Children's dacryocystitis is not scary and easy to operate

Dacryocystitis is an ophthalmological disease of an inflammatory nature. Pathology develops against the background of stenosis (narrowing) of the lacrimal canal, which affects the lacrimal sac. Normally, a person's eyes constantly produce fluid to wash the eyeball. The lacrimal glands function more strongly if the eye experiences a negative effect of the external environment - in windy weather, when a foreign body gets into the mucous membrane, if the influence of allergens is felt, and conjunctivitis develops. Naturally, tear fluid flows into the lacrimal canal, the opening of which goes to the inside, located on the lower and upper eyelids of each eye. Normally, if the lacrimal openings are not blocked and the canals are wide enough, the fluid from there enters the nasolacrimal canal and is discharged into the nasal cavity.

Dacryocystitis is associated with obstruction of the nasolacrimal duct. In this case, the liquid has no outflow paths, and therefore begins to accumulate in the lacrimal sac, located in the upper part of the canal. When tear fluid stagnates, infection occurs, pathogenic microflora develops and an inflammatory process begins, which in ophthalmology is called dacryocystitis.

The disease occurs mainly in adults, and most of the patients are people of working age, often pensioners. It is noteworthy that most often women suffer from inflammation of the lacrimal sac - their canal is narrower, and therefore susceptible to blockage. If dacryocystitis is diagnosed in children, then usually the pathology is congenital in nature and is associated with a pathological narrowing of the lacrimal canal or infection in utero, or during passage through the mother’s birth canal.

Reasons for the development of dacryocystitis

The causes of the disease in adults and children are different. For adults, the list is wider, and it is also supplemented by a number of factors that can provoke pathology. Dacryocystitis can develop due to:

• the presence of polyps in the nose, sinusitis, which, when swollen, compress the nasolacrimal duct, causing stagnation of fluid there and disrupting its outflow;
• rhinitis of allergic, vasomotor and hypertrophic types, which are associated with swelling of the mucous membrane;
• sinusitis - ethmoiditis or sinusitis;
• injury to the nasal septum;
• penetration of a foreign body;
• viral or infectious pathologies affecting the mucous membrane, such as conjunctivitis;
• injury to the eyelids in the area of ​​the nasolacrimal duct;
• tumor neoplasms.

Factors in the development of dacryocystitis are decreased immunity, allergic reactions, complications of which include rhinitis and conjunctivitis, decreased body defenses, severe chronic pathologies, systemic diseases, such as diabetes, metabolic disorders, and work in hazardous conditions.

The causes of dacryocystitis in children are different. Manifestations of pathology can be noticed as early as 8–10 days after birth. Doctors note that dacryocystitis is caused by:

• congenital pathologies of the nasolacrimal duct (fusion, narrowing);
• incorrect location of the holes, which impedes the normal flow of fluid;
• the child retains a gelatinous plug, which should dissolve in utero (for this reason, for example, dacryocystitis is diagnosed in prematurely born babies);
• delayed opening of part of the bone near the nasolacrimal system;
• infection during childbirth - syphilis, herpes, chlamydia, staphylococcus or streptococcus.

Medicines

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In the treatment of dacryocystitis, general and local remedies are used. The following groups of drugs are prescribed:

Anti-inflammatory. Most often used topically in the form of drops. Help eliminate swelling and hyperemia, reduce the severity of pain. The duration of use is determined by the attending physician, usually no more than 2 weeks.

• Antibacterial. Contained in eye drops or prescribed orally in the form of tablets and intramuscular injections. The best option is a combination of local and systemic therapy. The duration of treatment with general antibiotics is 7-10 days. The medicine is selected taking into account the sensitivity of the pathogen; medications from the group of penicillins, aminoglycosides and cephalosporins are often used.
• General strengthening. In the initial period of the disease, vitamins help accelerate the softening of the infiltrate and subsequently stimulate healing. Immunomodulators increase the activity of the immune system and help activate the body's defenses.

In the case of chronic dacryocystitis with a constantly ongoing inflammatory process, ointments and drops with glucocorticoids can be used. This allows you to achieve a stronger and more lasting anti-inflammatory effect.

Types of pathology

Traditionally, the inflammatory disease dacryocystitis is divided according to the type of course into two types: acute form of pathology and chronic. It is noteworthy that the acute form can also have two options for the development of pathology - an abscess or phlegmon.

In most cases, the pathological process begins with a protracted, sluggish inflammation, in which patients experience lacrimation, the mucous membrane of the eye turns red, itching appears, and in the area of ​​the lacrimal sac there is pain when pressed. Externally, there is swelling, and if you press on the corner of the eye, purulent contents are released. If you miss the first symptoms of the disease and do not treat dacryocystitis, then noticeable skin tension in the area of ​​inflammation will soon appear. The area turns red, the skin becomes thin and shiny. If atrophy of the lacrimal sac occurs, ulcers may appear on the cornea.

The acute form of the pathology is more severe, and its course is pronounced. In the area of ​​the lacrimal sac, significant redness of the skin appears, the eye swells, and the palpebral fissure decreases; sometimes there is complete adhesion and the inability to open the eyelid. The inflammation progresses quickly and can spread to the cheek or nasal cavity. As a result of the suppurative process, phlegmon or an abscess appears.

Acute dacryocystitis seriously worsens the patient's condition. Patients complain of severe weakness, fever and headache. Inflammation spreads to the tissues surrounding the lacrimal sac and the maxillary sinuses. Externally, the affected part of the face looks swollen, the cheek and nose are very swollen. When purulent contents accumulate over time, it comes out - the abscess opens with a fistula. If the affected area takes a long time to heal, then the formation of a fistula with an exit outward or inward is possible. From there, tear fluid will be released, and when an outlet is formed, purulent contents will enter the nasal cavity. A significant complication of the pathology is the formation of phlegmon, which affects not only the subcutaneous tissue, but also muscle tissue.

Also, the classification of pathology subdivides the disease not only according to the nature of its course, but also depending on the causes of its occurrence. Dacryocystitis occurs:

• traumatic;
• viral;
• parasitic;
• bacterial;
• mycotic;
• chlamydial;
• allergic.

Folk remedies

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In case of chronic dacryocystitis, massage is acceptable for regular emptying and to prevent stretching of the lacrimal sac. Before you begin, you need to wash your hands and cut your nails. Hands should be warm. You must first drop a disinfectant solution into your eyes or wipe your eyelids with a decoction of sage and chamomile. First, you should massage the area between the eye and nose well, then move on to massaging the area along the nose. The pressing force should be medium. The discharge is removed with gauze or a cotton pad soaked in chamomile decoction. The eye is washed with an antiseptic to prevent infection of nearby structures.

Kalanchoe with dacryocystitis causes a local irritant effect, helps remove plugs from the nasolacrimal canal and relieves inflammation in this area. To prepare Kalanchoe juice at home, you need to collect fresh leaves, wash them well, dry them and put them in the refrigerator for 2-3 days. Then the juice is squeezed out of the leaves and diluted in half with saline. You need to instill the Kalanchoe solution into your nose with a pipette, 10 drops into each nostril. After instillation, sneezing occurs, which stimulates the removal of pus.

Any traditional methods should be used only after consultation with your doctor. Self-medication without taking into account contraindications and the stage of the disease can cause serious complications.

The information is for reference only and is not a guide to action. Do not self-medicate. At the first symptoms of the disease, consult a doctor.

Dacryocystitis of newborns

Separately, it is worth highlighting dacryocystitis in newborns as a special type of disease, the causes of which are associated with pathologies of intrauterine development or complications encountered during childbirth (for example, infection from a sick mother). However, studies have shown that in most cases, dacryocystitis is precisely the result of pathologies of intrauterine development.

The fetus, while in the womb, does not have formed lacrimal glands. They are still filled with a mucous mass held in place by a membrane membrane. As soon as the baby is born and cries, the thin membrane bursts and the tear duct is cleared of gelatinous mass. By this time, it is quite liquid and comes out freely without causing problems. In 7% of cases in newborns, the membrane does not rupture, and the lacrimal canal remains blocked. In this case, the child will develop dacryocystitis, the symptoms of which will appear in the near future.

In the first month of life, children have a slight discharge, but already in the second month you can notice stagnation of tear fluid and significant suppuration from the lacrimal sac. If the pathology is not treated in a timely manner, it will quickly progress to the acute stage and be complicated by phlegmon.

In a child with the manifestation of dacryocystitis, there is pain when pressing on the corner of the eye, an increase in body temperature, a blood test will show typical inflammatory markers confirming the presence of pathology. There is a danger of phlegmon when opening the pathology inside, which can lead to purulent contents entering the cranial cavity. This can provoke such serious diseases as purulent meningitis and brain abscess, which can be fatal in young children.

Another complication is no less dangerous - the appearance of ulcers on the cornea of ​​the eye. If left untreated, the pathology leads to blindness.

Prevention

In order to prevent the development of this disease, it is recommended to follow these rules:

• Avoid unsanitary conditions: it is important that all items used to care for the baby are clean.
• Parents should always wash their hands before handling their baby.
• If the eye is watery, bandages should not be used, as this can lead to complications.
• If symptoms of dacryocystitis develop, you should immediately show the child to a doctor and consult with him about your further actions.
• It is important to promptly treat all colds and follow the recommendations of a specialist.
• Adults should use only high-quality cosmetics that have not expired.
• You should protect your eyes when performing work where there is a risk of injury, and also protect your eyes when playing sports.

Diagnostic features

Dacryocystitis is easy to diagnose if you monitor the condition of the eye and notice the symptoms of the pathology in time. If you suspect dacryocystitis, you should contact an ophthalmologist who will conduct an examination and, if necessary, prescribe other methods for diagnosing the pathology. You should not draw conclusions on your own - dacryocystitis requires professional help and immediate treatment. Delaying therapy leads to complications.

Diagnosis of the disease includes the following methods:

1. Primary examination and diagnosis is the initial stage at which the doctor will identify the symptoms of pathology in the patient, palpate the area, and assess the condition of the lacrimal canal.
2. Vesta color test is carried out to assess the patency of the lacrimal canal and involves instilling the eye with a solution of fluorescein or collargol, which have a bright color and will clearly show whether there is a blockage of the canal. With normal patency, the dye will certainly remain on the napkin when the patient is asked to blow his nose after 5–7 minutes. If after 20 minutes the napkin remains clean, this means obstruction of the lacrimal canal and the presence of an inflammatory process (resulting in either blockage with purulent contents, or the disease is accompanied by significant swelling).
3. Instillation test is similar to the Vesta color test and is carried out with the same fluorescein solution, after which the patient is examined using a blue lamp. The technique allows you to detect damage to the cornea, since the reagent stains only healthy tissue.
4. Probing - determining the patency of the lacrimal canals using a Bowman probe. The procedure is performed under local anesthesia as it is quite painful.
5. X-ray – carried out if pathology of the nasal cavities and sinuses is suspected, and with the help of X-ray you can determine the patency of the lacrimal canal and the presence of damage.
6. Biomicroscopy of the eye is performed using a special device (slit lamp), which allows you to determine a number of pathologies, including dacryocystitis.
7. Passive nasolacrimal test - application of special substances to the cornea, which are quickly washed off with an antiseptic, and then using a slit lamp, the staining of healthy tissues and the presence of unpainted pathologically altered areas are observed (they acquire a specific yellowish tint).
8. Culture of discharge from the lacrimal canal to identify pathogenic microflora and prescribe the most effective medications for the treatment of the disease. The bacterial culture is taken in the morning, before hygiene procedures, and the doctor will receive the results of the study in about a week.

When examining the patient, the doctor will conduct a differential diagnosis with other ophthalmological pathologies, primarily with bacterial conjunctivitis, the symptoms of which resemble dacryocystitis, but the causes are different, and therefore the treatment tactics are different.

List of sources

• Kataev M.G. External dacryocystorhinostomy // Modern methods of diagnosis and treatment of diseases of the lacrimal organs: scientific and practical. conf.: Sat. scientific Art. - M., 2005. - P. 121-126.
• Ophthalmology: national guide / ed. S.E. Avetisova, E.A. Egorova, L.K. Moshetova, V.V. Neroeva, Kh.P. Tah-chidi. - M.: GEOTAR-Media, 2008. - 944 p.
• Strogal A.S. Efficiency of treatment of congenital dacryocystitis // Ophthalmol. Journal 1983. No. 7. pp. 437-438.
• Cherkunov B.F. Diseases of the lacrimal organs: Monograph. - Samara: GP Perspective, 2001. - 296 p. (140-152).

Drugs for therapy

The basis of conservative therapy is various eye drops that have a pronounced antimicrobial effect. Among them are recommended:

1. Tobrex - available in the form of ointment or drops. It works well against various types of pathogenic microorganisms, therefore it is widely used not only for the treatment of dacryocystitis, but also for the treatment of other ophthalmological pathologies associated with infection. You need to use 1-2 drops for several days. Eye drops are given every three hours, but a specialist will write out a detailed treatment regimen. Tobrex is usually well tolerated by patients, but sometimes it provokes inflammatory reactions in the form of itching, burning, and swelling of the soft tissues around the eyes. Not for use in children or pregnant women.
2. Albucid are antibacterial drops, but they are highly irritating and therefore not recommended for children.
3. Floxal is a broad-spectrum antibiotic that is available in the form of ointment or drops. Application is quite economical - just one drop or a small amount of ointment is enough to effectively treat the affected surface. The course of treatment lasts 10 days.
4. Vitabact is a very effective medicine against dacryocystitis, which is effective against most known pathogens that provoke pathology. It is noteworthy that the active substance does not enter the blood, but works exclusively locally, and therefore does not cause side effects.
5. Collargol is a silver-based drug that has a high antiseptic effect and perfectly kills pathogenic microflora. It is prescribed for instillation and washing of the inflamed area.

In severe cases of the pathology, the doctor will prescribe antibiotics for internal use for an average of 7 days. Mostly this is a group of cephalosporins and penicillins.

Diet

Diet 15 table

• Efficacy: therapeutic effect after 2 weeks
• Timing: constantly
• Cost of food: 1600-1800 rubles per week

A baby whose tear sac is inflamed should receive breast milk like all newborns. As for the advice about dropping breast milk into the eye, you shouldn’t follow it. Such use of breast milk can be not only useless, but also harmful, because in this case the risk of infection with pathogenic bacteria increases.

Adults can eat their usual food, trying to formulate a diet so that it is both varied and nutritious.

Surgical treatment of dacryocystitis

If conservative treatment is ineffective, surgery is performed to free the canal from purulent contents. There are several treatment methods used today:

• bougienage - probing the lacrimal canal and rinsing with an antiseptic solution, which allows you to restore patency and disinfect the canal;
• balloon dacryocystoplasty is the same procedure, only a balloon is inserted along with the probe, which expands in volume as it passes, thereby restoring the lumen of the canal;
• dacrycystorinomia - the formation of a new lacrimal sac if it is not possible to restore patency by other means (sometimes surgical treatment requires turbinate plastic surgery).

The choice of surgical treatment method is determined by the severity of the pathology and the changes that have already occurred during the inflammatory process. Unfortunately, the mucous membrane suppurates very quickly, and there is a risk of adhesions and infection of the passage, so you should not delay your visit to the doctor.

Massage

Prepare your hands before the procedure: wash, disinfect or wear gloves.

Massage scheme:

1. Press on the outer corner of the eye, turn your finger towards the bridge of the nose.
2. Gently press and massage the lacrimal sac, removing purulent masses from it.
3. Instill a warm solution of furatsilin and remove the discharge.
4. Carry out pressing and massaging movements along the tear ducts.
5. Jerky movements along the nasolacrimal sac with some force to open the canal and extract the discharge.
6. Instill a solution of chloramphenicol.

Lacrimal gland disorders

Disorders of the lacrimal gland manifest themselves in increased tear production ( hyperfunction ) or insufficient production of tear fluid ( hypofunction ).

Increased lacrimation may occur due to bright light, strong wind, cold and other external irritants, or as a result of disturbances in the innervation of the eye. A characteristic sign of lacrimal duct pathology is increased lacrimation (epiphora).

Hypofunction of the lacrimal glands (or “dry eye syndrome”) is one of the manifestations of Sjögren’s syndrome. It also occurs in endocrine and autoimmune diseases, in patients on hormone replacement therapy, in people who work for a long time behind a monitor, in smokers.

What are tears for?

With the help of tears, you can not only express your emotional state, first of all, we need them to protect our eyes. A thin layer of tear film covers the surface of the cornea and makes it perfectly transparent and smooth, protecting the eyes from drying out.

At the heart of tears is an antibacterial enzyme - lysozyme , which helps cleanse the conjunctival sac of small foreign bodies and microorganisms.

In normal conditions, a small amount of tears is required to moisturize the eye - 0.4-1 ml per day; it is produced by additional conjunctival glands. Large lacrimal glands begin to work when additional irritants appear: severe pain, emotional stress, foreign body contact with the conjunctiva or cornea. And also in too bright light, exposure to smoke and toxic substances.

Risk group

People ask me who is most susceptible to this disease? Most often women aged 35 to 70 years are affected. This is explained by the genetic characteristics of the female body - narrower tear ducts compared to males. In addition, women use cosmetics and, with insufficient hygienic care, can cause an infection in the eye.

Also at risk are people with weak immune systems, newborns and infants.

Predisposition to dacryocystitis is sometimes “written on the face.” People with a characteristic appearance - a round skull, a flattened nose, an oblong face - are more susceptible to the disease. In such patients, the complex anatomy of the nasolacrimal ducts and lacrimal gland becomes a predisposing factor.

In representatives of the Negroid race, dacryocystitis almost never occurs due to wider nasolacrimal ducts.

Dacryocystitis in adults has an unusual pattern - the left nasolacrimal duct is mainly affected. The fact is that the lacrimal glands are asymmetrically located: on the left side the distance is smaller, and the duct is narrower than on the right.

With timely consultation with a doctor and the absence of secondary pathologies, the disease in children and adults has a favorable prognosis. But in advanced cases, the infection may spread and dangerous complications may arise, even with the risk of death.

Unsuccessful surgical interventions caused by late consultation with a doctor and ignoring clinical recommendations can also lead to complications.

During the treatment of dacryocystitis, other ophthalmological interventions (cataract surgery and laser vision correction) are postponed until complete recovery from dacryocystitis.