Stenosis of the lacrimal canal in newborns and adults: what to do, treatment. Lacrimal punctal stenosis. Causes. Symptoms Diagnostics. Treatment Stenosis of the lacrimal ducts its treatment

Blocked tear ducts occur for many reasons.

Congenital blockage: One fifth of all babies are born with a blocked tear duct. This may be caused by an underdeveloped or abnormal canal or problems with the development of the facial and cranial structure.

Age-related narrowing of the tear ducts: In adults, the opening of the tear duct may narrow, increasing the likelihood of a blocked tear duct.

Infections and inflammation: Infections and inflammation of the tear duct, eyes and nose can also cause blocked tear ducts. A blocked tear duct itself can lead to infection and inflammation.

Bruises and facial injuries: Any bruises affecting the tear ducts and bone structure near them can lead to blockage of the tear duct.

Tumors, cysts and stones: Blocked tear ducts can be caused by tumors and other growths.

As you can see, while a blocked tear duct causes a variety of symptoms, it can also indicate an underlying condition. Always consult your eye doctor for eye problems so that they can provide timely assistance.

According to statistics, dacryocystitis is detected in children in the first two months of life, because gelatin plugs located in the nasolacrimal ducts prevent amniotic fluid from entering the child’s body, since he spends all nine months of intrauterine development in water.

Normally, when a baby is born, the gelatin film should break with his first cry. This opens the nasolacrimal ducts and allows normal tear production. With dacryocystitis this does not happen: the eye is not washed with tears, which creates favorable conditions for the proliferation of microbes and the occurrence of eye pathologies.

Causes

The causes of dacryocystitis in most cases are based on obstruction of the nasal canals, blockage of one or both lacrimal canals.

Blocked tear ducts can occur for the following reasons:

• Congenital stenosis of the fetal lacrimal duct, an abnormality of the vessels or lacrimal ducts.
• Trauma to the maxillofacial area.
• Syphilis, rhinitis, and other pathologies that pose a serious danger to the nasolacrimal duct.
• Pathological process could develop against the background of tuberculosis of the lacrimal sac.
• Purulent inflammation of the eyelids, which causes the development of dacryocystitis.

In some cases, obstruction is provoked by various pathologies acquired during the intrauterine development of the fetus.

Dacryocystitis occurs in the presence of physiological pathologies, namely congenital narrowing of the duct (stenosis). Sometimes doctors detect a complete blockage of the tear duct.

The main causes of the disease:

1. Trauma to the eyes or paranasal sinuses.
2. Inflammatory process of the nose, which provokes swelling of the tissues around the eye.
3. An infectious process caused by bacteria and viruses, which leads to blockage of the duct.
4. Getting foreign particles into the eye or working in dusty and smoky rooms. As a result, the channel becomes clogged.
5. Allergy to exposure to an irritant.
6. Reduced protective properties of the body.
7. Overheating and hypothermia.
8. Presence of diabetes mellitus.

Often this pathology occurs in newborn babies. This is due to the structural features of the tear ducts. When the baby is in amniotic fluid, the tear duct is closed with a special membrane, which must rupture during or after childbirth. This process does not occur if pathology occurs.

Tears collect in the canal and this provokes an inflammatory process. It mainly develops in women. Men are also no exception, but this pathology is detected very rarely in them. The reason is differences in the structure of the lacrimal canal. Women use cosmetics, most of which cause inflammation.

Tears in the human body are produced by a special gland, and then enter the sac through special channels. After this, a stack is carried out in the nose area.

The tear sac is located in the inner corner of the eye. Newborns are characterized by a small length of this tubule - only eight millimeters. The hole itself is not yet fully developed, so various infections and harmful bacteria can enter the infants’ body through it.

In the mother's womb, this hole is closed with a special film, which is removed immediately after the newborn is born. With the first breath, a slight inflammation of the lacrimal sac begins. It is called dacryocystitis.

This disease also develops due to a narrowing of the tear duct, which may additionally be clogged with dead cells. The disease can often be diagnosed in newborns. Restoration of the channel must be restored in the first weeks of life, otherwise it will be possible to note the presence inflammatory process who must undergo appropriate treatment.

This disease can occur with physiological pathologies of the lacrimal glands - for example, if there is a congenital narrowing of the lacrimal ducts. Sometimes they are completely blocked.

Main causes of the disease:

• injury to the eyes or sinuses;
• inflammatory diseases of the nose, causing swelling of the tissues located in the eye area;
• bacterial and viral infections;
• hit foreign bodies in the eyes, long stay in very dusty rooms or working with chemicals harmful to the eyes;
• allergic reactions;
• decreased immunity;
• metabolic disorders;
• hypothermia or overheating of the body;
• diabetes.

Dacryocystitis is often diagnosed in newborns. This is due to the structural features of the tear ducts in infants in the first months after birth.

In adults, dacryocystitis also occurs, but much less frequently. Females are more susceptible to this disease than males. The reason here is the structural features of the tear ducts in women. One of the causes of the disease in women may be the abuse of cosmetics, many of which provoke the formation of inflammatory processes inside the tear duct.

Our tear fluid is secreted from the tear glands located above each eye. Tears flow down the surface of the eye, moisturizing and protecting it. The tear fluid then seeps into the thin openings in the corners of the eyelids. The “waste” tear fluid enters the nasal cavity through special channels, where it is reabsorbed or excreted.

Blockage of the lacrimal canal at any point in this complex system leads to disruption of the outflow of tear fluid. When this happens, the patient's eyes become watery and the risk of infection and inflammation increases.

Congenital obstruction. Some children drainage system may be underdeveloped. Often the tear duct becomes blocked with a thin mucus plug. This defect may disappear on its own in the first months of life, but may require a special procedure - bougienage (probing).

Abnormal development of the skull and face. The presence of abnormalities such as those found in Down syndrome increases the risk of tear duct obstruction.

Age-related changes. Older people may experience age-related changes associated with narrowing of the openings of the tear ducts.

Infections and inflammation of the eyes. Chronic inflammation eyes, nose and tear ducts leads to obstruction.

Facial injuries. When a facial injury occurs, the bones near the tear ducts can be damaged, which disrupts normal drainage.

Tumors of the nose, lacrimal sac, bones, when significantly enlarged, sometimes block the lacrimal canals.

Cysts and stones. Sometimes cysts and stones form within this complex drainage system, causing drainage problems.

External medications. In rare cases, the use of eye drops (for example, to treat glaucoma) can cause blockage of the tear ducts.

Internal medicines. Obstruction is one of the possible side effects the drug docetaxel (Taxoret), used to treat breast or lung cancer.

Risk factors

Age and gender. Older women are more likely to suffer from this disease as a result of age-related changes.

Chronic inflammation of the eyes. If your eyes are constantly irritated and inflamed (conjunctivitis), there is an increased risk.

Surgical operations in past. Surgeries on the eye, eyelid, or nasal sinuses can cause scarring in the drainage system of the eye.

Glaucoma. Glaucoma medications sometimes cause tear duct obstruction.

Cancer treatment in the past. If a person has had facial radiation or taken certain anticancer drugs, the risk increases.

Risk factors

The cause of a blocked tear duct may be:

1. Underdevelopment of the drainage system of the eye. In some babies, the tear ducts are sealed with a thin plug of mucus. This problem usually goes away on its own during the first months of life. Only in some cases, blockage of the tear duct in children may require medical intervention.
2. Disorders in the structure of the skull (often accompanied by mental disorders).
3. Physiological aging (with age, a person’s tear ducts become greatly narrowed).
4. The presence of a focus of infection and inflammation in the eye area.
5. Facial injuries. In case of severe injury, the bones in the area of ​​the lacrimal canal may be damaged, resulting in disruption of the outflow of tear fluid.
6. The presence of benign or malignant tumors in the eye or nose.
7. Long-term use of certain topical medications (for example, drops for the treatment of glaucoma) or systemic (for example, Docetaxel for breast and lung cancer).

In the area of ​​the lower eyelid, at the inner corner of the eye, there is a lacrimal punctum - a hole less than a millimeter in diameter. A tear flows down her. This mechanism is very interestingly thought out by nature: the pressure in the lacrimal sac is always negative, due to this, the eye fluid is sucked out. Through the lacrimal opening, the fluid passes into the lacrimal canal, and from there it can flow freely into the nose.

As a rule, inflammation of the canal caused by obstruction occurs either in infants or in old age. In newborns, the cause of obstruction is the fusion of the nasolacrimal canal. The fact is that a child, while still in the womb, forms a special membrane in this canal, which must break by the time of birth. Therefore, most often, pathological lacrimal duct occurs in premature babies.

damage,

infectious ophthalmological diseases and complications after such diseases.

The disease is very common in newborns. Often, inflammation is caused by the initial underdevelopment of the tear ducts or secondary infection. In any case, this problem is solved as the child grows.

Causes of inflammation in adults

In an adult, this disease most often occurs after an injury, or after an inflammatory disease in the nasal cavity, as a complication. But in most cases, the cause of inflammation is not established.

In older people, symptoms of the disease are caused by atherosclerosis of blood vessels, in particular those responsible for tears. Insidious cholesterol can be deposited even in the openings of the lacrimal ducts, which are already tiny. In this case, the lacrimal ducts are expanded by washing with various solutions under pressure, for example, furacilin.

Risk factors

Types of dacryocystitis

Chronic dacryocystitis in adults most often is not an independent disease, but a secondary one, that is, it develops against the background of another, underlying pathology. In order to understand what dacryocystitis is, it is necessary to have a clear understanding of the forms in which the ophthalmological disease can manifest itself.

Congenital dacryocystitis of the eye can be of several types:

• The stenosing type of disease develops against the background of tuberculosis, syphilis, trachoma and some other vascular diseases.
• Catarrh of the lacrimal ducts. This name is chronic catarrhal simple dacryocystitis.
• Cellulitis of the lacrimal sac. With this form of pathology, purulent discharge from the eye canals is observed, so you should definitely seek medical help.
• Empyema - obstruction of the lacrimal canal and blood vessels is accompanied by increased secretion of purulent contents.

Chronic canal obstruction is accompanied by increased lacrimation, swelling of the lacrimal sac, and discharge of pus. If the disease occurs in an acute stage, there is a risk of acquiring chronic dacryocystitis. The latter is most often accompanied by phlegmon of the lacrimal sac, increased production of purulent secretion from the canal.

There is also a type of disease known as dacryocystocele - congenital disease, which, unlike conjunctivitis, is cystic swelling in the area of ​​the tear ducts or nasal canal.

As a rule, acute dacryocystitis in adult patients is not an independent disease, but represents an exacerbation of a chronic process.

It is necessary to highlight the following clinical manifestations of chronic dacryocystitis: simple catarrhal and stenotic dacryocystitis, phlegmon and empyema of the lacrimal sac.

1) stenosing dacryocystitis;

2) simple catarrhal dacryocystitis;

3) phlegmon of the lacrimal sac;

4) empyema of the lacrimal sac.

IN normal conditions tear fluid, which is produced by special glands, constantly washes the surface of the eyeball, washing away dust, germs and foreign particles. Then it is retracted to the inner corner, where it is absorbed through the mouths of the lacrimal openings, openings leading into the lumen of the nasolacrimal canal.

At the onset of dacryocystitis, due to the fact that the nasolacrimal duct becomes impassable, the process of draining tears from the eye suffers. As a result, waste tear fluid collects inside the lacrimal sac, and as it fills (this is a cylindrical cavity that exists at the beginning of the nasolacrimal sac), tears accumulate in the corners of the eyes.

Based clinical symptoms, can be distinguished separately:

• Acute dacryocystitis, is typical of sharp, actively occurring symptoms, up to the formation of an abscess of the lacrimal sac or provocation of phlegmon of the tissues surrounding it;
• chronic dacryocystitis with periods of exacerbations against the background of aggressive infections and remissions, when the outflow of tears is almost unaffected.

As mentioned above, dacryocystitis in adults does not occur alone, but occurs as an accompaniment of another disease. The disease manifests itself in different ways and can be acute or chronic. Conventionally, several types of dacryocystitis can be distinguished.

Nasolacrimal duct obstruction is often a childhood disease.

Qatar of the lacrimal ducts - chronic illness which is common in newborns;

• Stenosing dacryocystitis - occurs as a consequence of tuberculosis, syphilis, trachoma and other diseases;
• Cellulitis of the lacrimal sac is a complication that occurs when an adult has a chronic form of dacryocystitis. Accompanied by purulent inflammation;
• Empyema of the lacrimal sac - as in the case of phlegmon, with this form the patient develops a large amount of pus.

Acute dacryocystitis very rarely occurs as independent disease, more often becomes a complication of any inflammatory process. Based on the nature of the inflammation, dacryocystitis is classified into:

1. spicy;
2. chronic;
3. congenital.

Based on clinical manifestations, four forms of pathology are distinguished. This:

1. stenosing dacryocystitis;
2. simple catarrhal dacryocystitis;
3. phlegmon of the lacrimal sac;
4. empyema of the lacrimal sac.

Cellulitis and empyema develop as a complication of improper or untimely treatment of a simple form of dacryocystitis.

Stages of development of dacryocystitis, classification

• inflammatory swelling of the canal against the background of the development of colds and acute respiratory viral infections, as well as pathologies associated with ENT organs. These include chronic rhinitis with pronounced swelling of the mucous membranes, sinusitis, plus also nasal polyps, proliferation of adenoids.
• traumatic effects on the ENT organs or eye damage. These include nasal bone fractures, injuries to the orbit and tissues of the eye, serious damage to the lacrimal openings or canaliculi themselves, injuries to the eyelid or inner corner of the eyes, accumulation of blood and ichor there.

As a result of all these influences, tear fluid stagnates in the lumen of the lacrimal sac and canal, which loses its antimicrobial properties and provokes the proliferation of various microbes in it. Usually this is an opportunistic group of pathogens, but the entry of pathogenic organisms into the eye can also lead to specific forms of dacryocystitis. Typical pathogens include coccal flora, viruses, chlamydial agents and allergens.

Gradually, the walls in the lacrimal sac are stretched, an acute or sluggish chronic process of inflammation occurs inside it, and pus can often accumulate, which flows out if you press on the wing of the nose. Usually the secretion of the sac turns from liquid and watery into mucous contents, and due to the introduction of bacteria, it becomes purulent.

Chronic or acquired sinusitis increases the chances of developing the disease. The disease occurs due to more serious reasons– the presence of tuberculosis, syphilis and a number of other ailments.

Inflammation of the mucous membrane of the tear duct leads to narrowing of the nasolacrimal duct. As a result, tears accumulate in the lacrimal sac.

Such conditions are most favorable for the development of harmful bacteria. There are gradually more bacteria, and this leads to the fact that the inflammatory process begins to be accompanied by purulent discharge.

In adults, dacryocystitis often develops with eye diseases, especially glaucoma. Also, the cause of blockage of the tear ducts can be the independent use of eye drops (without a doctor’s indication) or a side effect from taking anticancer drugs based on docetaxel. If a person receives a facial injury, blockage of the tear duct can be caused by displacement or deformation of the facial bones of the skull.

Despite the fact that blockage of the lacrimal gland in newborns disappears on its own during the first year of life, it is still recommended to take some measures. So, parents of the baby should carefully ensure that his eyes always remain clean. To prevent tear fluid from accumulating in the canal, the area of ​​blockage can be lightly massaged. When an infectious process develops, antibiotic therapy is used.

If the situation has not improved 6-12 months after birth, the child will undergo probing, which widens the tear ducts. Finally, the ducts are washed.

The main treatment for blocked tear ducts in adults is surgery. It can be performed using surgical instruments or a laser. The latter method is more modern, which is why doctors prefer it today. The advantage of the laser is that it “solders” blood vessels and thus reduces the risk of bleeding and infection of healthy tissue.

After the procedure, a soft silicone tube may be inserted into the canal to prevent re-narrowing.

In some cases, the doctor may fracture the bone deep in the nose. The shape and size of the organ will remain the same. In the most advanced cases, surgeons create a new artificial tear duct for the patient.

• swelling and redness;
• soreness in the area of ​​the inner corner of the eye;
• presence of discharge;
• unilateral lesion (usually).

In addition, pathology is divided into primary and secondary.

The diagnosis is made by obstruction of the nasolacrimal canal or blockage of the lacrimal openings.

Provoking factors are:

• Congenital anomalies, underdeveloped/narrowed tear duct;
• Injury;
• Runny nose, syphilitic lesion of the nose;
• Inflammation in the maxillary sinuses and nearby bones;
• Blepharitis;
• Tuberculosis and inflammation of the lacrimal gland and its sac;
• Atherosclerosis.

Diagnostics

The conclusion is made based on complaints and after examination. The following activities are prescribed:

• Vesta color test to determine the patency of the lacrimal ducts;
• Diagnostic probing to clarify the level of obstruction;
• Passive nasolacrimal test to confirm obstruction;
• Biomicroscopy of the eye;
• Fluorescein installation test;
• Contrast radiography with iodolipol solution;
• Bacteriological culture of the discharge to determine the causative agent of inflammation and its sensitivity to antibiotics;
• If necessary, consultation with other highly specialized specialists.

Tactics are chosen depending on the form of the disease (primary, secondary). For example, with congenital dacryocystitis, efforts are directed toward eliminating the embryonic film that did not break through at birth.

For this purpose, massage, rinsing, and probing are prescribed. And in the secondary form, complex surgical interventions are required to restore lacrimation. Medications, massage, washing are conservative methods of treatment, and bougienage, probing, operations are radical (surgical).

Medicines must be used simultaneously with surgical methods. They are prescribed before and after operations in order to eliminate infectious and inflammatory phenomena or prevent their occurrence in the postoperative period. In this case, a wide variety of anti-inflammatory drugs are used, ranging from paracetamol and antibiotics to synthetic hormones.

Acute course requires general and local use antibacterial drugs. Their choice depends on the sensitivity of the inflammatory agent. For local use, ointments or drops based on antibiotics are prescribed (eg Vigamox, Tobrex, Oftafix). Levomycetin and gentamicin are used.

Ciprofloxacin is contraindicated during the neonatal period. You should not use albucid, as it causes a burning sensation, crystallizes and thickens the embryonic film, which needs to be gotten rid of. When using several drugs simultaneously, the interval between their use should be at least a quarter of an hour.

Massage plays important role both in treatment and prevention. But the procedure cannot be performed in the presence of inflammation, because pus can get into the tissues surrounding the lacrimal sac and cause phlegmon. The doctor shows you how to do a massage correctly.

Before the procedure, wear sterile gloves or treat your hands with an antiseptic solution. then you need to squeeze out the discharge and clean your eyes with a solution of furatsilin. It is better to massage the tear duct before feeding.

In the first 2 weeks, the number of procedures per day can reach 10. Movements are performed with the index finger: press on the area of ​​the eye sac, moving from top to bottom, trying to break through the gelatin film with sharp but gentle pushes.

If everything is done correctly, pus is released, which is removed with cotton wool soaked in a decoction of herbs (chamomile, calendula, tea) or a solution of furatsilin. You can also use a pipette. Then remedy removed with boiled water. After the massage, use antibacterial drops prescribed by your doctor.

During this treatment, you must visit an ophthalmologist twice a week. After 14 days, he must evaluate the effectiveness of the therapy and, if necessary, change it. It is worth noting that massage as a treatment measure is effective only in children of the first year of life. It may be necessary to flush the tear ducts with a sterile saline solution containing an antibiotic. This procedure is performed by a doctor who first instills an anesthetic (0.25% dicaine solution) into the eyes.

Probing the tear duct

Doctors' opinions differ significantly regarding the advisability of this procedure in childhood. Some experts believe that it should be carried out no earlier than six months later if there are no results from the massage. Proponents of sounding recommend resorting to it 2 weeks after the start of conservative therapy if there is no effect.

The procedure is performed on an outpatient basis by an ophthalmologist for both adults and children. Local anesthesia is used first. Then a probe is inserted through the lacrimal opening. This device allows you to break through the film and expand the channel for high-quality outflow of tears.

The procedure is painless and takes only a few minutes. It is worth noting that smaller child, the better he tolerates such an event. In about a third of cases, probing has to be repeated several days later. In almost 90% of cases, it is possible to restore tear flow using this method. To exclude inflammation, antibiotic therapy (eye drops) is prescribed in the postoperative period.

Bougienage to widen the tear duct

This method is more gentle than a full-fledged operation. A bougie is inserted into the tubules - a special probe that removes obstacles and widens the duct. The bougie is administered as during the probing procedure. The event does not cause any discomfort and takes a few minutes.

As in the previous case, if after probing the tear duct there is still a tear, a repeat procedure may be required.

Surgical methods for treating inflammation

Surgical intervention is indicated in the absence of effect from medications, massage, probing and bougienage, as well as in some congenital anomalies development. Radical surgery is also used in cases of secondary dacryocystitis, in the presence of a chronic form of the disease and complications.

Inflammation of the lacrimal duct in newborns usually requires laser dacryocystorhinostomy. In older children and adults, an artificial passage is created through surgery that connects the nasal cavity and the eyes. IN exceptional cases in adults, the sac is also removed.

The procedure can be performed in two ways: externally and through the nose. The latter option is preferable, as it is less traumatic and does not leave scars. The patient is given a local anesthetic. The operation itself is performed in the “sitting” position.

Radical methods can also be used for newborns if conservative therapy is ineffective. As already mentioned, in order to prevent infection, antibacterial drugs are prescribed before and after surgery.

Personal hygiene rules play an important role. Without following them, you can negate all the results of treatment. You can reduce and eliminate the symptoms of the disease (swelling, redness, burning) using folk recipes. They are not the main method of treatment, but complement it well. Compresses with infusions of mint, chamomile, and dill are allowed; lotions made from Kalanchoe juice and tea bags.

Remember that inflammation of the tear duct cannot be self-treatment. It is necessary to consult an ophthalmologist. Children may be referred for additional examination to a pediatrician and otolaryngologist.

If any violations appear, immediate action must be taken, because the gelatin film (in the case of infants) turns into cellular tissue after 2-3 months, and it can only be eliminated by radical methods.

Treatment of the disease in children and adults

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

In this article we will look at the features of a disease such as dacryocystitis in adults and the treatment of this pathology.

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

viral and bacterial infections;

metabolic disease;

foreign bodies getting into the eyes;

working with chemicals that are harmful to the eyes;

long stay in a very dusty room;

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

In adults, dacryocystitis (pathology photos are available in medical reference books) is much less common, 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.

In the first stages, dacryocystitis does not manifest itself particularly clearly. Classic symptoms of this disease are a feeling of fullness and swelling in the area of ​​​​the projection of the lacrimal sac.

After a certain period of time, continuous lacrimation is added to them. mild pain and constant feeling discomfort, and when you press on the area of ​​the lacrimal sac, fluid or even pus is often released. In later stages, due to continuous lacrimation. the skin around the area becomes red and inflamed.

At the initial stages of the development of dacryocystitis, conservative treatment methods are used, such as regular massage of the lacrimal sac and washing of the lacrimal sac and nasolacrimal ducts using anti-inflammatory (Dexamethasone), antibacterial (Floxal. Levomycetin, Ciprofloxacin, etc.

If the disease is in an advanced stage, the only effective treatment for dacryocystitis in adults is surgery.

1) bougienage and lavage, which consists in restoring the flow through the nasolacrimal duct;

2) dacryocystorhinostomy, as a result of which a new connection is formed between the nasal cavity and the lacrimal sac.

If we talk about the symptoms of isolated dacryocystitis, then quite characteristic manifestations are typical. But the symptoms differ significantly due to the form of the pathology - be it acute or chronic.

The latter is characterized by constant lacrimation with parallel swelling, which is observed in the area of ​​​​the skin covering the lacrimal sac. Pressure on the tumor area causes mucous droplets or purulent globules to discharge from the openings (called lacrimal openings). A special element is the lacrimal caruncle (pink fold of mucous membrane), which is sharply swollen and reddened; in addition, the edges of the eyelid and semilunar folds also turn red along with it.

For acute dacryocystitis, a more active, sharp and violent clinical picture is typical. The symptoms are pronounced - the skin becomes very red, a very painful swelling forms above the surface of the dilated and inflamed lacrimal sac, the skin of the eyelids becomes swollen, the eyelids narrow or close completely, especially near the inner canthus.

Redness and swelling may extend to the area of ​​the bridge of the nose or eyelids, to the area under the eye and cheek. Externally, the inflammation may look like erysipelas, but there is no sharp boundary between healthy and damaged tissues. Patients complain of pain that is sharp and jerking in nature, localized near the eye. In addition, headache and fever with chills, signs of intoxication due to inflammation are typical.

After a few days, as the process develops, the previously dense infiltrate begins to soften, a feeling of fluctuation (fluid flow under the fingers) may appear, and the skin over the affected area acquires a yellowish tint. These are signs of education purulent abscess, which can open out, forming a fistula from which pus swells.

The opening of an abscess can also occur inside the nasal cavity, then tear fluid mixed with purulent contents will flow out of one half. When the pus spreads to the surrounding tissues, affecting the orbital tissue, phlegmon eventually develops. Often acute process, if it is not actively treated immediately, it is prone to relapses and transition to a protracted form.

If a diagnosis of acute dacryocystitis is established, hospitalization and treatment in a hospital are indicated. Before the infiltrate softens, vitamins and heat are applied to the area of ​​compaction, and UHF therapy. As the abscess “ripens”, it is opened and all pus is removed and the cavity of the sac is washed with antiseptic solutions (furacilin, dioxidin) or hydrogen peroxide.

Local use of drops with antibiotics is indicated, taking into account the sensitivity of pathogens - gentamicin, chloramphenicol, miramistin, sulfonamides. The use of antimicrobial ointments behind the eyelid is also indicated. In parallel with local treatment the use of antibiotics orally is indicated with the selection of drugs as much as possible wide range activity.

If there is a diagnosis of chronic dacryocystitis, one of the leading methods of therapy will be surgical correction - dacryo-cystorhinostomy with the creation of an artificial connection between the lacrimal openings and the nasal cavity itself, involving the lacrimal sac. This will allow for the outflow of tear fluid from the affected eye, as it should normally.

Today, ophthalmologists use minimally invasive methods of surgery with endoscopic or laser channel creation. Sometimes doctors try to restore patency by probing the canal or using balloons to inflate them in the area of ​​stenosis with air. This allows you to expand the area of ​​the narrowed channel.

For dacryocystitis, patients are prohibited from using it until complete recovery. contact lenses and carry out any procedures if there is contact with the cornea. This is the prevention of the development of corneal lesions with ulceration.

Diagnostics

When the nasolacrimal duct is blocked or narrowed, adults can develop a dangerous eye disease - dacryocystitis. Without proper diagnosis and quality treatment, this disease is fraught with irreversible consequences, which in advanced cases can even lead to the death of the patient. Therefore, in this article we will consider all aspects of this disease, symptoms and modern methods treatment.

To treat a blocked tear duct in an adult, the same conservative and surgical methods: probing or operation to expand the channel. If the pathology is advanced, sometimes it is necessary to perform plastic surgery of the lacrimal sac to remove the resulting tumor.

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

Signs

The main symptoms of a blocked tear duct include:

• pathologically large volume of tear fluid (while the eyes are constantly wet);
• inflammatory processes affecting various parts of the eye;
• formation of swelling in the inner corner of the eye (in some cases it can be painful);
• discharge of pus from the eye;
• admixture of blood in tear fluid;
• visual impairment (loss of clarity, blurriness).

Causes and symptoms of inflammation of the tear duct. Treatment methods for tear duct inflammation

The main symptoms of dacryocystitis most often appear in the later stages of the disease, at initial stage Determining the presence of pathology is quite difficult.

Obstruction of the lacrimal duct may be accompanied by such a distinguishing symptom as swelling that appears under the lacrimal sacs. The first thing you need to pay attention to is the presence of pain in the area of ​​the tear ducts.

You can take a simple test: you need to lightly press the swelling under the eye; the appearance of purulent fluid indicates the development of pathology. A doctor will help you make sure that your tear duct is inflamed by palpating the area under your eyes and noting the thickening of the skin and an increase in its elasticity.

The symptoms of the disease are quite varied, and only an ophthalmologist can answer with confidence what it is, dacryocystitis or another disease.

Many patients confuse various ophthalmological diseases, wondering whether conjunctivitis or dacryocystitis affects their organs of vision. How to distinguish inflammation of the lacrimal sac from conjunctivitis? It must be remembered that with dacryocystitis, redness of the eyelids, their swelling, soreness, and the appearance of purulent discharge when clicking on the channel area.

Tears are necessary for the normal functioning of the visual organs. They moisturize the cornea of ​​the eye, protect against mechanical irritants, and perform an antibacterial function.

Sometimes tears stop flowing, this is the first sign of tear duct obstruction. Treatment is one way to cope with the problem and prevent the development of canaliculitis. Sometimes massage of the tear duct helps.

Main symptoms:

• painful and discomfort in the eye area;
• redness of the skin around the eye;
• feeling of squeezing and bursting;
• swelling of the skin;
• lacrimation;
• edema;
• vision problems;
• increased secretion of mucus, which smells bad;
• formation of pus;
• high body temperature;
• intoxication of the body.

The acute stage of dacryocystitis appears as an inflammatory process affecting one eye. At chronic stage the tear duct swells, the eye turns red and the number of tears increases.

If the tear ducts are blocked, tears cannot pass through them. This situation is dangerous in strong winds, or concomitant diseases ARVI. Treatment of the disease in newborns must begin on time, otherwise it will lead to the formation of a protrusion, which may be purulent.

Newborns in this situation are characterized by the presence of a strong inflammatory process in the lacrimal sac. Treatment will eliminate soreness and redness. Correct therapy in a few days it will remove the swelling and prevent the disease from developing into chronic form. As suppuration increases, an increase in body temperature is observed. Cellulitis can open on its own at any time after maturation.

This disease has its own characteristics. Acute dacryocystitis develops with the following symptoms:

• the appearance of swelling in the area of ​​the lacrimal sac, which responds with pain when it is squeezed;
• swelling of the eye, in which the eyelids swell and the palpebral fissure narrows, preventing a person from seeing normally;
• pronounced redness in the area of ​​the tear duct;
• area around ocular orbit very painful - aching pain can be replaced by acute pain at the moment of touching the inflamed area;
• increased body temperature;
• intoxication of the body - weakness, fatigue, malaise.

IN initial stage disease, the swelling formed in the area of ​​the tear duct is very dense to the touch, over time it becomes soft. The redness from the sore eye subsides, and an abscess forms at the site of the swelling. The inflammation disappears with the abscess breaking through. Instead of an abscess, a fistula may form with constant release of the contents of the lacrimal canal.

Chronic dacryocystitis is manifested by the following symptoms:

• continuous lacrimation, sometimes with the presence of pus;
• discharge increases when the lacrimal sac is pressed or squeezed;
• upon external examination, you can notice an oblong swelling under the sore eye;
• eyelids swollen, edematous, overflowing with blood;
• As the infection spreads further, purulent ulcers may occur.

In the advanced form of dacryocystitis, the skin under the eye becomes sluggish, flabby, thin, and is easily stretched by fingers. The danger of chronic dacryocystitis is that it causes almost no pain. A person suffering from this form of the disease does not consult a doctor immediately, when the disease has already spread widely or has caused severe complications.

When the inflammatory process worsens, phlegmon of the lacrimal canal may form. Its main symptoms are severe swelling in the lacrimal sac area, swelling and redness in the lower eyelid area. As an inflammatory process occurs in the body, body temperature rises sharply. Tests can reveal an increased number of leukocytes and ESR.

Cellulitis is a very dangerous phenomenon with dacryocystitis. It doesn't always open up. If the phlegmon is opened internally, the purulent contents will penetrate the tear ducts, through them enter the orbit, and then can spread into the cranial cavity, causing infection of the brain.

These complications can arise only when the patient delays a visit to the doctor, or when the immune system is weakened. A timely visit to the doctor, diagnosis of the disease and the correct course of treatment help to successfully cope with this unpleasant disease.

Diagnostics

Before prescribing a course of treatment, the doctor examines the patient, studies the symptoms and medical history, and then sends the patient for examinations:

1. General analysis of urine and blood.
2. A smear that determines the presence of bacterial microflora.
3. Rhinoscopy. This examination will help identify pathologies in the structure of the nasal sinuses and structures, as well as the presence of diseases that lead to obstruction of the lacrimal canals.
4. Examination of the eye under a microscope.
5. A special solution (collargol) is instilled into the patient's eyes, and after a while a cotton swab is inserted into the sinus. If drops of collargol are not found on it, then there is an obstruction of the lacrimal canal.
6. X-ray with the introduction of a special dye into the eye ducts.

Dacryocystitis in children is diagnosed in the same way as in adults. Treatment is prescribed only after comprehensive survey patient. If even after all the diagnostic procedures The doctor doubts that the patient has dacryocystitis; he usually prescribes washing the ocular ducts with a solution of furatsilin.

Video - Obstruction of the lacrimal canal. The doctor will tell you Aznauryan I.E.

Obstruction of the tear duct can be observed either on one eye or on both sides.

Excess tear fluid (wet eyes).
Frequent inflammation of the eye (conjunctivitis).
Inflammation of the lacrimal sac (dacryocystitis).
Painful swelling in the inner corner of the eye.
Mucous or purulent discharge from the eye.
Blood in tear fluid.
Blurred vision.

Dacryocystitis – medical term, meaning when inflammatory processes affect the tubule located at the nasal septum and the inner corner of the eye. Symptoms of inflammation occur due to obstruction of the tear duct. As a result, microorganisms accumulate in it, leading to the occurrence of an inflammatory process. Let's consider what the treatment of the disease should be in children and adults.

In the area of ​​the inner corner of the eye, pain is felt, redness and swelling occur.

Discharge – also important signs diseases.

During diagnosis, the doctor examines the tear ducts, assesses the degree of development of the process and examines the patient to detect additional concomitant pathologies.

a swelling appears in the area of ​​the lacrimal sac, and if it is squeezed, pain occurs;

severe redness appears in the area of ​​the tear duct;

incessant tearing;

the eyelids swell, swell, and become filled with blood.

The following clinical manifestations occur with dacryocystitis:

• constant lacrimation;
• mucopurulent discharge from the eyes;
• hyperemia and swelling of the lacrimal caruncle, conjunctiva and semilunar fold;
• swelling of the lacrimal sac;
• sore eyes;
• narrowing palpebral fissure;
• increased body temperature;
• general intoxication of the body.

Dacryocystitis can have an acute or chronic form of the disease. Clinical manifestations of the forms of the disease vary.

At acute form Disease clinical symptoms manifest themselves most clearly. In the area of ​​the inflamed lacrimal sac, sharp redness of the skin and painful swelling occur. Due to swelling of the eyelid, the palpebral fissures become very narrow or completely closed. The patient may experience pain in the eye area, chills, fever, and headache.

Advanced stage of dacryocystitis

The chronic form of the disease is characterized by constant lacrimation and swelling in the area of ​​the lacrimal sac. When pressing on this area, mucopurulent exudate is released from the lacrimal canals. A swollen neoplasm forms in the area of ​​the lacrimal sac, visually resembling a bean. As it develops, it becomes densely elastic.

Inside the cavity of this neoplasm, pus accumulates, which, when pressed, is released out. With further development of the infection, phlegmon of the orbit or fistulas may occur.

Diagnostics

In order to identify the disease, the patient must be examined by an ophthalmologist. As a rule, dacryocystitis is quite easily diagnosed due to its characteristic clinical symptoms. During the examination, the doctor conducts an external examination and palpation of the area of ​​the lacrimal sac, performs the West lacrimal-nasal test, instillation fluorescein test, and radiography of the lacrimal ducts.

First of all, the ophthalmologist listens to the patient’s complaints and carries out an external examination of the lacrimal sac area. When palpating this area, purulent secretion should be released from the lacrimal canaliculi.

The most commonly performed test is the West nasolacrimal test. It is one of the most common diagnostic techniques. During this procedure, a solution of collargol or protargol is instilled into the conjunctival sac. These staining substances are used to determine the patency of the lacrimal canal. A cotton wool or turundum swab is inserted into the sinus. Traces of the coloring substance should appear on the tampon no later than after 5 minutes. Delay in the entry of the substance into nasal cavity or its absence indicates a violation of the patency of the nasolacrimal duct.

If it is necessary to identify microbial pathogens of dacryocystitis, bacteriological culture is performed.

To clarify the diagnosis, the patient must undergo an additional examination by an otolaryngologist. As a rule, an otolaryngologist performs rhinoscopy for dacryocystitis. The patient may also need to consult a dentist, traumatologist, neurologist or neurosurgeon.

Treatment

As a rule, if dacryocystitis is without complications, the prognosis for recovery is favorable. Treatment of dacryocystitis, first of all, depends on the form of the disease and the causes of its occurrence.

The treatment process for dacryocystitis is generally divided into two parts:

Diagnosis of the disease

Dacryocystitis of the eye requires careful diagnosis. It is mandatory to carry out a collarhead test, which makes it possible to determine where the source of inflammation is located and at what level the patency of the lacrimal canal is maintained, as well as to differentiate dacryocystitis from conjunctivitis.

In case of dacryocystitis, the following tests are required to identify the form of the disease and select the optimal treatment:

• Biomicroscopy of the eyes.
• Probing.
• X-ray of the organs of vision.
• Sowing of the secreted secretion.
• Nasolacrimal duct test.

Diagnosis is the key to a speedy recovery.

Treatment options for tear duct obstruction

Treatment of dacryocystitis in adults is most often carried out using two methods - medicinal and surgical. Drug treatment consists of instilling special antibacterial and anti-inflammatory drops into the eyes.

Dacryocystitis in adults can be treated at home, based on the recommendations given by your doctor. The main goal of treatment is to normalize the functioning of the lacrimal canal. In addition to eye drops, lotions with Ofloxacin, Levofloxacin, Tetracycline will help cure obstruction of the lacrimal canal, which allows you to defeat dacryocystitis faster.

Doctors say that those patients whose purulent fluid continues to come out for 2-3 weeks require surgery.

For a disease such as dacryocystitis, treatment is carried out by forming a completely new lacrimal canal, bougienage, probing or rinsing with certain medications.

At the active stage of the disease, vaccinations are prohibited. It is especially important to pay attention to the timing of vaccinations in young children and newborns. Any vaccine is an intervention in the body that can cause the most unexpected reaction. In case of inflammatory processes, in particular, with obstruction of the lacrimal canal, vaccination should be abandoned for a while.

Among the traditional medicines that are effective aids can be dill, chamomile, tea, mint compress, which must be combined with drug treatment.

We must not forget about massage, which helps to quickly defeat the disease. It is better to find out how to do it correctly from an ophthalmologist. However, we will still describe the principle of its implementation. 10 times you need to use your index fingers, pressing firmly or vibrating movements, to go down the line from the beginning of the eyebrows to the wings of the nose.

You need to move your fingers in the opposite direction 11 times. If pus comes out during the massage, then you did everything correctly, and purulent discharge should be removed with cotton pads soaked in a decoction of herbs or furatsilin. If you left clear liquid, it should also be removed. It is necessary to perform a massage until the eye is completely gone, that is, until complete recovery.

Dacryocystitis is detected without much difficulty. At the appointment, the doctor performs a visual assessment of the eye and palpation of the lacrimal sac.

Additional events:

1. Test using paint. The eye is instilled with a solution containing a dye. If pigment appears in the eye after a few minutes, this indicates a blockage of the tear ducts.
2. Probing. Using a probe with a needle, the ophthalmologist penetrates the duct, which helps to expand it and get rid of the problem.
3. Dacryocystography. Carrying out x-ray examination with the introduction of a dye. In the picture you can see the structure of the eye system and identify the problem.
4. Patency can also be checked with the West test. A cotton swab is placed in the nasal passage, on the affected side. Collargol is instilled into the eye. The condition is considered normal when after 2 minutes the tampon turns dark. If the swab remains clean or stained after 10 minutes, there is a problem.

Fluorescent dye test. The test is done to check how well the eye's drainage system is working. A drop of a special solution with a dye is dropped into the patient’s eyes. If after a few minutes of normal blinking a large amount of dye remains on the eye, then there is a problem in the outflow system.

Probing the lacrimal canal. The doctor may use a special thin instrument to probe the canal to check its patency. During the procedure, the canal expands, and if the problem existed before the procedure, it may simply be resolved.

Dacryocystography or dacryoscintigraphy. This test is designed to obtain images of the ocular outflow system. Before the examination, a contrast agent is instilled into the eye, after which an X-ray, computed tomography or magnetic resonance imaging is performed. The dye highlights the tear ducts in the pictures.

Although blockage of the tear ducts in adults and children is accompanied by pronounced clinical symptoms, an examination is still necessary. Otherwise, there is a risk of misdiagnosis.

The examination may include:

1. Fluorescent dye test. This procedure is necessary in order to find out how the drainage system of the eye works in a person. To do this, the patient instills 1 drop of dye into each eye, and after a few minutes evaluates appearance cornea. If the paint remains in large quantities, it means that there are problems with the outflow of tear fluid.
2. Probing the lacrimal canal. The essence of this method is that the doctor inserts a special thin instrument into the patient’s tear duct and thus checks the patency.
3. Dacryocystography. Thanks to this study, it is possible to obtain an image of the outflow system of the eye. During the procedure, a specialist instills a special contrast agent into the patient’s eyes, after which he performs a CT scan (can only be done to detect blockage of the tear duct in adults) or an MRI. Thus, the tear ducts become clearly visible in the photographs.

In order to identify the disease, the patient must be examined by an ophthalmologist. As a rule, dacryocystitis is quite easily diagnosed due to its characteristic clinical symptoms. During the examination, the doctor conducts an external examination and palpation of the area of ​​the lacrimal sac, performs the West lacrimal-nasal test, instillation fluorescein test, and radiography of the lacrimal ducts.

First of all, the ophthalmologist listens to the patient’s complaints and carries out an external examination of the lacrimal sac area. When palpating this area, purulent secretion should be released from the lacrimal canaliculi.

The most commonly performed test is the West nasolacrimal test. It is one of the most common diagnostic techniques. During this procedure, a solution of collargol or protargol is instilled into the conjunctival sac. These staining substances are used to determine the patency of the lacrimal canal.

The degree of patency of the entire lacrimal drainage system, as well as the level and localization of areas of obliteration, are determined using contrast radiography. During this diagnostic method a solution of iodolipol is used.

If it is necessary to identify microbial pathogens of dacryocystitis, bacteriological culture is performed.

To clarify the diagnosis, the patient must undergo an additional examination by an otolaryngologist. As a rule, an otolaryngologist performs rhinoscopy for dacryocystitis. The patient may also need to consult a dentist, traumatologist, neurologist or neurosurgeon.

In typical cases, dacryocystitis can be recognized by external signs, typical complaints of the patient himself, together with taking into account the examination data by a doctor with palpation of the corner of the eye and the projection of the canal with the lacrimal sac. The doctor is based on the detection of lacrimation and swelling of the corner of the eye, complaints of pain when palpating the affected area and the appearance of clear or cloudy discharge against the background of pressure from the lacrimal openings.

To assess the patency of the lacrimal canal if dacryocystitis is suspected, the doctor uses a specific test (Vesta or colored). A cotton swab is placed in the nasal passage on the side of the affected area, and in parallel with it, a protargol solution is dripped into the eye. After 2 minutes, the staining of the nasal swab is assessed.

When it is necessary to clarify the level and extent of damage to the canal, the doctor probes the canal. A passive test is also indicated, which confirms the violation of the patency of the canal. An attempt to rinse the bag with the channel does not lead to the outflow of the solution into the nose; it is discharged in streams from the lacrimal openings.

Additionally within ophthalmological examination To clarify the diagnosis, the following are used:

• Biomicroscopy of the eyes;
• Application of a fluorescent test with instillation of solutions;
• Use of contrast radiography of all tear ducts (dacryocystography). It uses a solution of iodolipol, which gives a clear picture of the structure of all outflow tracts, the area of ​​their narrowing or blockage.
• Cultures of the contents of the bag to isolate microbes, as well as tests for the sensitivity of bacteria to antibiotics.

For differential diagnosis or to clarify the variant of the pathology, identify combined health problems, the patient is examined by an ENT doctor; it is necessary to perform a rhinoscopy (examination of the nose). If necessary, a maxillofacial surgeon or a dentist, neurologist or traumatologist can also consult.

Dacryocystitis in adults: treatment

Eyes are the mirror of the soul. When an eye problem arises, there is no need to take risks. Treatment should be prescribed by a doctor after preliminary diagnosis. The treatment method is selected depending on the form and cause of the pathology that provoked it, and age characteristics.

Treatment methods:

1. Rinsing the eyes with antibacterial and disinfectant solutions.
2. The use of special drops and ointments.
3. Massage procedures and compresses to help clean the canal.

Eye rinsing with antiseptic solutions is carried out several times a day. The procedure is performed by an ophthalmologist in a hospital setting.

Ointments and drops that have an antibacterial effect:

• Phloxal. Antibacterial drug with a wide spectrum of effects. Fights the inflammatory process. The course of treatment is 10 days, two drops twice a day.
• Dexamethasone. Drops with an antibacterial effect. Effective when infectious processes. Instill 5 times a day. The required dosage and course of treatment are selected by the doctor individually for each patient.
• Levomycetin – hormonal drug. Used when allergic reactions and inflammation.
• Ciprofloxacin. Prescribed for infections of the lacrimal duct. Buried every three hours.

If the treatment does not have a positive effect, bougienage is performed - cleaning the lacrimal canal from purulent contents;

You can quickly cope with the disease only if treatment is started in a timely manner. If symptoms are negative, you should visit an ophthalmologist.

Treatment should not be carried out by parents without consulting a doctor. Tea, decoction, or antibacterial drops should be prescribed after visiting your pediatrician's office. Most often, they help relieve inflammation only for a short period of time. The main goal of treating the disease in newborns is to ensure sufficient patency of the canal and drainage of tears.

Treatment of the disease is simple, but requires careful implementation of all recommendations. At the first stage, newborns are given a massage of the lacrimal canal, which is located on inside eyes. To achieve a quick effect from the treatment, the procedure is performed at least four times a day. Doctors recommend choosing the period after feeding for this.

Movements should be jerky and directed from top to bottom. The pouch area is massaged five times on each side. In this case, all movements must be made with a certain pressing force. Massage actions are performed correctly if tears, mucus and pus gradually begin to leave the lacrimal sac.

When the massage is completed, it is necessary to rinse the cavity. For this purpose, you should use a chamomile decoction, which is prepared at home. Don't forget to refrigerate it until room temperature. Pediatricians also recommend using furatsilin solution, which can be purchased at a pharmacy.

It is instilled into the area of ​​conjunctivitis using a pipette. To remove residual liquid, use a cotton pad. Washing, which involves wiping with a cotton swab dipped in liquid, is also effective. In this case, discharge should be removed only from the eyelid, and not from the entire surface of the eye. Treatment should be carried out only using fresh solution.

The therapeutic approach to the treatment of dacryocystitis largely depends on the following factors:

• forms of the disease - acute or chronic;
• patient's age;
• reasons for the development of the disease.

Treatment of the disease in adults begins with active rinsing of the lacrimal canals with disinfectants. Next, the use of special drops or ointments is prescribed that prevent the spread of infection and have an antibacterial effect - Floxal, Ciprofloxacin, Dexamethasone, Levomycetin.

View surgical intervention DescriptionBugienationThis operation consists of cleaning the tear ducts using a special instrument. After this operation, the tear fluid is no longer blocked and the patency of the ducts is restored. This method is usually used if the patient experiences frequent relapses of the disease. Dacryocystomy. This procedure consists in the fact that an additional message is formed between the nasal mucosa and the lacrimal canal. Thanks to this operation, pus stops accumulating, and the outflow of tears is normalized

Treatment of newborns

Many parents try to cure their child of inflammation of the tear ducts on their own - they wash the child’s eyes with decoctions of various herbs, put on tea lotions, buy some drops of their choice, guided only by the opinion of the pharmacist and their intuition.

Some of these procedures can actually help positive effect, but only for a short time. After stopping these treatment methods, the child’s eyes begin to water again, sometimes with the release of pus. This is due to the fact that the cause of the disease is often physiological pathologies, expressed in obstruction of the tear ducts and these pathologies cannot be eliminated with drops and lotions alone.

That is why it is highly not recommended to take independent measures to treat the baby. When the first signs of illness appear, the child should definitely be shown to a specialist.

When dacryocystitis is detected in a child, the doctor usually prescribes special therapy, which consists of carrying out special massage procedures, using antibacterial eye drops and washing the eyes with disinfectant solutions.

Massage of the lacrimal canal is a very important part in the treatment of dacryocystitis.

Education correct technique The massage is performed by a doctor. Before starting the massage, the mother needs to wash her hands thoroughly with soap. It is recommended to massage with sterile gloves, but you can simply rinse your hands in a special antiseptic solution.

First, you need to carefully squeeze out the contents of the lacrimal sac, then remove the released pus using a tampon soaked in a furatsilin solution. Only after these procedures can you start massage. Perfect time for massage - before feeding.

The massage is carried out 4-5 times a day, and you need to make squeezing movements on the lacrimal sac. An approach that is too gentle will not bring much effect, but it is also not recommended to apply excessive pressure to the affected area. A similar procedure will help push the gelatin membrane inside the canal connecting the lacrimal sac with the sinuses. Massage is very effective for newborn babies. For adult children, such procedures will not give much results.

After the massage, you can treat the eyes with a swab soaked in a solution of chlorhexidine or furatsilin, and then drop the same solution into the child’s eyes so that the discharged substance is removed not only from the eyelid, but also from the surface of the eyeball. Ready-made solutions can only be used within 24 hours from the moment of preparation. Instead of these medicines You can use decoctions of herbs that have antibacterial effects: calendula, chamomile and others.

If a lot of pus accumulates in a child’s eyes, it is recommended to use antibacterial drops - Albucid, Floxal, Tobrex. They need to be buried three times a day.

Conservative treatment This disease only makes sense until the baby is two months old. If massage and drops do not help, probing of the lacrimal canal is prescribed. Under local anesthesia, a special probe is inserted into the child's lacrimal canal, which pierces the membrane that caused the development of dacryocystitis. After this, the lacrimal canals are washed with antiseptics.

The effectiveness of such a procedure is very high in the first months of a child’s life. The result is visible almost immediately - the baby’s constant tearfulness and watery eyes disappear. After surgery, antibacterial drops are prescribed.

ethnoscience

Dacryocystitis can be cured using traditional methods only if its occurrence is not caused by physiological pathologies.

A good effect can be had by dropping aloe juice into the eyes, diluted in half with water, or applying compresses with this juice to the eyes. Instead of aloe, you can use eyebright juice. It is prepared and used in the same way as aloe juice.

Thyme has anti-inflammatory properties, so it can be used for dacryocystitis. This plant is steamed, then allowed to brew for several hours, after which it is filtered. This decoction is used to wash sore eyes.

restoration of patency of the nasolacrimal canal;

anti-inflammatory therapy.

Surgery

• restoration of patency of the nasolacrimal canal;
• anti-inflammatory therapy.

Surgical therapy

In particularly advanced cases, there is no alternative to surgical intervention. Restoration of normal lacrimation is carried out using balloon dacryocystoplasty or endoscopic dacryocystorhinostomy.

Endoscopic dacryocystorhinostomy

The surgical intervention is based on the formation of a new connection between the nasal cavity and the lacrimal sac. The operation is performed using modern minimally invasive equipment. An endoscope is inserted into the blocked tear duct to provide a clear view. surgical field. Using the same endoscope, an incision is made in the blocked tear duct.

The rehabilitation period lasts 6–8 days. To avoid postoperative infectious complications, the patient is prescribed antibiotics (orally and locally in the form of eye drops).

The operation is contraindicated for patients who are allergic to anesthetic drugs.

Balloon dacryocytoplasty

A safe operation that can be performed even on children over 1 year of age. The essence of the procedure is that a device equipped with a microscopic balloon with liquid is inserted into the tear duct through the inner corner of the eye. At the site of blockage, the balloon, due to the pressure created, expands and opens the walls of the lacrimal canal.

Drug treatment

Used as antibacterial drugs eye drops Floxal, Ciprofloxacin, Levomycetin and others. Anti-inflammatory eye drops Dexamethasone and topical vasoconstrictors are also prescribed.

In acute cases of dacryocystitis, when rinsing does not give the desired effect, a decision is made to probe the canal and prescribe a course of antibiotics.

Bougienage is a procedure based on restoring the flow of fluid through the nasolacrimal duct using a special rigid probe (bougie). The method refers to gentle procedures, used in acute forms and frequent relapses chronic dacryocystitis.

To avoid infectious complications (purulent encephalitis, brain abscess), antibacterial treatment carried out in a hospital setting. Antibiotics (penicillins, cephalosporins, aminoglycosides) are prescribed intramuscularly or orally.

Massage

Massage is an important component of conservative treatment. The procedure must be carried out with clean hands in a certain sequence.

1. Squeeze out the purulent secretion from the lacrimal sac by lightly pressing your finger on the inner corner of the eyelids.
2. Drop a solution of furatsilin into the inner corner of the eye.
3. Carry out a massage - use your index finger to press the area of ​​the lacrimal sac with jerking movements 5-6 times.
4. Apply antiseptic eye drops prescribed by your doctor.

The procedure is carried out 4–5 times a day throughout the entire treatment course.

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After prior approval from a doctor, traditional medicine is successfully used at home.

Folk remedies:

1. Aloe. For inflammation, it is good to instill freshly prepared aloe juice, half diluted with saline solution.
2. Eyebright. Cook in the same way. Use for eye drops and compresses.
3. Chamomile has an antibacterial effect. You need to take 1 tbsp. l. collection, boil in a glass of boiling water and leave. Use to wash eyes.
4. Thyme. Due to its anti-inflammatory properties, the infusion is used for dacryocystitis.
5. Kalanchoe is a natural antiseptic. Cut off the leaves and keep in the refrigerator for two days. Next, extract the juice and dilute it in a 1:1 ratio with saline. This tool can be used to treat children. Adults can instill concentrated juice into the nose, 2 drops each. The person begins to sneeze, during which the tear duct is cleared of pus.
6. Leaves from a rose. Only those flowers that are grown on your own plot are suitable. You will need 100 gr. collection and a glass of boiling water. Boil for five hours. Use as lotions.
7. Burda ivy-shaped. Brew a tablespoon of herb in a glass of boiling water, simmer for 15 minutes. Use for rinsing and compresses.
8. Bell pepper. Drink a glass of sweet pepper fruit every day. adding a teaspoon of honey.

• Compresses based on tinctures of mint, chamomile or dill.
• Lotions using tea leaves. Sachets need to be briefly immersed in hot water, cool and apply to eyes. Cover with a warm towel.
• Drops or lotions from Kalanchoe juice.
• Cold compresses. Used for eyelid twitching. A regular cloth is moistened with cold water and applied to the eyelids. The duration of the procedure is 15 minutes, and it is recommended to perform it 3 times a day.

Carrying out massage procedures

Only a doctor can recommend effective ways elimination of dacryocystitis. One of these methods is tear duct massage, which brings truly guaranteed results. But it 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 lacrimal canals, leading to the formation of phlegmon.

The doctor teaches the parents how to perform this procedure. The massage begins with the contents being squeezed out of the lacrimal sac. A tampon is moistened in a solution of furatsilin and the released pus is removed with it. Massage of the tear duct is best done before feeding.

The squeezing movements should not be too soft, but not too strong. Due to this effect on the lacrimal sac, the gelatin membrane is pushed into the canal. Massage is effective only for newborn babies; it no longer brings adequate relief to older babies.

Treatment with folk remedies

Dacryocystitis is difficult to overcome immediately using traditional methods. Definitely, the emphasis is on massage. It needs to be done often and as efficiently as possible. It is important to ensure that the plug softens and comes out, and with it the suppuration. In folk medicine, aloe-based drops are recommended after a massage. Leaf juice perennial plant you need to squeeze out and dilute one to one. Apply this mixture to your eyes or make compresses in the evening and morning.

To avoid this, you should use Kalanchoe. The plant has long been familiar to us and even our grandmothers remember the effect of sneezing from drops based on it. Thanks to it, it is good to remove liquid or purulent snot and prevent blockage of the lacrimal canal. If you have inflammation of the eyes, you can experiment with urine therapy.

After soaking a cotton pad in urine, you need to wipe your eyes with it every two hours. After this, it is better not to touch them again so as not to spread the infection. This method, of course, seems a little strange, but in practice it works. Chamomile and calendula also help relieve swelling of the mucous membrane and redness. They are brewed in equal parts, and then the eyes are actively washed. You can alternate strong tea leaves with herbs.

Complications of the disease

Due to the fact that tears cannot flow where they are supposed to, the liquid stagnates, becoming fertile ground for fungi, bacteria and viruses. These microorganisms can cause persistent eye infections.

In infants, the main sign of obstruction of the tear ducts is suppuration (“sourness”) of one or both eyes. The doctor immediately prescribes antibiotic drops, the condition improves, but after stopping treatment, the infection reappears.

The greatest danger of dacryocystitis is the possibility of developing purulent and septic complications with skin lesions on the cheeks and eyelids, in the area of ​​the tissue of the orbit or dorsum of the nose. No less dangerous is the breakthrough of pus into the skull with the provocation of brain abscesses, encephalitis or meningitis (inflammatory process meninges).

In chronic dacryocystitis, secondary infection of the eye membranes or provocation of blepharitis, keratitis or conjunctivitis often occurs. Purulent ulcers may also form on the cornea, which leads to the formation of a cataract and deterioration of vision.

1. Development of swelling in the area of ​​the inflamed eye.

2. Pain when palpating tissues near the eye.

3. The appearance of severe swelling in the lacrimal sac area.

4. Severe narrowing of the palpebral fissure, which makes it difficult for a person to see.

5. Redness of the tear duct area.

6. Loss of ability to work.

7. Fatigue.

8. Dizziness.

9. Blue discoloration of fabrics.

10. Promotion blood pressure(in adults).

11. Tissue compaction near the eye.

12. Formation of an abscess at the site of swelling.

13. Loss of appetite.

14. Aching pain in the eye.

1. Constant tearing.

2. The appearance of purulent discharge in the area where the abscess has formed.

3. Swelling of the eyelids.

4. Pain when blinking.

5. Severe pain.

6. Headache.

7. Sleep disturbance.

8. Irritability.

9. Loss of elasticity of the skin under the eye (it can become thin, flaccid and stretch easily).

In newborns, this disease can be identified by the presence of small purulent discharge and swelling on the eyelids. If this condition is not treated, the child will have constant watery eyes.

1. Phlegmon is one of the most dangerous complications of this state. Phlegmon cannot always break out. Moreover, if pus breaks into the patient’s tissues, it will penetrate the lacrimal canals and may even seep into the skull. This will cause severe infection.

2. Due to the penetration of pus into the tissues, the patient may not only have an increase in temperature, but also memory deterioration and disruptions in the functioning of the nervous system.

3. A person may lose sight and consciousness.

Such complications can develop only in the absence of timely treatment and delay in going to the doctor. If you visit a doctor at the first signs of illness, then negative consequences can be avoided.

Dacryocystitis – enough serious illness, which, if untimely or improper treatment can lead to serious consequences. In this regard, chronic dacryocystitis is especially dangerous, which can cause infection of other eye membranes.

Gradually, the cornea is involved in pathological processes, a purulent ulcer is formed, and subsequently a cataract is formed, which not only becomes a cosmetic defect, but also significantly reduces visual function. In addition, a consequence of a corneal ulcer can be inflammation of the internal structures of the eye and the development of endophthalmitis.

Also, the lack of timely treatment can result in dangerous diseases leading to disability or even fatal outcome. This:

• orbital phlegmon;
• thrombophlebitis of the orbital veins;
• sepsis;
• inflammation of the meninges and internal structures of the brain.

Risk factors

As practice shows, blockage of the lacrimal duct is most often diagnosed in patients:

• elderly;
• have ever undergone eye surgery;
• with a history of eye diseases;
• patients with oncology.

Disease prevention

The exact causes of obstruction may vary, so there is no single method of prevention. To reduce the risk of infection, you should follow the rules of personal hygiene, do not rub your eyes with your hands, avoid contact with people with conjunctivitis, never share cosmetics with strangers, and handle contact lenses correctly.

If the process is not complicated by secondary pathologies, the prognosis is favorable, but against the background of a corneal ulcer, loss or decrease in visual acuity is possible.

The basis of prevention is visual hygiene, protection from eye and nose injuries, and timely treatment of colds.

Alena Paretskaya, pediatrician, medical columnist

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

Prevention for adults consists of timely treatment of inflammatory and acute respiratory diseases. Eyes should also be protected from dust, do not touch them with dirty hands, and maintain sterility when putting on/removing contact lenses. If plant safety regulations require the use of safety glasses, this should not be neglected. Any speck of dust can cause blockage of the tear ducts and provoke inflammation.

Timely diagnosis and treatment of infectious diseases of the eyes and ENT organs can prevent the development of inflammation of the lacrimal sac. Preventing foreign particles from entering the eye and maintaining good hygiene also reduces the risk of developing dacryocystitis. In general, the prognosis of this ophthalmological disease is favorable, but only with early diagnosis and complete passage course of treatment.

Forecast

If the blockage of the tear duct is treated on time, the prognosis will be quite favorable. Otherwise, a person may develop a cataract, endophthalmitis, eye subatrophy, thrombophlebitis of the eye veins, inflammation of the membrane of the brain and its tissues, as well as sepsis.

To prevent the development of blockage of the tear duct, you need to avoid injuries to the face and eyes, treat pathologies of the ENT organs in a timely manner and strengthen the immune system.

Lacrimal Duct Stenosis (Blocked Tear Duct; Nasolacrimal Duct Obstruction; Lacrimal Duct Obstruction; Dacryostenosis)

Description

Tear duct stenosis and insufficiency is a narrowing of the tear duct. This disorder can occur in children and adults. Below is information on tear duct stenosis in children (infants).

Lacrimal ducts are the common name for two narrow ducts originating from the superior and inferior lacrimal openings and connecting the lacrimal lake with the lacrimal sac.

Causes of tear duct stenosis

In some children, problems with normal development can cause blocked tear ducts. The exit of the canal into the nose may be covered by a thin membrane.

Risk factors for tear duct stenosis

Factors that increase the likelihood of tear duct stenosis in a child:

• Premature birth;
• Abnormal development of the face or skull.

Symptoms of tear duct stenosis

If a child has any of these symptoms, they may not be due to tear duct stenosis but may be caused by other disorders. Tell the doctor if your child has any of the following symptoms:

• lacrimation;
• Occasional redness or irritation of the eyes;
• Tear duct infections (inflammation of the tear sac), which causes redness, swelling around the eyes, and discharge of pus;
• Cloudy or mucus-like discharge from the tear duct;
• Crust on the eyelid;
• Blood in tears.

Diagnosis of lacrimal duct stenosis

The doctor will ask about your child's symptoms and medical history and perform a physical examination. You may need to see a doctor who specializes in eye conditions in children. An eye doctor can test to see if the dye has faded. This will help confirm the presence of a blocked tear duct.

Treatment of lacrimal duct stenosis

In infants, the disorder often resolves on its own within the first year of life. It can also be treated with massage or opening a blocked tear duct.

Treatment includes:

• Massage - The doctor may apply gentle pressure to the area where the tear duct exits the eye, between the baby's eye and nose. This helps the tears pass through the canal;
• Probing - The doctor may insert a tiny probe into the duct to open it. In some cases, the canals can be widened with a balloon or stent to keep them open;
• Surgery - In some cases, surgery may be necessary to open the canal. During surgery, the doctor inserts a tiny, flexible instrument into the tear duct to remove the cause of the blockage. The doctor may then remove the fluid. A laser may also be used to remove the blockage.

Prevention of lacrimal duct stenosis

Tear duct stenosis cannot be prevented. To reduce the chance of your child having eye infections, you need to keep your child's eyes clean and free of mucus.

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If a person is blockedtear ducts, then the normal outflow of tear fluid is disrupted, the eyes constantly water, and an infection develops.

About 20% of newborn babies have this condition, but the tear ducts usually clear by the end of the first year of life.

In adults, a blocked tear duct can occur as a result of infection, inflammation, injury, or tumor. This disease is almost always curable, but treatment depends on the age of the patient and the specific cause of the disease.

Causes of the disease

Our tear fluid is secreted from the tear glands located above each eye. Tears flow down the surface of the eye, moisturizing and protecting it. The tear fluid then seeps into the thin openings in the corners of the eyelids. The “waste” tear fluid enters the nasal cavity through special channels, where it is reabsorbed or excreted.
Blockage of the lacrimal canal at any point in this complex system leads to disruption of the outflow of tear fluid. When this happens, the patient's eyes become watery and the risk of infection and inflammation increases.

Causes of tear duct obstruction include:

Congenital obstruction. In some children, the drainage system may be underdeveloped. Often the tear duct becomes blocked with a thin mucus plug. This defect may disappear on its own in the first months of life, but may require a special procedure - bougienage (probing).

Abnormal development of the skull and face. The presence of abnormalities such as those found in Down syndrome increases the risk of tear duct obstruction.

Age-related changes. Older people may experience age-related changes associated with narrowing of the openings of the tear ducts.

Infections and inflammation of the eyes. Chronic inflammation of the eyes, nose and tear ducts leads to obstruction.

Facial injuries. When a facial injury occurs, the bones near the tear ducts can be damaged, which disrupts normal drainage.

Tumors of the nose, lacrimal sac, bones, when significantly enlarged, sometimes block the lacrimal canals.

Cysts and stones. Sometimes cysts and stones form within this complex drainage system, causing drainage problems.

External medications. In rare cases, the use of eye drops (for example, to treat glaucoma) can cause blockage of the tear ducts.

Internal medicines. Obstruction is one of the possible side effects of the drug docetaxel (Taxoret), used to treat breast or lung cancer.

Risk factors

Among known factors risk of tear duct obstruction:

Age and gender. Older women are more likely to suffer from this disease as a result of age-related changes.

Chronic inflammation of the eyes. If your eyes are constantly irritated and inflamed (conjunctivitis), there is an increased risk.

Surgeries are a thing of the past. Surgeries on the eye, eyelid, or nasal sinuses can cause scarring in the drainage system of the eye.

Glaucoma. Glaucoma medications sometimes cause tear duct obstruction.

Cancer treatment in the past. If a person has had facial radiation or taken certain anticancer drugs, the risk increases.

Symptoms of tear duct obstruction

Obstruction of the tear duct can be observed either on one eye or on both sides.

Signs of this disease may be due to direct blockage of the canals or an infection that develops as a result of the blockage:

Excess tear fluid (wet eyes).
Frequent inflammation of the eye (conjunctivitis).
Inflammation of the lacrimal sac (dacryocystitis).
Painful swelling in the inner corner of the eye.
Mucous or purulent discharge from the eye.
Blood in tear fluid.
Blurred vision.

Diagnosis of the disease

Diagnostic tests to determine tear duct obstruction include:

Fluorescent dye test. The test is done to check how well the eye's drainage system is working. A drop of a special solution with a dye is dropped into the patient’s eyes. If after a few minutes of normal blinking a large amount of dye remains on the eye, then there is a problem in the outflow system.

Probing the lacrimal canal. The doctor may use a special thin instrument to probe the canal to check its patency. During the procedure, the canal expands, and if the problem existed before the procedure, it may simply be resolved.

Dacryocystography or dacryoscintigraphy. This test is designed to obtain images of the ocular outflow system. Before the examination, a contrast agent is instilled into the eye, after which an X-ray, computed tomography or magnetic resonance imaging is performed. The dye highlights the tear ducts in the pictures.

Treatment of tear duct obstruction

Treatment depends on the specific cause of the blockage or narrowing of the canals. Sometimes multiple treatments are needed to correct the problem.

If an infection is suspected, your doctor will likely prescribe antibiotics.

If the tumor has caused the obstruction, treatment will focus on controlling the tumor. To do this, the tumor is usually removed surgically.

Conservative treatment

In a large percentage of infants, congenital tear duct obstruction resolves on its own in the first months of the child's life. If this does not happen, the doctor will first recommend giving the child a special massage, and will prescribe drops containing antibiotics to fight the infection.

Minimally invasive treatment

Minimally invasive methods are used to treat congenital tear duct blockages in young children when other methods have failed. The most common method is bougienage, in which a special tube is inserted into the lacrimal canal, restoring its patency. The procedure does not require anesthesia and takes only a few minutes. After bougienage, your doctor will prescribe antibiotic eye drops to prevent infection.

Surgery

Surgery is usually prescribed for adults and older children with acquired tear duct obstruction. They are also prescribed for congenital obstruction if all other methods have been ineffective.

Surgeries are necessary to reconstruct damaged or underdeveloped tear ducts. One of the operations, dacryocystorhinostomy, involves creating a new passage between the nasal cavity and the lacrimal sac. Such operations are quite complex and are carried out under general anesthesia.

After surgery, patients will need to take medications for some time. The doctor may prescribe a nasal spray to relieve swelling of the mucous membrane, as well as eye drops to prevent infection and reduce post-operative inflammation.

Complications of the disease

Due to the fact that tears cannot flow where they are supposed to, the liquid stagnates, becoming fertile ground for fungi, bacteria and viruses. These microorganisms can cause persistent eye infections.

In infants, the main sign of obstruction of the tear ducts is suppuration (“sourness”) of one or both eyes. The doctor immediately prescribes antibiotic drops, the condition improves, but after stopping treatment, the infection reappears.

Disease prevention

The exact causes of obstruction may vary, so there is no single method of prevention. To reduce the risk of infection, you should follow the rules of personal hygiene, do not rub your eyes with your hands, avoid contact with people with conjunctivitis, never share cosmetics with strangers, and handle contact lenses correctly.

Stenosis of the nasolacrimal duct (dacryostenosis) is a pathological process that leads to disruption of the movement of fluid through the nasal passage. Many factors contribute to the occurrence of lacrimal duct stenosis. The pathological process is triggered by viral and bacterial lesions of the nasal mucosa and conjunctiva of the eye. Lack of treatment leads to an increased risk of developing tear duct obstruction.

The pathology can be congenital, which is detected in 6% of infants, and acquired, which is mainly diagnosed in older people (most often in women).

Congenital dacryostenosis in newborns appears as a result of the formation of a common network of vessels of the lacrimal canal and nose, structural features of the lacrimal ducts, and the appearance of diverticula.

The acquired form develops under the influence of the following factors:

• inflammatory pathologies, benign and malignant neoplasms in the area of ​​the lacrimal drainage system;
• severe injuries to the nose and eyes;
• constant instillation of eye drops;
• radiation therapy;
• sinus surgery.

A rare form is idiopathic lacrimal duct stenosis, in which the disease develops for an unknown reason.

Symptoms

The disease manifests itself with quite specific symptoms, so it is not difficult for an experienced doctor to make an accurate diagnosis.

In general, patients or their relatives may notice the following symptoms characteristic of nasolacrimal duct stenosis:

• constant excessive tearing for no apparent reason;
• blurred vision;
• photophobia;
• the appearance of a tumor in the area of ​​the corner of the eye, where the lacrimal sac is located, when pressed, purulent exudate is released from the lacrimal openings;
• over the affected eye, the eyelids are slightly drooping and the skin is red and hot;
• redness of the ocular conjunctiva due to the inflammatory process, which was caused by narrowing of the lacrimal canal and impaired fluid outflow;

The swelling in the corner of the eye grows over time, the skin over it becomes thinner and spontaneously opens, and a fistula appears in this place. This situation is quite dangerous for the patient’s life. Opening the tumor is accompanied by the release of pus, which spreads through the bloodstream throughout the body. And since the pathology develops near the brain, this can lead to serious consequences and even death. To prevent such developments, it is necessary to consult a doctor when the first signs appear.

Diagnostics

The initial examination in adults is carried out by a therapist (you can consult an ophthalmologist yourself). If a child is sick, parents should contact a pediatrician.

Diagnostic measures begin with a medical history, during which the doctor asks about disturbing symptoms. Then carry out:

• physical examination;
• tonometry;
• biomicroscopy;
• assessment of total tear production (Shimmer test);
• Ultrasound, MRI, CT scan of the sinuses;
• examination of the channel contents to identify bacteria.

A collarhead test or Vesta test is mandatory. A dye is dropped into the eye. A cotton swab is inserted into the nose and wait 10 minutes. If during this time the cotton wool becomes colored, this means that the test is positive and the nasolacrimal ducts are passable. If the turunda remains clean, then we are talking about a violation of the patency of the canals.

Treatment methods

Some people try to eliminate dacryostenosis on their own, which is not recommended at all. The therapeutic method should be chosen by the doctor based on the degree of narrowing of the ducts. To treat stenosis of the lacrimal canal, it is washed with solutions of glucocorticoids, antibiotics, and proteolytic enzymes.

Obstruction is usually eliminated with the help of drops and ointments. They must be prescribed only by a doctor who will determine the dosage. Vigamox, Tobrex, Oftaquix, Levomycetin, Gentamicin and Dexamethasone ointments are usually prescribed. To wash the eyes, antiseptic solutions of Furacilin and Chlorhexidine are prescribed.

In more complex cases, the following procedures are prescribed:

1. Intubation. To do this, a tube made of polymer materials is inserted into the duct, through which excess liquid is drained. After 6 months it is removed.
2. Balloon angioplasty. A tube is inserted into the narrow lacrimal canal, at the end of which a balloon is attached. It is carefully inflated, gradually expanding the walls of the ducts.

Massage

In childhood, narrowing of the lacrimal canal is eliminated with the help of massage, as a result of which the embryonic membrane ruptures and the patency of the lacrimal ducts is restored. The procedure boils down to 7-10 jerking movements of the inner corner of the eye.

Before performing a massage, you must wear sterile medical gloves. Wipe the child's eye with a cotton swab dipped in chamomile infusion from the temple to the nose. Carefully feel a small bump in the inner corner of the eye with your finger and begin to massage it. In this case, pus should be released, which should be removed by washing with antiseptics.

After completing the eye massage, Levomycetin drops or Vitabact are instilled. Massage should be performed 5-6 times a day. If after 3 months of regular procedures the problem has not been resolved, the doctor will suggest an operation to probe the nasolacrimal duct. A probe is inserted into it, with the help of which the embryonic film is broken through. In particular difficult cases dacryocystorhinostomy is required.

Complications and prognosis

In most cases, the prognosis for lacrimal duct stenosis is positive, but only if the visit to the doctor was timely and treatment began immediately. If therapy is delayed, complications may develop. Any narrowing of the lacrimal canal leads to disruption of lacrimal drainage, natural circulation of fluid, dry eyes, inflammation of the edges of the eyelids, and the formation of a fistula in the lacrimal sac.

Prevention

The congenital form of dacryostenosis cannot be prevented. The embryonal film is formed in each fetus during intrauterine development. And if it does not burst at the first cry of the child, you will need to eliminate it yourself or with the help of doctors. Acquired lacrimal canal stenosis can be prevented using basic hygiene rules. You should not touch your eyes with dirty hands, you should use contact lenses correctly and visit an ophthalmologist regularly.

These methods will prevent the development of dacryostenosis and will significantly increase the effectiveness of therapy when pathology is detected.

Stenosis of the lacrimal canal is a diagnosis that is quite common in newborns. Otherwise, this condition is called “standing tear,” since due to obstruction of the canal, the natural outflow of tear fluid does not occur. In our case, the problem turned out to be hereditary - almost 30 years ago, my parents also faced a similar diagnosis, made to me at the age of three months. Therefore, when my daughter’s eyes began to water, I had no reason to panic, because the most likely reason was already known.

I noticed that the baby’s left eye began to leak while still in the maternity hospital on about the 3rd day. The neonatologist decided that the reason was that skin particles had gotten there. Just at this time, my daughter’s dry skin began to peel off, the top layer of which should have completely come off, so the theory could very well turn out to be correct. We were advised to wash our eyes with boiled water more often and after a couple of days we were sent home.

But regular rinses had no effect, and when the doctor came to us after discharge, both eyes began to water and even fester. We were prescribed drops and a decoction of chamomile or a weak solution of furatsilin to clean the eyes, since they were supposedly infected in the maternity hospital. A week later, despite following all the recommendations, things did not get better, rather, quite the opposite, and by the time the doctor visited us again, the eyes were already quite festered.

As a result, Lisa was prescribed two more types of eye drops, one of which was an antibiotic. The situation improved a little, but my eyes continued to water. The suspicion that infection is not a cause, but a consequence, became increasingly substantiated.

Drops and massage

We saw an ophthalmologist only a month later, after a visit to a neonatologist. The doctor finally made a diagnosis and prescribed 2 more types of drops and massage of the tear duct. A follow-up visit was scheduled after 4 weeks.

My daughter’s drops didn’t work; they only made her eyes even more inflamed and festered. The only thing that really worked was washing with chamomile decoction, which, contrary to fears, did not cause dryness or irritation.

They didn’t really show me exactly how to do the massage, since the ophthalmologist refused to touch the child, and, as it later turned out, I understood her verbal explanations in my own way. Moreover, to achieve positive result the procedure needs to be repeated 6 times a day, which they also forgot to tell me about.

In the end, of course, nothing changed significantly in a month. We cured the infection, but the eyes continued to water, which means that new inflammation was only a matter of time. The second time we were lucky to get to another specialist who approached the consultation much more responsibly. My daughter was prescribed more drops, and I finally received detailed instructions on how to do a massage. The next visit was due at 3 months of age.

I honestly tried to instill, rinse and massage with the regularity that was prescribed. But the problem was that the older Lisa became, the more negatively she perceived all these manipulations. At some point, I realized that I simply couldn’t cope with it alone. My daughter turned her head, grabbed my hands, and squirmed. She was not in pain, she just took any attempts to wash her eyes, give her a massage, clean her nose or ears with hostility, and began to scream and struggle. Now all this had to be done with 4 hands, and, as a result, there was simply no talk of any 6 times a day.

Visits to the ophthalmologist and new appointments

When Lisa was 3 months old, it got cold outside, and her eyes were seriously infected, so she had to wash them thoroughly in the morning, otherwise it would be difficult for the baby to open her eyelashes. During a scheduled visit to the ophthalmologist, the doctor gave us a referral for a consultation at the children's hospital and prescribed more drops.

In general, during the 5 months during which I was treating my daughter’s eyes, we managed to drip Ophthalmoferon, Levomecitin, Tobrex, Okamestin and half a dozen other drugs, but the only thing that really helped was Tobriss drops made in India.

It turned out to be quite difficult to find them in pharmacies; they offered Tobrex everywhere, since they contain the same thing active substance. However, Tobrex only made the situation worse, and Tobriss dealt with the problem in less than 3 days. Moreover, during the course of treatment (or perhaps due to the abundance of purulent discharge), the tear duct in the right eye finally cleared.

It was possible to make an appointment with an ophthalmologist at the children's hospital only at the end of next month. All this time, I continued to regularly wash my eyes and massage whenever possible, but my left eye continued to water - the obstruction of the canal was still obvious.

My visit to the hospital was a bit perplexing, and it's not about the waiting in line or the poor attitude of the staff; in that regard, everything was relatively good. We were seen by an ophthalmologist who was clearly younger than me, looked at everything carefully, felt it, saw stenosis of the canals in both eyes (although in fact at that moment it was only the left one) and made prescriptions.

Do a massage, drip another new drops (I was surprised by the very fact that there is something that we haven’t dropped yet) and come for a follow-up appointment in a week. Of course, the receptionist looked at me with indifferent fatigue and said that there was no appointment with an ophthalmologist until the end of December.

To be fair, when I told the doctor this information and asked what to do, she did not send us to make an appointment for a fee, but went to the manager to find out what to do. While we were waiting for an answer, we also managed to visit an ENT specialist, whose consultation was necessary to continue monitoring with an ophthalmologist. As a result, I was informed that a new doctor would start working in early December, and appointments with him would begin in a week.

As a result, after about 10 days we went for a follow-up appointment. The fox was carefully examined (this time they saw stenosis of only one of the canals), previous treatment attempts were discussed and surgery was suggested. I agreed.

Editorial opinion

Elena Kalita

Magazine editor

If the actions of parents towards a sick child serve the purpose of his recovery, then they are correct.

Canal probing operation – is it worth worrying about?

Probing of the lacrimal canal is usually carried out at the age of three months to a year (Lisa was already 5.5 months old). During the operation, performed under local anesthesia, a probe is inserted into the lacrimal duct, which pierces the film covering it, after which the canal is washed generously with a disinfectant solution. The duration of the operation is only 5-10 minutes.

I don’t think that surgery is always the best way out of a situation, and I’m even glad that in our country doctors have finally begun to believe that the best surgery is the one that was avoided. But in this case, I weighed all the pros and cons and decided in favor of probing. My opinion was largely influenced by the fact that I myself underwent a similar intervention as a child, which was relatively painless for me and without any consequences.

How older child, the more stress he experiences from carrying out such manipulations, so I was not ready to wait a few more months, subjecting my daughter to daily execution in the form of a massage (remember, 6 times a day!) and the risk of a new infection, and therefore taking antibiotics.

Even though surgery is always a risk. In this case, as a result of medical errors, bleeding, inflammation or scarring may have occurred, as well as the need for repeated probing.

For the niece of one of my good friends, the parents were able to clean the channel themselves. This took 7 months of active work.

Before probing, we had to take 2 blood tests, get a certificate from a pediatrician (or neonatologist) and a referral from an ophthalmologist from the children's clinic. This is unless you count a whole pile of photocopies of all kinds of documents. On the day of the operation, we had to arrive at the hospital in the city center by 9 am, so we took a taxi and, fearing traffic jams, ended up arriving much earlier. The doctor was another 20 minutes late. The procedure itself really took no more than 5 minutes.. The fox was taken from me, taken to the office and almost immediately returned, bawling, but absolutely unharmed. They prescribed regular drops and copious rinsing of the nose 3 times a day to avoid re-clogging the canal due to swelling.