation to adults for therapeutic purposes, it will not bring the desired result.

Preparation and methodology

Before the procedure, anesthetic drops are injected into the conjunctiva. If the event is performed for therapeutic purposes, painkillers can be omitted. Flushing set lacrimal ducts sterile. Sets are disposable.

manipulation takes place in sitting position, with a slight tilt of the body forward. The specialist fills the syringe with a solution and places a blunt needle on it to flush the lacrimal canal. The eyelid is pulled down, the syringe is placed in the channel and the solution is injected into the eye.

Actions after washing

Washing the nasal canals is a kind of micro-operation. Quite unpleasant without anesthesia. To consolidate the result and to eliminate the risk of complications, it is necessary to perform the following measures:

• During the week, massage the lacrimal ducts;
• Instill antibacterial drops prescribed by the attending specialist in the eyeball.

Most often, after washing the lacrimal ducts, the desired effect is observed immediately. If the patient's condition has not improved within a month, it is necessary to repeat the event.

At birth defects or a curvature of the bridge of the nose as a result of an injury, it does not make sense to take this measure to eliminate the plug. More severe surgical interventions are needed.

Complications

Like any surgical effect on the eyes, washing the lacrimal canals can cause complications. Each organism perceives anesthesia and surgery differently.

Most often, small scars may form at the injection site. This can lead to re-clotting. Washing will have to be repeated. To avoid unpleasant consequences, follow all the instructions and recommendations of the treating specialist.

• Reasons for the appearance
• Symptoms of the disease
• Diagnostics
• Treatment
• Lacrimal duct surgery in adults
• Lacrimal canal massage
• Alternative treatment

Blockage of the tear ducts subsequently interferes with the healthy outflow of tear fluid. In the future, this leads to an inflammatory process. Often similar problem occurs in adults. The causes of this pathology are congenital features, injuries and diseases. Inflammation may require probing of the lacrimal duct in adults.

Probing of the lacrimal canal in adults

As the disease progresses, the symptoms become stronger. In this article, you will get to know effective methods treatments, such as the use medications, bougienage of the lacrimal canal in adults, surgical intervention.

Reasons for the appearance

Blockage of the tear ducts (dacryocystitis) is an inflammatory process. It affects the lacrimal canal, which is located between the nasal septum and the inner corner of the eye. As a result of blockage, pathogenic microorganisms can accumulate. Their activation leads to the onset of inflammation and impaired fluid outflow.

Diagram of the lacrimal canal

Most often, obstruction of the lacrimal duct occurs due to the following reasons:

1. Congenital pathology of patency. The defect appears at birth and may disappear in the first months of life. However, sometimes it can stay. In this case, it is necessary to pierce the lacrimal canal.
2. Non-standard development of the skull and face.
3. Infectious diseases and inflammatory processes.
4. Surgical operations that were performed on the eyes.
5. Trauma and damage to the face. Displaced bones can interfere with the normal outflow of fluid.
6. Tumors on the face. Formations that occur in the nose bones and lacrimal sac can block the canal. This happens if the tumor greatly increases in size.
7. Medicinal preparations for external use. Some eye drops provoke obstruction of the tear ducts.
8. Medicines internal use. Obstruction occurs as a side effect of certain medications.
9. Irradiation. If a person has endured oncological disease during treatment, the risk of blockage increases significantly.

Symptoms of the disease

The blockage may occur in one or both eyes. Inflammation of the tear duct may be accompanied by the following symptoms:

• increased tearing;
• frequent occurrence of conjunctivitis;
• inflammation and swelling in the corner of the eye;
• discharge of mucus or pus from the eyes;
• the manifestation of traces of blood in the lacrimal fluid;
• decreased visual clarity.

It is important to know! On the initial stage disease, this disease manifests itself rather weakly. The patient may feel discomfort in the lacrimal sac. After a certain time, there may be strong pain and redness of the skin.

Diagnostics

To confirm this diagnosis, the ophthalmologist may prescribe certain studies. These include:

1. Dye test. Doctors instill a special dye solution into the patient's eyes. If after a few seconds in the eyes there is a large number of dye, this will indicate that the channel is clogged.
2. Channel sounding. With the help of a special tool, doctors penetrate the lacrimal canal. In the process of piercing the lacrimal canal, it expands, and the problem can be solved.
3. Dacryocystography. X-ray of the lacrimal canals with the introduction of a dye into them. With this method, specialists will see the outflow system of the eye.

Probe for bougienage

If the diagnosis is confirmed, then specialists prescribe bougienage of the lacrimal canal in adults.

Treatment

Therapy of the disease will depend on the cause that caused it. To combat a complex disease, you can use:

1. antibiotic therapy. If the infection caused the disease, then antibiotics are prescribed: ciprofloxacin, levomycetin, and also Erythromycin.
2. Bougienage. Probing of the lacrimal canal in adults is a more gentle method. For similar procedure can use a special probe. Its introduction is carried out through the lacrimal opening and mechanical cleaning of the lacrimal canal begins. The method of therapy can be considered completely painless, but you may encounter unpleasant sensations. Sometimes, before this procedure, the patient is given intravenous anesthesia. The procedure is a few seconds. In advanced cases, it may be necessary to repeat the bougienage, which is performed at intervals of several days.
3. Eye drops. You can also get rid of blocked tear ducts with the following eye drops:

• Phloxal. These drops have antibacterial action. active substance, which is present in the composition is the antibiotic ofloxacin. In the lower conjunctival sac, 1 drop should be instilled up to 4 times a day. In some cases, Floxal ointment can also be used. It is laid under the lower eyelid up to 3 times a day. Only allergic reactions can become a contraindication.
• Gentamicin. It should be applied 1-2 drops up to 4 times a day. Contraindications include severe kidney disease, neuritis auditory nerve, as well as hypersensitivity to the ingredients of the drug.
• Oftalmoferon. These are antiviral eye drops. Doctors will instill 1-2 drops up to eight times a day during acute inflammatory reactions. Then the number of instillations is reduced to 3 times. Contraindications of the drug include hypersensitivity to its components.

Floksal eye drops are an effective antibacterial agent.

If a drug treatment If it doesn’t work, then more serious methods of treatment are prescribed.

Lacrimal duct surgery in adults

Surgery is usually prescribed for difficult cases. The operation has the following types:

• Endoscopic dacryocystorhinostomy. During the surgical procedure, a flexible endoscope with a camera is inserted into the lacrimal duct. With its help, a small incision is made on the affected area. The operation will be available to patients who do not have allergic reactions. Duration rehabilitation period is up to 8 days. The advantages of such an operation are that after its implementation there are no visible scars on the skin and the tear ducts are not damaged.
• Balloon dacryocytoplasty. This is a safe surgical intervention that is performed, even for children under one year old. Specialists insert a thin conductor into the lacrimal canal. On it there is a bottle with a special liquid. At the site of blockage, a pressure balloon expands the problem area of ​​the tear duct and helps to clear it. During the procedure, you can use local anesthesia. After surgery, antibiotic drops may be prescribed.

Balloon dacryocytoplasty

Lacrimal canal massage

Massage of the tear ducts is part of the treatment of the disease. First, the doctor must teach the patient how to properly massage and give him instructions. After that, the patient will be able to perform it at home. During the massage, the following rules must be observed:

1. Hands should be treated with an antiseptic solution.
2. Press on the inner corner of the eyelids to release the pus.
3. Remove it from your eyes with a cotton pad dipped in a solution of furacilin or chamomile.
4. A solution of furacilin should be instilled into the inner corner of the eye.
5. Get a massage with index fingers making jerky movements with your fingers, press on the lacrimal sac up to six times.
6. After the massage, drip antiseptic drops.

Alternative treatment

Many people know that kalanchoe juice has an irritating effect, which favorably affects the removal of clogging plugs from the lacrimal ducts and relieves the inflammatory process. To prepare the remedy you will need:

• disrupt fresh leaves plants;
• wash and dry them;
• put in the refrigerator for several days to increase the concentration of nutrients;
• squeeze the juice from the leaves;
• dilute it with saline;
• draw the medicine into a pipette and drip it into the nose.

After the procedure, prolonged sneezing may begin, but this is normal. Now you know how the lacrimal canal is washed in adults. Of course, it is better to solve the problem immediately after birth, since at this age the canal is not yet fully formed. In adults, such an operation can cause certain complications. We hope that this information was useful and interesting.

Dacryocystitis is caused when the glands are blocked for some reason. The liquid from such a channel enters and stagnates there, which leads to accumulation and reproduction pathogenic microorganisms, which, in turn, lead to inflammatory process.

With this disease, lacrimation constantly occurs, swelling appears. If you press on the area of ​​the lacrimal sac, then purulent fluid will begin to stand out.

In this article, we will consider the features of such a disease as dacryocystitis in adults, the treatment of this pathology.

Causes

This disease occurs when physiological pathology lacrimal glands, for example, if the tear ducts have a congenital narrowing. Sometimes they can be completely blocked.

Inflammation of the lacrimal sac can occur for the following reasons:

• trauma to the sinus or eyes;
• viral and bacterial infections;
• allergic reactions;
• metabolic disease;
• diabetes;
• inflammatory diseases of the nose, provoking tissue swelling in the eye area;
• hit ;
• work with chemicals that are harmful to the eyes;
• long stay in a very dusty room;
• decreased immunity;
• overheating or hypothermia of the body.

Quite often, dacryocystitis is diagnosed in newborns. This is explained by the fact that the lacrimal ducts in infants in the first months of life have structural features.

When a child is in the womb, his tear ducts are closed by a membrane that ruptures at the time of birth. But in some cases, the membrane persists for a very long time even after birth, causing the accumulation of lacrimal secretions and pathogenic microflora in the eye canal.

In adults, dacryocystitis (there is a photo of the pathology in medical reference books) is much rarer, and women suffer from it more than men. This is due to the fact that the fair sex has a slightly different structure of the tear ducts.

Symptoms of an acute form of the disease

Dacryocystitis has its own characteristic features. Acute inflammation of the lacrimal sac has the following symptoms:

• swelling appears in the region of the lacrimal sac, and if it is squeezed, pain occurs;
• occurs as a result of which the palpebral fissure begins to narrow, which prevents a person from seeing normally;
• in the area of ​​​​the lacrimal duct, severe redness appears;
• around ophthalmic orbit there is a strong pain of a aching nature, which is replaced by an acute one, if you touch the inflamed area;
• body temperature rises;
• intoxication of the body occurs - malaise, fast fatiguability, weakness.

Symptoms of the chronic form of the disease

In the initial stage, dacryocystitis, the photo of which is not very pleasant to look at, has a painful swelling in the region of the lacrimal duct. To the touch it is very dense, softens after a while. The redness begins to subside, and an abscess appears at the site of the swelling, with a breakthrough of which the inflammation disappears. Instead of an abscess, a fistula is formed, and the contents of the lacrimal canal begin to constantly stand out from it.

The chronic form of dacryocystitis manifests itself as follows:

• incessant tearing;
• when pressing on the lacrimal sac, the discharge increases;
• under the sore eye there is an oblong swelling;
• eyelids swell, swell, overflow with blood.

Treatment of acute form of dacryocystitis

If acute dacryocystitis occurs in adults, it should be treated in a hospital. Systemic vitamin therapy, UHF therapy is carried out, and the area of ​​the lacrimal sac is applied dry heat. With the formation of pus, it is necessary to open the abscess, after which the wound is washed with antiseptics. It can be hydrogen peroxide, a solution of dioxidine, furacilin.

The doctor instills antibacterial drops or lays antimicrobial ointments. At the same time, a systemic antibiotic therapy drugs that have wide range actions (penicillins, cephalosporins, aminoglycosides).

Treatment of chronic dacryocystitis

If the acute form of the disease has passed into (in adults), treatment is carried out mainly operational method, called "dacryocystorhinostomy", with the help of which an additional message is formed between the lacrimal canal and the nasal cavity. This is necessary so that the pus stops accumulating and the outflow of fluid normalizes.

Sometimes the patency of the nasolacrimal canal is restored using bougienage or balloon dacryocystoplasty.

Bougienage is an operation (dacryocystitis treatment is carried out in this way quite often), due to which the lacrimal canals are cleaned with a special tool, which leads to the restoration of the patency of the ducts. This method is used for frequent relapses of diseases.

During balloon dacryocystoplasty, a probe with a balloon is inserted into the cavity of the duct, when it is inflated, the internal lumen of the canal begins to expand.

In order not to form a purulent corneal ulcer, patients are prohibited from using contact persons, imposing any ophthalmic procedures that are associated with direct contact with the cornea.

Treatment of newborns

If dacryocystitis occurs in newborns, then often anxious parents begin to treat inflammation on their own, washing the baby's eyes with decoctions various herbs, making tea lotions, purchasing special drops at the pharmacy, which were advised by the pharmacist.

These methods may work, but a short time. After the treatment is stopped, the baby's eyes begin to water again, sometimes even pus is released. This is explained by the fact that the disease occurs due to physiological pathology, expressed in the obstruction of the lacrimal ducts, and it is impossible to eliminate it only with lotions and drops. Therefore, as soon as dacryocystitis of the eye occurs, at its first signs, the baby should definitely be shown to the doctor.

If a child has such a disease, then special therapy is usually carried out, which consists of massage, the use of antibacterial drops and washing the eye with disinfectant solutions.

Carrying out massage procedures

Only a doctor can recommend effective ways elimination of dacryocystitis. One of these methods is lacrimal canal massage, which brings a truly guaranteed result. But he has one contraindication - a severe stage of the disease, which is characterized by the occurrence of extensive inflammatory processes. In this case, massage is strictly prohibited, since pus can get into the tissues that surround the tear ducts, leading to the formation of phlegmon.

The doctor teaches the parents how to carry out such a procedure. Massage begins with the fact that its contents are squeezed out of the lacrimal sac. In a solution of furacilin, a swab is moistened and the released pus is removed. Lacrimal duct massage is best done before feeding.

Squeezing movements should not be too soft, but not strong. Due to this effect on the lacrimal sac, the gelatinous membrane is pushed into the canal. Massage is effective only for newborns; for older babies, it no longer brings proper relief.

Conclusion

If a pathology such as dacryocystitis (in adults) has arisen, treatment should be started as early as possible, since there is a high probability of various complications. Some can be very serious, resulting in decreased vision. Newborns are most often prescribed massage. If it does not help, then probing is carried out, the effectiveness of which is quite high, after which the baby gets rid of this pathology forever.

Dacryocystitis is an inflammation of the lacrimal sac that develops against the background of stenosis or obliteration of the nasolacrimal canal. Dacryocystitis is characterized by persistent mucous purulent discharge from the eyes, lacrimation, swelling of the lacrimal sac, swelling and hyperemia of the semilunar fold, conjunctiva and lacrimal caruncle, narrowing of the palpebral fissure, and local pain.

Diagnosis of the disease includes a consultation with an ophthalmologist with palpation and examination of the area of ​​the lacrimal sac, an installation fluorescein test, radiography of the lacrimal ducts, and performing a lacrimal-nasal West test. The treatment for dacryocystitis is to use antibacterial ointments and drops, washing and probing the lacrimal ducts antiseptic preparations performing physiotherapy. If this does not work, then a dacryocystorhinostomy or dacryocystoplasty is prescribed.

Dacryocystitis: General information

Of all organ diseases diagnosed in ophthalmology, dacryocystitis accounts for 6–8%. The lacrimal sac in women becomes inflamed 7-9 times more often than in men, this is due to the narrower anatomy of the canals. Get sick with dacryocystitis more often in total, people aged 35–50 years, dacryocystitis is distinguished in a separate clinical picture in infants. The danger of dacryocystitis, especially in newborns, lies in the high likelihood of purulent septic complications from the subcutaneous tissues of the cheeks, eyelids, soft tissues of the orbit, nose, brain (brain abscess, meningitis, purulent encephalitis).

The secretion produced by the lacrimal glands ( tear fluid) normally washes the eye and moves to the inner corner eyeball, in which the lacrimal openings are located, passing into the lacrimal canals. With the help of them, the tear first enters the lacrimal sac, and then passes through the nasolacrimal canal into nasal cavity. During dacryocystitis due to obstruction of the nasolacrimal ducts, the function of lacrimal drainage is impaired, which leads to a large concentration of tears in the lacrimal sac - a cylindrical cavity that is located in the upper part of the nasolacrimal tract. Infection of the lacrimal sac and stagnation of the tear leads to the appearance of an inflammatory process in it - dacryocystitis.

By clinical symptoms distinguish:

• dacryocystitis of newborns;
• acute dacryocystitis (cellulitis or abscess of the lacrimal sac);
• chronic dacryocystitis.

Causes of the disease

Obstruction of the nasolacrimal canal underlies the pathogenesis of any form of dacryocystitis. With dacryocystitis in newborns, this is due to the presence of in the distal part of the nasolacrimal canal epithelial dense membrane, at the time of birth, an unresolved gelatinous plug, or congenital pathology lacrimal ducts (true atresia of the nasolacrimal ducts).

Obliteration or stenosis of the nasolacrimal tract leading to dacryocystitis in adults may appear due to:

chronic rhinitis;

• swelling of surrounding tissues with ARVI;
• polyps in the nasal cavity;
• sinusitis;
• damage to the tubules and lacrimal openings as a result of trauma to the eyelids;
• fractures of the bones of the orbit and nose.

Stagnation of tear fluid can lead to tear loss. antibacterial properties, This accompanied by the development of pathogenic organisms(as a rule, pneumococci, staphylococci, viruses, streptococci, in rare cases - chlamydia, tubercle bacillus and other specific microflora). Gradually, the walls of the lacrimal sac are stretched, a sluggish or acute inflammation process is formed in them - dacryocystitis. The secret loses its transparency and abacteriality, and becomes mucopurulent.

The main predisposing factors for the appearance of dacryocystitis are:

• decline protective functions immune system;
• diabetes;
• sudden changes in temperature;
• professional hazards.

Symptoms of the disease

The clinical manifestations of dacryocystitis are very specific. During chronic stage inflammation of the eye swelling is noted in the region of the lacrimal sac and persistent lacrimation. Pressing on the site of swelling leads to the release of a purulent or mucopurulent secret. There is hyperemia of the semilunar fold, conjunctiva of the eye and lacrimal caruncle.

continuous current chronic form disease can lead to stretching (ectasia) of the lacrimal sac - in this case, over the ectatic cavity of the sac skin covering becomes thinner and takes on a bluish tint. During chronic stage disease Great chance infection of other eye membranes with the occurrence of conjunctivitis, blepharitis, purulent ulcer or corneal keratitis with the further appearance of an eyesore.

acute form passes with more pronounced clinical picture: complete or partial narrowing of the closure of the palpebral fissure, swelling of the eyelids, painful swelling and sharp redness skin in the area of ​​the inflamed area lacrimal sac in the eye. Puffiness and hyperemia can pass to the cheek, eyelids, back of the nose. By appearance skin changes similar to erysipelas facial inflammation, but during dacryocystitis there are no sharp restrictions on the inflammatory focus. In the acute form of the disease, chills are noted, twitching pains in the region of the orbit, headache, fever and other symptoms of intoxication.

After two or three days, the compacted infiltrate over the lacrimal sac softens, the skin over it turns yellow, fluctuation develops, this indicates an abscess which can open on its own. Subsequently, an internal (in the nasal cavity) or external (in the area of ​​the skin of the face) fistula may develop in this area, from which pus or tears are regularly released. During the spread of pus to the surrounding tissues, a phlegmon of the orbit appears. The acute form of dacryocystitis very often turns into a recurrent nature of the disease.

Dacrycystitis

Dacryocystitis in newborns is marked by edema over the lacrimal sac. Pressure on this area may cause pus or mucus to be released. Dacryocystitis in young children is sometimes complicated by the appearance of phlegmon.

Diagnosis of the disease

The definition of dacryocystitis is carried out taking into account characteristic complaints, a typical picture of the pathology, palpation examination data and external examination of the area of ​​the lacrimal sac. During examination of a patient with dacryocystitis, swelling in the gas area and lacrimation are determined. During palpation of the inflamed part, the discharge of a purulent secret from the lacrimal openings and the presence of pain are determined.

With dacryocystitis, the study of the conductivity of the channels is performed using a color (tubular) West test. Why is a tampon inserted into the corresponding nasal passage, and the composition of collargol is dripped into the eye. Within 2 minutes, with passable channels, traces of the coloring element should appear on the swab. With a longer staining time of the swab (7–12 minutes), the conductivity of the lacrimal ducts can be doubted. When the collargol has not come out for more than 15 minutes, the West test is marked as negative, which indicates the impermeability of the channels.

To determine the extent and level of the lesion, diagnostic probing of the lacrimal ducts is performed. Performing a lacrimal-nasal passive test during dacryocystitis confirms the impermeability of the canals: in this case, during an attempt to wash the lacrimal-nasal tract, the fluid does not pass into the nose, but exits through the lacrimal points of the eye.

Eye biomicroscopy and fluorescein installation test are used in complex measures of ophthalmic diagnostics dacryocystitis. Contrast radiography of the lacrimal canals with iodolipol solution is required for an accurate representation of the localization of the obliteration zone or stricture and the architectonics of the lacrimal canals. To determine the microbial pathogens from the lacrimal openings, the discharge is examined using bacteriological culture.

For clarifying diagnosis, the patient must be examined by an otolaryngologist with rhinoscopy. According to indications, consultations of a traumatologist, maxillofacial surgeon or dentist, neurosurgeon, neurologist can be appointed. Differential Diagnosis this disease is produced with erysipelas, conjunctivitis, canaliculitis.

Dacryocystitis in adults: Treatment of the disease

Acute symptom of dacryocystitis should be treated in stationary conditions. Until softening of the infiltrate apply dry heat on the site of the lacrimal sac, UHF-therapy and systemic vitamin therapy is carried out. The abscess is opened during the appearance of fluctuation. Subsequently, drainage and wound treatment are performed using antiseptics (hydrogen peroxide solution, dioxidine, furacilin). Drip into the conjunctival sac antibacterial agents(gentamicin, chloramphenicol, miramistin, sulfacetamide, etc.), lay antimicrobial ointments (ofloxacin, tetracycline, erythromycin, etc.).

With dacryocystitis, systemic antibiotic treatment broad-spectrum drugs (penicillins, aminoglycosides, cephalosporins). In the "cold" period after the removal of the acute process, dacryocystorhinostomy is performed.

In newborns, treatment is carried out in stages and involves washing the lacrimal-nasal tract (for 1.5–2 weeks), massage(for 2.5–3 weeks), probing the nasolacrimal canals through the lacrimal openings (for 2.5–3 weeks), performing retrograde probing (for 2.5–3 weeks). If the treatment is ineffective, when the child reaches the age of two or three years, endonasal dacryocystorhinostomy is performed.

Operation dacryocystorhinostomy is the main way treatment of chronic dacryocystitis, this intervention involves the formation of an anastomosis between the lacrimal sac and the nasal cavity for effective drainage of the fluid. Also in surgical ophthalmology have widespread minimally invasive methods of treatment - laser and endoscopic dacryocystorhinostomy. AT certain cases the conductivity of the nasolacrimal ducts with dacryocystitis can be restored using balloon dacryocystoplasty or bougienage - the introduction of a probe with a balloon into the cavity of the duct, during which the internal canal lumen expands.

In order to prevent the development of a purulent corneal ulcer, patients are prohibited from performing any ophthalmic manipulations that are associated with touching the cornea (gonioscopy, ultrasound of the eye, tonometry, etc.), apply bandages to the eyes, and use contact lenses.

Prevention and prognosis

As a rule, the prognosis of treatment during uncomplicated dacryocystitis is quite favorable. The result of a corneal ulcer can become a thorn, which leads to both an external defect and a steady deterioration in vision. With perforation of the ulcer, the appearance of subatrophy and endophthalmitis of the eye begins.

Passage of dacryocystitis may be complicated by thrombophlebitis orbital arteries, phlegmon of the orbit, sepsis, inflammation of the brain tissue and meninges, thrombus of the cavernous sinus. In this case, there is a high probability of disability and lethal outcome for a person.

Prevention of dacryocystitis involves avoiding injuries to the facial skeleton and eyes, as well as timely and adequate treatment diseases of ENT organs. At timely treatment and the diagnosis of dacryocystitis, a full recovery is possible without serious complications.