Care after probing the lacrimal canal. Probing of the lacrimal canal in newborns

Childhood is a special time in everyone's life. During this period, all the anatomical structures of the body are actively developing: skin, bones, muscles, internal organs. Most of them are undergoing major changes, not only in growth. Many structures exist during fetal development. With some, a child is born. However, almost all of them are eliminated during the first few months of life. Otherwise, problems arise. Disorder of tear abduction into the nasal cavity is one of them. In this case, the doctor prescribes the probing of the nasolacrimal canal to the child.

Mechanism of abduction of tears into the nasal cavity

Lacrimal organs are an important component of the visual analyzer. The eyeball is protected from drying out by moisture, slightly different in composition from water. This fluid is produced by the lacrimal gland, hidden under the upper eyelid.

The tear, washing the eyeball, needs abduction pathways. In this regard, nature has come up with an extremely ingenious way out. The fluid flows along the lacrimal stream along the lower eyelid into the lake in the region of the inner corner of the eye. From here it travels to the lacrimal sac, then down the nasolacrimal duct. Nasal congestion that occurs when crying is a direct consequence of this anatomical feature.

The nasolacrimal duct is formed from the sixth week of embryonic life. It grows from the inner corner of the eye towards the nasal cavity. Sometimes the channel ends blindly. Thirty-five percent of newborns are born with a similar anatomical feature.

In most cases, an obstacle to the free outflow of fluid from the eyeball is a thin membrane - an echo of intrauterine life, located in the immediate vicinity of the opening of the nasolacrimal canal in the lower nasal passage.

Stagnation of tears leads to the multiplication of bacteria and inflammation of the tissues surrounding the lacrimal sac. In this case, redness and swelling of the paranasal region is noted. This situation is not at all harmless. The spread of infection can cause serious consequences:

Probing the nasolacrimal canal: the essence of the method

Probe is a medical term for a special tool for examining the patency of narrow closed body cavities.

Probing of the nasolacrimal canal is carried out to restore the patency of the outflow tract of tears and eliminate the membrane that closes the opening in the lower nasal passage. Its presence is indicated by a number of signs:

In these cases, a conservative technique can help - massage of the lacrimal sac. Under the pressure of the accumulated fluid, the membrane can be eliminated and the outflow will be restored. However, this measure may not be effective. In this case, the probing method is used.

With the help of an instrument inserted into the nasolacrimal canal, the doctor expands its lumen and restores patency. At the age of two months, the first attempts are made to probe through the lower nasal passage without anesthesia.

If there is no effect, such a procedure can be repeated twice more with an interval of five to seven days. If problems with tear drainage persist, upon reaching the age of six months, probing is carried out through the opening of the canal in the lower eyelid.

The main advantage of this method is the absence of the need for anesthesia and incisions. The main disadvantage is that even several such procedures may not have the desired effect. In this case, a radical intervention is used - dacryocystorhinostomy, which aims to create an outflow for the tear into the nasal cavity by surgery.

How to treat dacryocystitis - video

Indications and contraindications for probing

Probing is prescribed by a doctor in the following situations:

The main contraindication is an acute purulent process in the area of ​​the lacrimal sac (dacryocystitis). In this case, the procedure is carried out only after the symptoms subside on the background of antibiotic therapy. Probing is usually scheduled at the age of two to three months, but the doctor may perform the procedure earlier if the child's condition requires it.

Preparation for the procedure and execution methodology

On the eve of the procedure, an ophthalmological examination is mandatory. The doctor conducts an examination of the eyeball, retina. As anesthesia, an anesthetic drug is used in the eye. The procedure is carried out using a special probe inserted through the lower lacrimal opening. Then the nasolacrimal canal is washed with an antiseptic solution to prevent tissue infection.

The procedure ends with a test of the effectiveness of the intervention. To do this, a cotton turunda is inserted into the nose of the child, then a dye is instilled into the eye. After a short time, it should pass through the nasolacrimal canal. In this case, the paint will be found on the turunda, after which the probing ends. The intervention lasts about ten minutes on average.

Features of postoperative care

After probing, it is necessary to strictly follow the recommendations of the ophthalmologist. In most cases, antibacterial drugs are prescribed in the form of eye drops. On the recommendation of a doctor, a massage of the lacrimal sac area is performed. After the procedure, slight redness of the eye, nasal congestion may be observed for some time. Lachrymation may persist for up to two weeks. Bathing the child is allowed already on the day of the intervention.

Prognosis and complications

One procedure for probing the nasolacrimal canal may not solve the problem entirely. The doctor may subsequently prescribe the intervention again. If signs of obstruction persist, a surgical connection of the nasolacrimal canal and the nasal cavity is used.

After the procedure, the following consequences are possible:

In these situations, it is necessary to consult a doctor to find out the cause and prescribe adequate treatment.

Probing of the lacrimal duct in newborns is an ophthalmic operation that eliminates the gelatinous film that does not allow protruding tears to pass into the nasal cavity. Usually, the tear duct opens on its own with the baby's first breath and cry at birth. But 5% of children have a pathology.

The secretion of tears is necessary to provide moisture to the eyeball, protection from dirt on the cornea, which can significantly affect visual acuity.

With the development of a child in utero, the eyes are protected by a film stopper that protects the lacrimal canal from the ingress of amniotic fluid. If the film does not burst during birth, fluid begins to collect in the lacrimal sac, serving as a suitable environment for the development of all kinds of bacteria and fungi. Also, a deviated nasal septum with a congenital anomaly can block the lacrimal canal.

If the deficiency is noticed in the maternity hospital, the operation is prescribed at the age of 6 months. Early elimination of pathology provides a positive effect in 85 - 95% of cases. After a year, the film gradually hardens, which complicates the treatment. Older children are more likely to relapse, requiring repeated surgery.

A complete diagnosis is preliminarily carried out in order to exclude diseases with similar symptoms.

Signs of pathology of the lacrimal canaliculus:

• the presence of swelling in the corner of the eye from the side of the nose;
• lacrimation at a time when the baby is not crying;
• purulent or mucous discharge from one or both eyes;
• tears come out, but do not flow down the cheeks;
• eyelashes often stick together after sleep.

Sometimes the doctor confuses the symptoms with conjunctivitis, prescribing drops that do not bring relief. Then the child is sent for an examination to an eye doctor. Required diagnostics:

• consultation of an ophthalmologist, which confirms the blockage of the lacrimal canal in children;
• blood test for clotting rate;
• biomicroscopy of both or one eye;
• bacteriological culture of the contents of the lacrimal sac to determine the cause and response to medications prescribed by the ophthalmologist;
• West's test, which allows you to check the patency of the lacrimal tract. A liquid tinted with a special dye is instilled into one or both eyes of the baby, and a cotton ball is inserted into the nasal cavity. If the liquid passes freely into the nose and a spot of paint appears on the cotton wool, then the patency of the tubule is not impaired;
• if the studies undertaken are not enough, a consultation of other specialists is appointed.

If obstruction of the lacrimal passage is detected, the doctor recommends probing. Depending on the condition, the baby is prescribed a lacrimal sac massage. It is done by a doctor on an outpatient basis and parents at home.

What provokes the disease

The cause of the obstruction of the channel are:

• hereditary pathology transmitted at the gene level;
• getting injured;
• , blepharitis, tuberculosis;
• obstruction caused by syphilis;
• curvature of the nasal septum;
• atherosclerosis.

The causes of blockage of the lacrimal canal may have congenital or acquired origins.

If medical measures are not taken, then purulent discharge can infect the other eye, infect the ear, and flow into the brain. Postponing the operation for far-fetched reasons can cause a complication: loss or weakening of vision. If the obstruction of the channel for tears is caused by congenital causes, you can help the baby only after reaching the age of six.

How to prepare for the procedure

In order for the probing operation to be successful, it is necessary to properly prepare for it. In a few days, on the recommendation of a doctor, you should adjust the diet so that by the time of the procedure the baby has not eaten for at least 3-4 hours. Such abstinence is required for children under 6 years of age.

1. You should stop taking medications that are incompatible with anesthesia and drugs that will be used during surgery.
2. It is advisable to prepare the necessary linen and diapers to tightly swaddle the baby, preventing unintentional movements of the handles during the operation.
3. It is necessary to consult a pediatrician to exclude inflammatory colds that give similar symptoms.

How is the operation

The procedure is performed under full anesthesia, which usually does not cause complications in children under one year old. If the baby is naughty, one of the parents is allowed to stay with him until the anesthesia begins to take effect.

The procedure with no complications lasts 10-20 minutes. The doctor inserts a metal probe into the lacrimal canal, similar to a wire with a blunt tip. The tool removes the film and expands the passage for the discharge of tears. To check, a sterile saline solution is poured into the hole, which, without delay and obstacles, exits through the nasal cavity in full. When a small patient wakes up after anesthesia, in most cases he feels quite normal. Rarely, there is a slight pain at the probing site, which disappears within 1-2 days.

After a period of time determined by the attending physician, the child should be brought for a second examination, confirming the success of the operation.

If it turns out that the lacrimal canal does not function as expected, a second intervention is required, which is also performed under general anesthesia:

• silicone tubes are inserted into the tear ducts to expand the passage to a certain size. They are removed after 6 months under general anesthesia. Surgical intervention passes without complications in 80% of cases;
• a special rubber ball is used, which is inserted into the tear duct and gradually filled with saline. The channel is expanding. Then the liquid is pumped out and the rubber product is removed.

Eye care after surgery

To protect the eyes from infection after probing the tear ducts in infants, antibiotic drops are used almost immediately after the procedure. It is recommended to use antimicrobial treatment for 5 to 7 days.

Also be sure to do a massage of the lacrimal ducts and sac, as shown by the doctor.

It is necessary to prepare a solution of furacilin by putting the crushed tablet in 100 ml of boiled water. After wetting a cotton pad, you should wipe the baby's eyes from the outer edge to the inner. Use a new swab for each eye. With pressing movements of the fingers, walk at least 10 times along the lacrimal canal in the direction of the bridge of the nose. If a slight swelling appears, it's okay.

The baby may experience some phenomena.

1. The discharge of a small amount of blood from the nose is considered normal for 5 to 7 days.
2. Sneezing and congestion of the nasal passages is noted for 1-2 days.
3. Nausea and vomiting may occur within 1-2 days.
4. Lachrymation sometimes lasts up to 2 weeks.

It is allowed to swim without restriction, to rub your eyes with your fists.

If such symptoms persist for longer, it is recommended to consult a doctor - a second operation may be required.

Possible Complications

Although the intervention does not affect the surrounding organs, no incisions are made with the formation of scars, complete safety cannot be guaranteed.

You should immediately seek medical help if the consequences of the operation are observed:

• bleeding from the lacrimal canal;
• severe redness of the eyeball;
• discharge of cloudy or from under the eyelids;
• fever, fever;
• the child became lethargic, capricious.

How do children react to anesthesia?

• every tenth child has nausea, dizziness, headache for 2-3 days after surgery;
• 1% has a slight manifestation.

Summary

The success of the operation to free the lacrimal canal from the film that interferes with the free outflow of tears depends on the joint efforts of the doctor and parents. Do not try to solve the problem yourself. The longer the operation is delayed, the more unpleasant consequences can develop.

Does your baby's eyes fester and tears flow for no reason? The cause may be clogging of the tear ducts, which interferes with the proper outflow of fluid and leads to dangerous inflammatory processes in the body of the newborn. Based on the results of the examination, the doctor prescribes treatment, which often includes probing.

Indications for carrying out

During fetal development, the tear ducts of the child are covered with a thin film that serves to prevent the entry of amniotic fluid into the body. After birth, the need for it disappears, the film breaks, the lacrimal canal begins to work independently. However, sometimes this does not happen, resulting in an inflammatory disease: tears accumulate, suppuration begins, which is extremely dangerous.

If the drops do not help, then additional examinations are prescribed.

The first signs of obstruction of the lacrimal canal:

• swelling in the inner corner of the eye;
• discharge of mucus or pus from the eyes (often from one eye);
• lacrimation;
• tears flow when the baby does not cry;
• sticking of eyelashes after sleep.

These symptoms are easily confused with conjunctivitis, and a doctor may prescribe regular eye drops. When this treatment does not help, additional examinations are carried out. When diagnosing obstruction of the lacrimal canals, probing is prescribed, which will help to avoid complications.

Probing is prescribed at an early age, starting from three months.

Possible consequences

The best results are observed when probing the lacrimal canals in children under one year old. In 90% of cases, a second operation is not required, while at an older age, the likelihood of its implementation increases.

The procedure is considered practically safe: incisions are rarely made, vital organs are not affected. However, as with any surgical procedure, there is a risk of infection. If the child has a sharp rise in temperature and profuse discharge from the eyes and bleeding appear, immediately consult a doctor.

The risk of complications due to anesthesia is minimal, most babies tolerate it without any undesirable consequences. The only thing is that the child may become a little more irritable due to the influence of anesthesia and pain.

About 10% of children after anesthesia may experience headache, nausea, 1% may have a mild allergic reaction, and only one in twenty thousand general anesthesia leads to severe allergies.

How is it carried out in newborns

The scheme of probing the lacrimal canal

Food intake is stopped four hours before the operation. The doctor may conduct additional tests. For example, a test with a fluorescent dye, which will clearly show how the fluid moves through the tear ducts. Mandatory are a blood clotting test and an examination by an otolaryngologist, who must confirm that it is the blockage of the passages that is the cause of the disease.

The duration of the procedure is from ten to thirty minutes. After the onset of anesthesia, the surgeon inserts a thin metal wire with a blunt end into the tear duct (this reduces the risk of injury). Passing through the channel, the probe expands it, and a sterile saline solution is injected into the duct. If the operation is successful, this fluid is poured out through the nasal cavity. With the help of colored saline, the effectiveness of the operation is checked.

After a few hours, parents can take the child home. But if a serious infectious lesion was found, then the baby is left under the supervision of a doctor for several days until recovery.

Probing the lacrimal canal (video)

Reoperations

After the time appointed by the doctor, the child must be brought for examination. If the first operation did not give the desired result, a second one is prescribed, during which silicone tubes are inserted into the tear ducts. They are kept there for about six months to fully expand the channels and then removed.

There is another method that has been frequently used recently: an empty balloon is inserted into the duct and filled with saline already inside the duct. As it fills, it expands the lacrimal canal, then the ball is removed, having pumped out the liquid from it before that.

Procedures take no more than fifteen to twenty minutes. They are usually done under local anesthesia.

Care after the procedure

Immediately after the operation, drops with antibiotics are instilled into the eyes of the child. Their use is continued for five days.

During the week, there may be slight bleeding from the nose and nasal congestion. These are the usual consequences, which most often go away on their own. The discharge and tearing should also stop about 10-15 days after probing.

Bathing a child and rubbing his eyes is not prohibited.

Often the recovery process is quick and hassle-free. Within a few hours, many kids begin to actively play and lead a familiar lifestyle.

Alternative methods, or how to avoid probing

The doctor may prescribe a course of lacrimal canal massage. Parents are able to do it on their own at home. In parallel, anti-inflammatory drops are prescribed.

Massage 5-6 times a day

Remember, cleanliness is important, so wash your hands with soap and water before each massage.

For washing the eyes before the massage, a solution of furacilin is suitable. Use one tablet per 200 ml of water. In addition, you can use a decoction of chamomile. Rub the child's eyes from the outer edge to the inner.

The main task of the massage is to break through the clogged tear duct.

At the base of the nose, find the tubercle and start massaging from the farthest and highest point, moving towards the inner corner of the eye. Repeat about ten times. To enhance the result, massage should be repeated about five times a day. The result will not be quick, sometimes it takes several months to free the tear ducts.

Massage of the lacrimal canal in newborns (video)

Do not self-medicate, remember that postponing probing can lead to complications. After all, the older the baby, the harder it is to cure this disease. The operation itself is easy, complications are minimized. Your child will recover quickly if all the doctor's recommendations are followed.

From the first days of life, some children may have eye problems. Swelling of the inner corner of the eyelid, purulent discharge from the eye are symptoms that indicate an obstruction of the lacrimal canal. In this case, probing of the eye in newborns will be required. This is an absolutely safe procedure, but it is advisable to first familiarize yourself with the main points of its implementation.

At what symptoms it is worth deciding on probing?

In newborn babies, tears may appear on their own, without crying. If stagnation of tears is detected, parents should immediately consult a doctor. Other symptoms of tear duct dysfunction may include:

• constant souring of the child's eye;
• swelling of the skin in the corner of the eye from the inside;
• discharge of pus from the eye;
• the appearance of a seal near the eye from the side of the nose.

The symptoms listed above characterize a disease such as dacryocystitis of newborns. Occasionally, this disease is mistaken for conjunctivitis. Improper therapy of dacryocystitis can cause the accumulation of pus and lead to a deterioration in the child's well-being.

For a correct diagnosis of the disease, consultation with a competent ophthalmologist is necessary.

How is the preparation for the procedure of probing the eye?

To confirm the fact of obstruction of the lacrimal canal, the ophthalmologist must carefully examine the child's eyes and conduct certain studies:

• bacteriological culture of discharge from the eyes - to obtain information about infections in the lacrimal sacs;
• biomicroscopy - the study of the structure of the eye using a special lamp;
• West test - a colored liquid is instilled into the child’s eye, and a cotton tube is inserted into the nose (when a spot of paint appears on the cotton wool, the lacrimal duct is not disturbed);
• blood clotting test - to determine the ability of the baby's body to protect itself from blood loss.

After all the necessary studies, the ophthalmologist may prescribe a lacrimal sac massage. It is made by a doctor or the mother of a child teaches the technique. Massage in newborns should be done 5-6 times a day. If there is no effect from the massage within two weeks, the doctor performs a probing procedure.

Probing the lacrimal canal is an unpleasant procedure, but necessary

Probing (bougienage) is performed under local anesthesia for children under 6 months of age. At a later age, the effectiveness of such an operation is much lower.

The operation lasts 10-15 minutes and consists of several stages:

1. Drops (special anesthetic) are instilled into the eyes of a newborn.
2. The baby is swaddled so that he does not move his arms and legs and does not interfere with the procedure.
3. The nurse holds the baby's head, and the doctor inserts the thinnest probe into the lacrimal canal. The instrument pushes through the membrane membrane.
4. The tear ducts are washed with an antiseptic solution.
5. Check the effectiveness of the procedure with tinted saline.

During bougienage, the newborn may cry. This is not due to pain, but because the baby cannot move. The procedure is carried out in a hospital in an office with special equipment. Immediately after the operation, the child is returned to the mother.

To consolidate the positive effect of probing, the ophthalmologist prescribes medication and re-admission after 2 weeks

The procedure for probing the eye in newborns is simple and quite effective. The main thing is to consult a doctor in a timely manner and correctly follow the prescribed recommendations.

Dacryocystitis is an inflammation of the lacrimal sac of the eye. Occurs due to a narrowing of the tear-nasal duct or its blockage. Often occurs in newborns. Probing the lacrimal canal in children under one year old is an unpleasant, but necessary ophthalmic procedure.

In infants, the main reason for probing is the formation of a gelatinous plug in the lacrimal duct. When the baby is in the womb, it protects the canal from amniotic fluid. Normally, it ruptures during childbirth. If this does not happen, the tears stagnate. In this case, the child appears:

• pus;
• swelling of the inner corner of the eye;
• flow of tears when the newborn is calm;
• clumped eyelashes after sleep.

If you suspect a blockage of the canal, you should contact an ophthalmologist. Perhaps the cause of dacryocystitis was a congenital deviated nasal septum. Next, the doctor selects the appropriate treatment.

Probing indications:

• lacrimation;
• chronic inflammation of the lacrimal sac;
• anomalies in the development of the lacrimal duct;
• with the prescribed course of massage and drops, there is no positive dynamics.

Fact! Symptoms of the disease are similar to conjunctivitis, so they are often confused. In this case, therapy with anti-inflammatory drugs is not effective.

Probing is carried out in newborns under the age of 4-6 months, in the future it is ineffective.

The operation is performed in the period up to 4 months of the baby. The elimination of the film at this age gives a positive result in 90-95% of cases. If the cork is not removed in time, it hardens. This complicates the treatment. Probing of the lacrimal canal after a year is performed if a relapse of the disease has occurred.

Preparing for the operation

After confirming the diagnosis, the specialist conducts the following studies before ophthalmic intervention:

• a blood test to determine the rate of clotting;
• bacteriological culture of the contents of the lacrimal sac;
• eye biomicroscopy;
• West's test to check the patency of the lacrimal duct. A cotton turunda is inserted into the nasal cavity. A liquid with a dye is dripped into the desired eye. The patency of the canal is not impaired if a tinted spot appears on the cotton wool.

In order for the probing to pass without consequences, you should follow the recommendations of the doctor. For children up to a year they are as follows:

• Feed for a few days. The baby should not eat food 3-4 hours before the expected time of the operation, so as not to burp.
• Do not take medications that are incompatible with the drugs that will be used in the ophthalmic intervention.
• Prepare diapers or other underwear that restrict the movements of the hands of the newborn during the operation.

Probing in a child is usually performed on an outpatient basis. On the same day, parents will have the opportunity to go home. Recovery will be carried out at home under the supervision of a therapist and an ophthalmologist.

Probing in a child is usually performed on an outpatient basis.

Operation

Some medical facilities allow parents to be in the operating room. Probing of the lacrimal canal lasts about 10 minutes. It is often performed under local anesthesia. Alkaine 0.5% is instilled as anesthesia.

The operation consists of several stages:

1. A Sichel probe is inserted into the lacrimal canal to expand the space.
2. A thinner Bowman probe is inserted with rotational movements. When it is advanced, the integrity of the cork is broken, and the patency is restored.
3. The eyes are cleansed of pus and disinfected. If the operation is successful, the fluid will pour out through the nose.

After removing the film, the child is examined after a while. It happens that the lacrimal canal is still not able to function normally. In this case, a second operation is performed under general anesthesia. Instead of metal probes, silicone tubes and a tool that looks like a microscopic ball are inserted inside. There it is filled with saline. As a result, the plug breaks and the liquid is pumped out. The tubes remain inside for six months, after which they will be removed.

Fact! The effectiveness of probing is reduced if the cause of obstruction is the pathology of the structure of the ducts or the curvature of the nasal septum. Therefore, other surgical procedures are resorted to when the child reaches 6 years of age.

Alkain 0.5% is used as a site of anesthesia when probing the lacrimal canal.

Complications and recovery after probing

After probing the canals in children, you need to adhere to the prescribed therapy. Antibiotics are used in the form of drops, lacrimal duct massage. The eyes are wiped with cotton pads soaked in furacilin, from the outer edge to the inner.

Recovery in young children is quite fast. You can bathe in the bathroom almost immediately after the problem is fixed.

Basically, the probing of the canal is successful, but complications are sometimes possible:

• the first few days nasal congestion, nausea, vomiting;
• the appearance of blood from the nose for 7 days;
• lacrimation may continue for another 14 days.

If this condition does not improve, see a doctor. Reasons for immediate consultation are the following:

• tears do not come out naturally due to damage to the canal;
• severe redness of the eyes;
• elevated temperature;
• irritation of the mucous membrane of the eyelid and the formation of conjunctivitis;
• bleeding from the lacrimal canal;
• adhesions in case of non-compliance with the advice given by the doctor.

In some cases, the disease recurs. Then re-intervention is required. In children after a year, probing is done under general anesthesia.

Jul 11, 2017 Anastasia Tabalina