How to treat dacryocystitis in a child of 4 months. Anatomical features of the lacrimal ducts

Dacryocystitis - inflammation of the lacrimal sac - occurs mainly in childhood. It makes up, on average, 10% of all eye diseases. Such a high prevalence is due to the peculiarities of the embryonic development of the lacrimal ducts and some other reasons. In order to recognize the problem in a child in time and navigate further tactics, parents should be well versed in the main issues related to dacryocystitis.

Causes of children's dacryocystitis

It will be easier to understand the mechanism of development of this pathology after a short story about the anatomical structure of the eye and its lacrimal duct.

Anatomical features of the lacrimal ducts

The eyeball in a person is washed by tear fluid. Its role is difficult to overestimate:

it moisturizes the mucous membranes not only of the eyes, but also of the nose;
has disinfectant properties, removes microorganisms and foreign bodies;
participates in the nutrition of the cornea;
contains psychotropic substances, which causes a beneficial effect on the psyche.

Lacrimal fluid is produced by the lacrimal gland, washes the conjunctiva and is excreted through the lacrimal ducts (upper and lower) into the lacrimal sac. After that, normally, through the nasolacrimal duct enters the nasal cavity.

During the intrauterine period, the outlet openings of the nasolacrimal ducts of the fetus are closed by a thin gelatinous septum. This method is provided by nature in order to secure the entry of amniotic fluid through the tear ducts into the respiratory system of a developing baby. After birth, this film should break with a cry and the first respiratory movements. But in 3-5% of newborns, this does not happen, and the nasolacrimal duct remains closed, sometimes on both sides. The stagnation of the discharge in the lacrimal sac begins, an inflammatory process (dacryocystitis) develops - first serous, then purulent.

Other causes of dacryocystitis

In addition to the above main reason leading to dacryocystitis in children, there are other factors that contribute to its development:

narrowing of the lacrimal sac at the site of its transition to the duct;
diverticula, curvature along the canal (bone or soft tissue)
curvature of the nasal septum;
traumatic injury to the eye or nose;
chronic inflammation of the nasal mucosa of an infectious nature.

These reasons most often provoke the development of dacryocystitis in older children.

Symptoms of dacryocystitis

Inflammation of the lacrimal sac in newborns has a characteristic clinical picture that facilitates the diagnosis of the disease. A few days after birth, mucous begins, then purulent discharge from one or both (if there is a bilateral pathology) eyes. The mucous membrane turns red, especially on the inside. Up to three months, the eyeball is moistened only by conjunctival secretion, and tear fluid begins to be produced at the end of the second month. In this regard, excessive lacrimation with dacryocystitis in babies after birth is not observed.

Often, doctors take the first manifestations of inflammation of the lacrimal sac for conjunctivitis, prescribe bactericidal drops and ointments. Only after a while, in the absence of a result from the treatment, the search for another pathology can begin. Correct diagnosis will be facilitated by a simple method: lightly press the little finger or cotton swab on the inner corner of the eye (the location of the lacrimal sac), with dacryocystitis, a mucopurulent secret will appear from the lacrimal punctum (usually the lower one). But if the child has received antibiotic therapy for a week, this sign may not be informative, since the discharge is likely to be scanty and clean.

If a child is asked for help after three months, additional symptoms appear in the form of lacrimation (increased hydration of the eye in a calm state) and lacrimation, aggravated by windy weather. Sometimes a protrusion is possible in the projection zone of the lacrimal sac (dacryocele).

Dacryocystitis can turn into a chronic process, then it is characterized by a long (several months), sluggish course with periods of exacerbations. There is a secreted (scanty or profuse) pronounced lacrimation.

Dacryocystitis can cause serious complications that are dangerous both for the organ of vision itself and for the body as a whole. We are talking about the fusion of the lacrimal ducts, purulent ulcers of the cornea, the spread of purulent inflammation to neighboring tissues with the formation of an abscess or phlegmon. Further progression of the process is fraught with damage to the meninges (meningitis, encephalitis).

Diagnosis of the disease

Only an ophthalmologist can confirm or exclude the diagnosis of dacryocystitis by using special diagnostic tests.

1. Canalicular test.

A colored solution is instilled into the child's eye - 2% collargol and observed: if there are problems with tear drainage, the eye will not discolor, or the process will take too long (more than 10 minutes).

2. Nasal test.

They use the instillation of the same collargol, only now a cotton turunda is introduced into the nasal passage (under the lower sink). The baby at this time is held in an upright position, slightly tilting his head to the front. In the absence of blockage of the nasolacrimal canaliculus, the turunda will become colored within 5 minutes, and the eye will become clear. A delayed test (turunda stains within 10 minutes) suggests narrowing and partial obstruction. If the test is negative, then we are talking about a complete blockage.

The most accurate methods, after which all doubts will be dispelled, are washing and probing of the lacrimal ducts. They are made by a qualified ophthalmologist not only for diagnostic, but also for therapeutic purposes.

A laboratory analysis of the discharge is also carried out - the pathogen and its sensitivity to antibiotics are examined.

Conservative treatment

Children's dacryocystitis requires a competent approach to treatment, which is far from safe to postpone. The main therapeutic measures are aimed at restoring the patency of the outflow tract of the lacrimal fluid and relieving inflammation.

Massage for dacryocystitis

In most cases, treatment begins with a massage. For the first time, a doctor should do it, explaining to the mother of the child all the subtleties.

1. Before starting the procedure, wash your hands.

2. It is better to massage before feeding, 5 times a day.

3. With the index finger from the inner corner of the eye, 5 to 10 vertical jerky movements are carried out to the wing of the nose, pressing soft tissues to the bones. You can not massage the lacrimal sac directly.

4. After the procedure, eye drops prescribed by a doctor are instilled, but not breast milk or strong tea.

5. If there are symptoms of acute dacryocystitis with swelling and redness of the lacrimal sac, massage is prohibited.

6. Wrong massage technique will not only not bring the expected result, but also threatens to worsen the condition.

In newborns, this technique gives a positive result in only 30% of cases. And as the child grows older, its effectiveness decreases. If within two weeks the desired effect was not achieved, you should think about more radical methods.

Medical therapy

The use of medications is one of the important directions in the treatment of dacryocystitis. Antiseptic and antibacterial agents are used for this.

For the purpose of disinfection, a common decoction of chamomile, a solution of furacilin, drops of phthalmodek are prescribed. Having found out with the help of laboratory tests the sensitivity of pathogenic microflora in the lacrimal fluid, antibacterial drugs are used. Most often, with dacryocystitis, staphylococcus aureus (95% of cases), streptococcus and Pseudomonas aeruginosa are sown. They respond positively to treatment with Tobrex, Vigamox, and Floxal. Sometimes solutions of chloramphenicol and gentamicin are prescribed. If the treatment consists of several drugs, then it is necessary to adhere to the interval between each instillation (a quarter of an hour). All pharmacological mediators must be assigned exclusively by a physician. He also monitors the dynamics of the condition of a small patient and makes decisions regarding further tactics. The lack of recovery after 10-14 days of conservative therapy indicates the need for surgical intervention.

Surgical treatment of dacryocystitis in children

Operative technique is the most effective in the treatment of childhood dacryocystitis. Unfortunately, many parents have unreasonable fears about this method. As a result, precious time is lost, because the main percentage of recoveries is given by an operation performed at the age of 2-3 months.

Speaking of surgical treatment, they mainly mean probing the nasolacrimal duct. They do it in a hospital, but after the procedure, the child can be taken home immediately. The essence of the technique is as follows:
do local (in patients up to 5 months) or general anesthesia;
a microscopic cylindrical probe (Bowman probe) is inserted into the nasolacrimal duct through the lacrimal opening;
they push out a gelatin plug that clogs the passage;
wash the lacrimal passages with an antiseptic solution to prevent infectious complications;
in the postoperative period, drops containing an antibiotic, decongestants are prescribed;
within 10 days make a massage that prevents stagnation of the lacrimal fluid.

The whole operation lasts about 5 minutes, it does not leave any discomfort for the baby. In addition, the result is immediately visible - the discharge that bothers everyone disappears.

The early use of the radical method not only gives the best result, but is also easier to tolerate by patients psychologically and physically.

In children who have reached the age of six months, the gelatinous film thickens, cartilaginous elements appear in it. Such an obstruction is harder to eliminate with minimal side effects.

After a year, a more complex surgical intervention may be required - dacryocystoplasty. A balloon is introduced into the blockage site, which is gradually expanded with the help of fluid pressure.

Children's dacryocystitis is a rather unpleasant diagnosis. It requires medical supervision and a competent approach to treatment. However, this is not at all a reason for parents to panic, because there are effective treatments that allow you to completely get rid of the problem. The most effective is the probing of the lacrimal duct - a low-traumatic procedure, in which there are practically no unpleasant consequences.

- an infectious eye disease associated with obstruction of the nasolacrimal canal and inflammation of the lacrimal sac. With dacryocystitis in newborns, there is swelling in the area of the lacrimal sac, the release of pus from the lacrimal punctum with pressure on the inner corner of the eye, and lacrimation. Diagnosis of dacryocystitis in newborns is carried out by a pediatric ophthalmologist and includes a colored tear-nasal test, bacterial culture of the detached eye, rhinoscopy, and probing of the lacrimal ducts. The main measures for the treatment of dacryocystitis in newborns are massage of the lacrimal sac, washing the conjunctival cavity, instillation of antibacterial drops, probing the lacrimal canal.

General information

Dacryocystitis of newborns is a pathology of the lacrimal ducts, characterized by stagnation of tears and inflammation of the lacrimal sac due to congenital narrowing or obstruction of the nasolacrimal canal. In pediatrics and pediatric ophthalmology, dacryocystitis is diagnosed in 1-5% of all newborns. Dacryocystitis of newborns is isolated in a separate form, along with acute and chronic dacryocystitis of adults. Timely untreated dacryocystitis in a newborn may require repeated surgical interventions in the future, lead to the formation of a chronic inflammatory process, constant lacrimation, and limited choice of profession.

The reasons

Anatomical and functional features of the lacrimal ducts predispose to the development of inflammation of the lacrimal sac in newborns. Most often, neonatal dacryocystitis occurs due to congenital obstruction of the nasolacrimal duct, which can be caused by the presence of a gelatinous plug in the lumen of the nasolacrimal duct or a rudimentary embryonic membrane that has not resolved by birth.

Normally, up to the 8th month of intrauterine development, the nasolacrimal canal in the fetus is closed. At the time of birth, in 35% of newborns, the nasolacrimal duct is closed by an embryonic membrane; in 10% obstruction of the lacrimal ducts of varying severity is detected. In most cases, the patency of the lacrimal ducts is restored on its own in the first weeks after birth through the release of a plug or rupture of the film of the nasolacrimal duct. In cases where the lumen of the canal does not open on its own, the contents accumulating in the lacrimal sac (detritus, mucus, epithelial cells) become a favorable environment for infection - newborn dacryocystitis develops.

In addition, the patency of the lacrimal ducts in newborns may be impaired due to congenital pathology or birth trauma: folds and diverticula of the lacrimal sac, narrowing of the nasolacrimal canal, abnormally narrow or tortuous exit of the duct into the nasal cavity, agenesis of the nasolacrimal duct, etc.

The development of dacryocystitis in newborns is facilitated by anomalies of the nasal cavity, narrow nasal passages, curvature of the nasal septum, rhinitis. Sometimes dacryocystitis of newborns develops against the background of dropsy of the lacrimal sac (dacryocystocele). Direct infectious agents in dacryocystitis of newborns can be staphylococci, streptococci, Pseudomonas aeruginosa, less often - gonococci or chlamydia.

Symptoms of dacryocystitis in newborns

The clinical picture of dacryocystitis in newborns develops on the first day or weeks of life, in premature babies - on the 2nd-3rd month of life. In typical cases, a mucous, mucopurulent or purulent discharge appears in one or both eyes of the child. Painful swelling in the area of the lacrimal sac, hyperemia of the conjunctiva, less often - lacrimation and lacrimation may be detected. Very often this process is mistakenly regarded as conjunctivitis. A distinctive feature of dacryocystitis in newborns is the release of pus from the lacrimal openings during compression of the lacrimal sac.

Usually, inflammation of the lacrimal sac develops in one eye, but bilateral neonatal dacryocystitis is also possible. In some newborns, by the beginning of the third week of life, the gelatinous plug leaves on its own and the phenomena of dacryocystitis subside. In the absence of an outflow of infected contents, the child may form a phlegmon of the lacrimal sac. At the same time, the condition of the newborn worsens: the temperature rises sharply, intoxication phenomena increase. Suspicion of an abscess or phlegmon of the lacrimal sac requires immediate hospitalization of the child.

Diagnostics

If there are signs of inflammation of the eye, you should immediately contact a pediatric ophthalmologist, who will conduct an objective examination of the state of the lacrimal ducts: examination of the eyelids and lacrimal openings, compression of the lacrimal sac, assessment of the nature and amount of discharge, etc. To exclude rhinogenic, viral, allergic causes of lacrimation in a child consultation of a pediatrician, a pediatric otolaryngologist, a pediatric allergist is necessary.

Treatment of dacryocystitis in newborns

Therapeutic measures are aimed at restoring the nasolacrimal canal, stopping the inflammation of the lacrimal sac and sanitizing the lacrimal system. Treatment of dacryocystitis in newborns begins with a massage of the lacrimal sac, which allows you to remove the gelatinous plug or embryonic film that blocks the tear-nasal duct. The technique of downward massage is taught to the mother of a sick child, since it is necessary to carry it out 5-6 times a day. Observations show that correct and regular massage of the lacrimal sac leads to a complete recovery of 30% of children under the age of 2 months. After the massage, the conjunctival cavity is washed with antiseptics (furatsilin) or a decoction of herbs, followed by the instillation of antibacterial eye drops (picloxidine, moxifloxacin, tobramycin, chloramphenicol, gentamicin). With dacryocystitis of newborns, UHF, general antibiotic therapy may be prescribed.

In the absence of a result from massage and conservative measures during the week, therapeutic probing of the lacrimal ducts is carried out, during which a mechanical rupture of the embryonic plug is achieved. Immediately after probing, the lacrimal canal is washed. With dacryocystitis of newborns, caused by obstruction of the lacrimal canal with an embryonic film or plug, probing is effective in 92-98%. It is possible to conduct courses of therapeutic bougienage of the nasolacrimal duct. For complete relief of inflammation and exclusion of relapses of dacryocystitis in newborns, drug treatment and repeated washings continue for 1-3 months.

In case of ineffectiveness of minimally invasive ophthalmic manipulations, at the age of 5-7 years, children are shown surgical treatment: intubation of the lacrimal ducts or dacryocystorhinostomy - a radical operation involving the restoration of the communication of the lacrimal sac with the nasal cavity. With a formed abscess or phlegmon with fluctuation in the area of the lacrimal sac, an abscess is opened, systemic antibiotic therapy with broad-spectrum drugs is prescribed.

Forecast

Timely detection of dacryocystitis in a newborn by a neonatologist or pediatrician, urgent referral of the child to a pediatric ophthalmologist are the key to successful treatment. The tactics of using therapeutic massage and early probing of the lacrimal canal in neonatal dacryocystitis allows you to quickly stop the inflammatory process in the vast majority of cases.

Inadequate or untimely treatment of neonatal dacryocystitis can lead to the development of a corneal ulcer, the release of a purulent process beyond the lacrimal sac with the occurrence of severe life-threatening complications (purulent peridacryocystitis, phlegmonous dacryocystitis, orbital phlegmon, cavernous sinus thrombosis, meningitis, sepsis). In some cases, the process becomes chronic, leading to adhesions, atony, dilatation and ectasia of the lacrimal ducts.

Watery and festering eyes in a child are not a sight for the faint of heart. Even without special medical knowledge, moms and dads understand that something needs to be done in this situation. After reading this article, you will learn about one of the causes - dacryocystitis in children, as well as how to help the baby.

What it is?

Dactriocystitis is an inflammation that occurs in a special organ whose function is to accumulate tears (the lacrimal sac). This organ is located between the nose and the inner corner of the eyelids. Tears are produced by all people - as a natural antiseptic and a protective mechanism for the organs of vision. The excess of this fluid normally flows through the nasolacrimal canal into the nasal cavity and out.

If the lumen of this nasolacrimal canal is broken, then the outflow is very difficult. Tears accumulate in a bag in the corner of the eye, which is why the eyes look watery. Inflammation and suppuration occur due to the multiplication of pathogenic bacteria. Stagnant biologically active liquid for them is an excellent breeding ground.

Inflammatory changes in the lacrimal sac can be caused by eye injuries, eye infection, and the narrowing of the nasolacrimal canal is a consequence of eye diseases or a congenital feature of newborns. That is why dacryocystitis is often called a disease of newborns.

In ophthalmology, they decided not to combine these two varieties of one ailment, since neonatal dacryocystitis is a more physiological problem, which is solved as the child grows. And dacryocystitis in general (for example, in older children) is a pathology that will have to be dealt with in a completely different way.

Dacryocystitis that does not occur in infants can be acute or chronic. Moreover, in an acute form, a phlegmon or an abscess of the lacrimal sac often occurs.

The reasons

In newborns, the nasolacrimal canaliculi are very narrow; Dacryocystitis in newborns is considered the most favorable in terms of prognosis, since it often resolves on its own, without serious therapeutic measures.

In older children, the risk of developing obstruction and partial obstruction of the nasolacrimal canal increases during the period of acute respiratory viral infections or influenza, as well as other respiratory ailments, in which tissue edema occurs in the nasopharynx.

Obstruction of the lacrimal ducts can appear as a result of chronic or prolonged rhinitis, with adenoiditis, with allergic rhinitis, and also with a bacterial infection.

If a child has a deviated septum, which has occurred due to a fracture of the bones of the nose, if he has polyps in the nose, the risk of developing dacryocystitis increases significantly.

The mechanism of the development of the disease is approximately the same (regardless of the initial cause): first, due to swelling, the patency of the lacrimal canaliculus is disturbed, then tears accumulate in it and the lacrimal sac. The protective properties due to the lack of circulation are lost quite quickly.

In response to fluid stagnation, the lacrimal sac begins to stretch, increase in size, so an abscess or phlegmon is formed.

Symptoms and signs

In dacryocystitis, the symptoms are quite specific, and it is quite difficult to confuse them with signs of other eye diseases. Usually in children, the disease is unilateral - only one eye becomes ill. Only in 3% of cases dacryocystitis is bilateral.

The chronic form of the disease is manifested by increased lacrimation, as well as some visual swelling of the lacrimal sac. If you press lightly on this swelling, a cloudy or purulent liquid may begin to stand out.

The consequences of this form of dacryocystitis can be quite sad, since inflammatory processes can go to other membranes of the organs of vision, and the child will be diagnosed with such diagnoses as keratitis, blepharitis, conjunctivitis. A thorn may form.

In the acute form, dacryocystitis manifests itself more clearly. The eyelid turns red and swells, the area of the enlarged and inflamed lacrimal sac (in the inner corner of the eye) becomes painful to the touch. The swelling can be so extensive that it covers both the upper and lower eyelids, and the child cannot open the eye.

In some cases, it is quite difficult to determine the true focus of inflammation, since it does not have clear boundaries, it can “spill” into the orbit of the eye, and onto the cheek, and into part of the nose. The child complains of feeling unwell, the temperature may rise, chills begin, signs of fever and intoxication are likely.

This condition usually lasts for several days, after which the skin around the lacrimal sac begins to change color, it turns yellow and becomes softer. This is how an abscess begins to form. In most cases, it opens on its own, but here lies a new danger - pus can spread to the fiber and cause phlegmon.

In newborns, dacryocystitis is less pronounced. With it, the temperature does not rise, and an abscess usually does not form. Parents may notice that the baby's eye is turning sour.

This is especially noticeable in the morning, after a long night's sleep. The baby's eyes water, become cloudy. With a slight pressure on the lacrimal sac, a small amount of cloudy secretion, sometimes pus, may be released.

Blockage of the nasolacrimal duct and subsequent inflammation of the lacrimal sac is not a contagious disease. Although, if the signs described above are detected, parents must definitely take the child to an appointment with an ophthalmologist.

Diagnostics

It can be quite difficult for parents to independently examine the child, since the baby may desperately resist attempts to put pressure on the inflamed lacrimal sac. However, not every mother dares to do this on her own. Therefore, an examination by an ophthalmologist always begins with palpation of the lacrimal sac and determining the nature of the discharge.

To confirm the diagnosis, a special technique is used, which is called the “West tubular test”. The nasal passage from the side of the affected eye is tightly closed with a cotton swab, and a contrast agent (collargol solution) is instilled into the eye.

With the patency of the tubule, after a minute or two, traces of a coloring matter appear on a cotton swab. With obstruction, cotton wool remains clean. With difficult circulation, which occurs when the lacrimal canaliculus is narrowed, traces of collargol on the swab appear very late. That is why the West test is evaluated not only after 2-3 minutes, but also after 15 minutes, if there were no traces of dye on the swab for the first time.

To determine the extent of the blockage or narrowing, doctors may perform exploratory probing. During the procedure, the lacrimal canal will be washed. If the fluid flows only from the eye and does not enter the nose, doctors will be able to determine at what level the obstruction has occurred.

Diagnostic probing

If dacryocystitis is confirmed, then the doctor will need to find out another important nuance - which microbe or virus began to multiply in the overflowing lacrimal sac.

To do this, smears of the contents that are released during palpation are sent to the bacteriological laboratory for analysis. This allows you to establish the exact name of the pathogen, prescribe an adequate and effective treatment.

In difficult cases, other specialists are also invited for treatment - an ENT specialist, a surgeon, a facial surgeon, a neurosurgeon and a neurologist.

In a newborn and an infant, diagnostic actions are usually carried out according to a simplified scheme - an examination by an ophthalmologist and an analysis of the contents of the lacrimal sac for bacteriological culture are sufficient.

Treatment

In infants

When it comes to newborns and infants, there is usually no need for inpatient treatment. Since the condition is due to physiological reasons, it is enough to give the little one a daily massage of the lacrimal ducts. The massage technique is quite simple, and the procedure allows more than 90% of children with such a diagnosis to be successfully cured in this way, without other medical intervention and the use of strong medications.

Mom should get rid of nail polish and do all the manipulations with clean hands so as not to infect the child.

Massage begins with light tapping movements in the area of the lacrimal sacs (it is better to do a bilateral massage). Then thumbs should be held 10-15 times in the direction of the lacrimal canaliculus (with light pressure). The direction is simple - from the corner of the eye to the bridge of the nose. It is very important that the movements are from top to bottom, and not vice versa.

The massage session ends with vibrating movements in the area of the lacrimal sac.

The discharge of pus or cloudy liquid from the corner of the eye, where the lacrimal openings are located, should not be frightening. This fact rather suggests that the manipulations were done correctly.

It is recommended to repeat the exposure several times a day - for example, before feeding, but not more than 4-5 times. After each such session, you can drop a solution of furatsilin (1: 5000) or "Miramistin" into the child's eyes at a concentration of 0.01%.

Usually this treatment is enough to get rid of dacryocystitis completely. When there is no relief, and the inflammation begins to progress, doctors prescribe probing - a manipulation that allows you to restore the patency of the lacrimal canal.

Probing is carried out under local anesthesia (or after introducing the child into a state of medical sleep). The essence of the intervention is reduced to the mechanical release of the nasolacrimal canaliculus. To do this, a special probe is first introduced into the canal. Due to its conical shape, the probe not only eliminates the blockage, but also expands the channel itself.

Then a long probe is inserted and the patency is checked along the entire length. It breaks adhesions, if any, pushes out the plug, makes the channel clean and free throughout. The procedure ends with the introduction of antiseptics, washing. After that, the doctor again performs the West color test, described above, to check if the patency has been restored.

The rest of the children

Acute dacryocystitis, which has arisen under the influence of various factors at an older age, is treated in a hospital - under the supervision of specialists. While the abscess matures, only physiotherapeutic methods are used - UHF and dry heat compresses on the lacrimal sac.

When an abscess appears, it is opened, the lacrimal sac is cleaned and treatment is prescribed - depending on the type of pathogen. If the inflammation is bacterial, antibiotic eye drops or antibiotic ointment are prescribed. In case of viral infection, they are treated with antiseptic solutions.

Quite often, with a bacterial lesion (and it is the most common), systemic antibiotics are prescribed in tablets or syrups. When the acute period is left behind, a decision is made on the advisability of an operation to restore the patency of the lacrimal canal.

The disease dacryocystitis occurs in children due to a violation of the patency of the lacrimal canals, which contributes to the development of pathogenic microorganisms and inflammation of the mucous membrane of the lacrimal sac. Timely treatment of dacryocystitis will prevent serious purulent inflammatory complications of the nasal canals and the child's brain (abscess, meningitis, purulent brushes or encephalitis).

Causes of dacryocystitis in a child

All causes of dacryocystitis in adults and children are divided into congenital and acquired.

Congenital dacryocystitis

A newborn child is born with a violation of the lacrimal ducts (narrowing, complete blockage of the lacrimal canals or the presence of folded areas on the mucous membrane of the lacrimal sac), the preservation of the so-called gelatin plug (it protects the lower part of the lacrimal canal during intrauterine development and breaks at the first breath ).

Acquired dacryocystitis

A child and an adult can acquire a disease due to the presence of foreign bodies in the lacrimal canal (cilia, dust, etc.), or other infectious diseases of the eyes and nasal mucosa, the consequences of eye injuries, inflammation of the maxillary sinus or other sinuses.

Symptoms of dacryocystitis in children

The first and main symptom of the onset of dacryocystitis is profuse lacrimation and swelling of the lacrimal sac (swelling appears near the inner corner of the eye) in a child. If you press a little on this area with your finger, a purulent or mucopurulent transparent yellowish liquid may begin to be released. There may also be swelling of the conjunctiva of the eyelids.

Other symptoms of dacryocystitis include:

redness of the inner corners of the eyes,
elevated body temperature,
pain when lightly touching the swelling.

Depending on the form of the course of dacryocystitis, the clinical picture may differ slightly.

Acute dacryocystitis

In the acute form of dacryocystitis, a child has severe redness and swelling of the lacrimal sac area, which leads to the closure of the palpebral fissure. After two or three days, fistulas (holes) form in the inner corner of the eyes, which open on their own, purulent contents are released from the inflamed lacrimal sacs.

Chronic dacryocystitis

In cases of chronic course of dacryocystitis, a strong stretching of the lacrimal sacs occurs in children, the skin of which, located above the lacrimal sac, acquires a bluish tint.

Where does pus come from in the eye of a child with dacryocystitis?

Dacryocystitis, like conjunctivitis, is an inflammatory eye disease. With a disease in a child, stagnation of tears occurs, which contributes to the development of harmful microflora in the lacrimal sac and lacrimal canals. As a result of the inflammatory process and the vital activity of pyogenic microorganisms (staphylococci, streptococci, meningococci and others), suppuration occurs.

Diagnostics

To make and confirm the diagnosis of dacryocystitis, it will be enough to examine the child by a pediatric ophthalmologist, but in severe forms of the disease, the patency of the nasolacrimal canal is checked. This test is based on the instillation, directly into the conjunctival sac of a contrast (dye) substance. To do this, use the test of Bugaev and West.

Vesta test

A clean cotton swab is placed in the nasal passage while the eyes are instilled with a solution of collargol. If the swab is not stained within 5-10 minutes, the child is diagnosed with obstruction of the lacrimal ducts.

Bugaev's test for determining the disease dacryocystitis

Bugaev's test or fluorescein instillation test - a fluorescein solution is instilled into the child's eyes and examined with a special lamp with a blue filter. After that, the number of areas that were not painted over and the number of point defects (flaws) of the conjunctiva and cornea of the eye are counted. More than 10 defects or ruptures of the tear film indicate pathological changes in the eye.

Also, as a diagnostic use:

diagnostic probing (washing of the lacrimal canals),
passive tear-nasal test to confirm canal obstruction,
Ultrasound of the eyeball or biomicroscopy,
contrast radiography of the lacrimal ducts (iodolipol solution) - used to clarify the level of blockage or narrowing of the lacrimal canals,
bacteriological culture of the discharge - to determine the causative agent of inflammation.

All these methods allow you to thoroughly study all the structures of the eyeball and correctly diagnose for the appointment of a correct and effective treatment for dacryocystitis.

How to distinguish dacryocystitis from conjunctivitis?

With conjunctivitis, the child has redness of the eyes, itching and burning, there may be a slight swelling of the eyelids and discharge from the eyes. If it is dacryocystitis, redness is not observed, but severe lacrimation appears, but if you gently press on the lacrimal sac, pus or mucus is released. There is swelling of the inner corner of the eyes.

Treatment of dacryocystitis in children

With congenital dacryocystitis, newborns are treated with massage, probing and washing the eyes. With a secondary disease, complex surgical interventions are needed to partially or completely restore lacrimation disorders.

Drug treatment is used to prevent infections and fight pathogenic bacteria. To do this, use a number of anti-inflammatory drugs, drops, ointments, antibiotics, in rare cases, use hormonal drugs.

What children's drops should be chosen for the treatment of dacryocystitis?

All medications must be prescribed by your doctor. The most common and effective drugs are the following:

"Collargol" - anti-inflammatory and bactericidal drops;
"Signecef" is an antibacterial drug in which the active substance is the antibiotic levofloxacin, which is active against staphylococci, streptococci and enterobacteria, which can quickly and actively multiply in a favorable environment of the lacrimal canals;
"Tsipromed" - in its action is similar to "Signecef", it is considered its analogue;
"Albucid" - not desirable for use by newborns, causes burning and compaction of the embryonic film. It is used only as directed by a doctor, in cases where other drops are powerless;
"Tobrex" - a quickly effective bactericidal agent, a strong antibiotic;
"Levomycetin" - can be prescribed both in the form of drops and in the form of ointments. The ointment should be applied at night, behind the lower eyelid of the child;
"Ophthalmoferon" is an antimicrobial and antiviral drug from the interferon family. It has a local anesthetic effect, which can reduce the feeling of discomfort and burning in the eyes;
"Floxal" - is used to treat inflammatory diseases of the eye departments, which are caused by bacteria sensitive to this drug (streptococci, staphylococci, salmonella, shigels, etc.);
"Vitabact" - an antimicrobial drug that has an effect, in addition to bacteria, also on some types of viruses and fungi that can cause concomitant diseases with dacryocystitis;
"Vigamox" - is used to treat inflammation that is caused by microorganisms resistant to other antibacterial drugs;
"Gentamicin" - is prescribed in the form of both drops and ointments, with concomitant inflammatory processes of the lacrimal sac and canal.

If the doctor has prescribed several drugs, they should be used with an interval of at least 15 minutes. A prerequisite for the medical treatment of dacryocystitis is the combination of the latter with massage.

How to properly massage a child with dacryocystitis?

Before starting the massage, wash your hands thoroughly and treat with a special antiseptic or use sterile gloves. Next, you should carefully squeeze out the contents of the lacrimal sac and clean the eyes of pus and mucus by washing with a solution of furacilin.

After carrying out the preparatory manipulations, you can proceed to the massage. It is best to carry it out before feeding and at least five times a day, in the first 2 weeks of the disease, it is recommended up to 10 times a day.

Massage technique:

Step #1

We put the index finger on the inner corner of the baby's eye, with the fingertip towards the bridge of the nose. It is important to know that it is correct to massage with the index finger.

Step #2

Lightly press on this point. The pressure should be moderately strong in order to break through the film that closes the lacrimal canal.

Step #3

Move your fingers down along the bridge of your nose, without ceasing to press on the skin. This movement should be sharp and confident. This is necessary in order to tear, and not stretch (as with normal stroking) the film, which prevents the movement of fluid from the lacrimal canal into the nasal cavity. With the help of such sharp movements, you push the fluid and pus accumulated above the septum into the nasal cavity.

Step #4

After your finger reaches the bottom of the bridge of the nose, it is best to slightly loosen the pressure, but do not lift your finger from the skin, and return it to its original position at the corners of the eyes.

Step #5

If you do everything right, you can see how the tears with pus began to come out of the tubules into the eyes. In cases where the massage does not give any results for 23 weeks, probing the lacrimal canal is performed.

Probing for dacryocystitis

This procedure is performed on an outpatient basis. An ophthalmologist, under local anesthesia, inserts a probe through the lacrimal opening into the lacrimal canal. This allows you to break through the film that has been preserved and expand the channel for the normal outflow of tears. In a third of cases, probing has to be repeated again after a few days. This procedure allows you to restore the outflow of tears in 90% of cases.

Now gaining popularity as a type of probing, bougienage of the lacrimal canal. This method consists in the introduction of a special probe - a bougie into the lacrimal canaliculi. Buzh pushes and expands the narrowed walls of the lacrimal canal. Sometimes synthetic elastic threads or hollow tubes are used during bougienage.

Can dacryocystitis be cured without probing?

The answer is, of course you can. In most cases, following the doctor's instructions, a properly conducted massage course will help to cope with the disease. But if you see that for 3 weeks, such therapy does not give any result, be sure to consult a doctor for probing. It is better not to delay this procedure, probing that has not been carried out in time can lead to a more rough surgical intervention or complications.

Surgical treatment

It directly depends on the age of the child and the type of dacryocystitis.
In the primary disease in newborns, a less traumatic operation is used - laser or endoscopic dacryocystorhinostomy.

Laser dacryocystorhinostomy

Using an endoscope with a laser, a hole is made in the nasal bone that connects the nasal cavity and the lacrimal sac.

Endoscopic dacryocystorhinostomy

A similar procedure to laser dacryocystorhinostomy is to make a new passage between the tear duct and the nasal cavity by making an incision at the site of the blocked tear duct.

Secondary dacryocystitis in a child is treated only by surgery.

One type of surgery is tear duct intubation, which is the insertion of a thin silicone tube into the tear duct to keep the tear duct open. After some time, from 3 weeks to a year, the tube is removed, a new shell is formed around the tube. Due to this sheath, the duct is preserved even after the tube is removed.

Fracture of the nasal bone, without displacement of fragments

Children are carried out very rarely, only in the most extreme cases. The procedure is performed to restore the patency of the tear duct by destroying and displacing one of the nasal bones.

Balloon dacryocystoplasty

A thin conductor is inserted through the hole in the corner of the eye, to which a microscopic expanding balloon is attached. It is brought to the site of blockage and filled with liquid, as a result of which the balloon opens and expands the duct. Then it is removed along the conductor.

Dacryocystorhinostomy

In children, this type of surgical intervention is almost never used. The method consists in creating a new duct between the lacrimal sac and the nasal cavity, which goes around the blocked duct. Through the lacrimal sac, a tube is inserted into the nasal cavity through a hole in the bone. This tube stays for 5-6 weeks.

How to understand that dacryocystitis has completely passed?

If all the doctor's prescriptions have been followed correctly, you will see that the child begins to release a tear naturally. All signs of the inflammatory process and dacryocystitis, such as swelling and redness, disappear.

After you see these signs, you should re-consult a doctor to conduct a study of the patency of the nasal passages using the Bugaev or West test. Ate after the cotton swab, which is inserted into the nose, is stained, you can talk about the complete recovery of your child.

But, nevertheless, even with successful treatment, it is worth paying special attention to the hygiene of the child's eyes. After a full recovery, it is recommended to regularly see a doctor, as well as have all the necessary drops in the first-aid kit for washing the lacrimal canals.

Consequences of dacryocystitis

If you consult a doctor in time, there will be no consequences for the child after the disease. But if the dacryocystitis has been delayed or the wrong treatment has been prescribed, the lacrimal sac may stretch. It is also possible the occurrence of phlegmon of the lacrimal sac (purulent inflammation of the sac, without treatment can lead to its death), eyelids, orbital tissue or panophthalmitis - this is the spread of purulent inflammation of the eyes, this can lead to complete blindness or a severe decrease in vision.

A prolonged inflammatory process can develop into an abscess of the lacrimal sac, which in turn will cause the development of various complications in the child, and inflammation of the membranes of the brain (encephalitis or meningitis).

Homeopathy for dacryocystitis

Recently, homeopathic remedies have become increasingly popular. Among the numerous drugs, the most noticeable effect in the treatment of dacryocystitis is:

"Argentum Nitricum 30c" - as an anti-inflammatory agent;
"Cochlearia Armoration 6c" - a medicine based on horseradish, used for inflammation and irritation of the eyes;
"Thiosinaminum 12c" - helps with the removal of fluid from the lacrimal-nasal lacrimal canal;
"Pulsatilla 6c" - is used mainly in the form of ointments, to divert purulent discharge;
Silicea 30c is used as an anti-inflammatory agent.

Before using any homeopathic remedy, a doctor's consultation is necessary.

Traditional medicine in the treatment of dacryocystitis

A decoction of crushed chamomile flowers

Boil a few tablespoons of dried flowers in boiled water. Let it brew, filter, moisten a cotton pad and apply to the affected eye. The procedure is carried out twice a day.

Kalanchoe juice

Kalanchoe juice has disinfectant properties. To use Kalanchoe, you need to thoroughly wash the leaves and put in the refrigerator for two days. Then grind and squeeze the juice, mix it in equal proportions with saline and instill into the nasal passage.

Eyebright tincture

You can use the plant, both internally and as lotions, because eyebright is sold in the form of tablets. Dissolve a few tablets in warm water, moisten a cotton pad and wipe the child's eyes three times a day.

An effective treatment for dacryocystitis is:

infusion of calendula flowers,
mint leaves,
eucalyptus,
oregano,
sage.

Mix all the ingredients in equal quantities, brew this mixture in boiled water and insist for two days. Filter the solution and use as a lotion. This remedy has anti-inflammatory and antimicrobial effects.

Decoction of oak bark

Mix oak bark, celandine and eucalyptus leaves. Pour boiling water over everything and leave for one hour, strain and instill eyes 2 times a day or do eye baths.

Treatment of a child with folk methods against dacryocystitis was effective in some cases, but it is strictly forbidden to self-medicate. Before using any decoction or tincture, be sure to consult an ophthalmologist.

352 03/08/2019 4 min.

When diseases associated with the eyes occur, it is always unpleasant, and sometimes dangerous. But the situation is even more aggravated when it comes to newborns. In their case, the consequences can be very negative, and the procedure for treating the disease is difficult. One example of this phenomenon is dacryocystitis. In this article, we will consider the methods of treating this disease and what are the main symptoms.

What it is

Dacryocystitis is a specific inflammatory process commonly seen in newborns. It is localized in the region of the lacrimal sac of the eye. The disease is difficult to treat and often occurs in a chronic form.

There is a partial narrowing or complete blockage of the nasolacrimal canal, which leads to inflammatory processes in the paranasal sinuses surrounding. There is a delay in the outflow of tear fluid, pathogenic microbes begin to develop.

The reasons

The causes of the development of the disease can vary, but the two main reasons that provoke the appearance of a problem in young children are as follows:

infectious diseases of the visual apparatus;
injury.

If the disease is diagnosed in a newborn, then this is usually due to the fact that he already had it in a congenital form (also an example of a congenital disease). The fact is that during the intrauterine development of the baby, the lumen of his nasolacrimal canal is always filled with a special mucous mass, and the passage is covered with a special membrane. In the vast majority of babies, this membrane ruptures already with the first breath, but in very rare cases it may remain, which leads to the development of the disease.

Symptoms

The first symptoms of this disease appear approximately in the first week of a baby's life, but less often the disease may go unnoticed during the first couple of months. Characterize the problem, as a rule, and the appearance of the affected eye.

Many parents mistake the problem for, which is not surprising, since the problems are really quite similar. Therefore, it is necessary to look at additional symptoms in order to understand what kind of disease the baby has.

Other symptoms include swelling of the eyelids and redness of the conjunctiva. Also, for diagnostic purposes, you can press on the lacrimal sac area, then characteristic discharges will appear, which indicate that purulent-mucous masses have begun to accumulate.

Most often, the disease affects only one eye, but sometimes it happens that both eyes are affected at once.

Diagnostics

Diagnosis should be carried out immediately after the discovery of this disease. In order for the doctor to prescribe a suitable treatment, he must carefully examine the patient. To begin with, the newborn must be sent to an ophthalmologist for a general examination. Further, they may appoint a visit to other specialists, for example, a pediatrician, an otolaryngologist, an allergist, and others. This allows you to rule out other causes of the problem.

Manifestation of dacryocystitis

An important element of the examination is taking a smear from the conjunctiva, which will then be sent to the laboratory for laboratory culture. This will help to understand exactly what kind of infection the baby has, and, therefore, to understand which medications will be most effective when interacting with it.

Optionally, a so-called colored tear-nasal test can also be performed. Its essence is as follows - the doctor squeezes out the contents of the lacrimal sacs, after which he clears the nasal passages. A cotton swab is inserted into the nose, and a special brown solution is injected into the conjunctival cavity. After that, it is noted how soon the cotton swab in the nose will be painted over. Thanks to this, it is possible to clearly understand how passable the lacrimal canal is.

Treatment

Many people believe that the problem can be easily, for example, chamomile decoctions or strong tea. These methods are indeed quite effective in a number of other eye problems, but in this case they simply will not bring the slightest benefit.

After contacting the ophthalmologist, the baby will be prescribed medication. Various common and safe eye drops are used, which include:

Vitobact;
Collargol.

Massage for dacryocystitis

In parallel,. First, the ophthalmologist shows how to carry it out, after that, with the preservation of certain precautions, it is possible to carry out the massage personally.

This massage is carried out with the most smooth, unhurried and careful movements, which, nevertheless, should be jerky. This will contribute to the fact that the lumen of the channel will gradually open.

Thus, the treatment is carried out for about a week or a little more. If a positive result does not occur, then it is necessary to resort to the so-called probing. This is a procedure in which the patency of the nasolacrimal canal is restored with the help of a special physical impact. It is necessary to carry out this procedure only in a clinic setting. But the result is almost 100% guaranteed.

Complications

Although many believe that the disease can simply be left to chance, and it will pass by itself, this is not at all the case. There may be contraindications, and these indications can be quite negative. For example, what first appeared as a normal inflammatory process later becomes a chronic disease.

If the problem is constantly in a recurrent stage, then the lacrimal ducts may undergo atony and / or fusion, which will cause serious discomfort to the baby.

Less commonly, a phlegmon or abscess of the lacrimal sac develops. Rarely, there are situations such as sepsis and meningitis, so far these are only isolated cases, but still no one excludes their theoretical probability.

Prevention

To prevent the disease, many newborns in the hospital are instilled. Otherwise, you just need to try to prevent injuries in the child.

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conclusions

The disease is not so easy to treat, but it is really possible to cope with it if you consult a doctor promptly enough. Then you can increase the chance that the treatment will pass without the slightest complications and that the disease will not become chronic. Otherwise, the child may develop which can be complicated which will be more painful for the baby.