In the first few days after the birth of the baby, his crying is not accompanied by the release of tears. And this is the norm. But, their absence after 2 to 3 weeks should force parents to contact a specialist who will find out the reason. Indeed, in most cases, obstruction of the lacrimal canal in newborns is manifested in this way.

From this article you will learn

What is lacrimal duct obstruction and what are its causes

Obstruction of the lacrimal duct (dacryocystitis) is an inflammatory process that affects the lacrimal sac, the area eyeball and around it. The main cause of dacryocystitis lies in the film that protects the nose. lacrimal canal fetus in the womb.

During the first cry of the baby after birth, it does not burst, but remains in place. This leads to the fact that tears cannot come out and accumulate in the lacrimal sac, along with bacteria that contribute to the appearance of the inflammatory process. Hence the redness, swelling of the eyes, which appears when the lacrimal canal is obstructed.

Knowing the structure of the nasolacrimal canal, you can eliminate the cause by asking for help from a doctor who will prescribe effective treatment. And before proceeding to eliminate them, you should understand why this is happening. Causes of dacryocystitis can be as follows:

• Congenital obstruction. She is characterized high density mucous film. In the event that after 2-3 months after the birth of the baby, his condition does not normalize, the film does not resolve on its own, it is necessary to resort to the bougienage procedure.
• The blockage can be caused by an infection in the lacrimal sac.
• Pathology associated with the fact that the nasal bone continues to grow and form. Due to this, it puts pressure on the lacrimal canal, blocking it.
• The formation of a tumor of the face or nose, cysts in the duct.

How does it manifest

It is quite difficult to determine the presence of obstruction of the lacrimal canal in a baby in the first weeks of his life, because it does not manifest itself in any way. But a little later, with the advent of tears, the first symptoms appear.

Most parents do not pay enough attention to them, assuming that it is all about conjunctivitis. After all, the symptoms of these two diseases are very similar. But in the case of dacryocystitis, the use of antibiotic drops helps to eliminate the symptoms only for the duration of their use.

An impassable lacrimal canal appears, as a rule, only in one eye, less often simultaneously in two. Symptoms may be as follows:

• Copious flow of tears, due to which the child's eyes regularly remain moist.
• In the corner of the eye, there is a collection of gray or yellowish color. When they dry out, they turn into a crust that gives the baby discomfort, gluing the cilia after sleep.
• There is swelling and redness of the eyelids.
• AT advanced cases pus can be released from the eyes, the baby feels pain, with light pressure on the nose.

Noticing that the baby has become capricious, refuses to sleep, eat, he has the symptoms listed above, you should show him to the doctor as soon as possible.

Having diagnosed dacryocystitis, as well as finding out the cause of its appearance, he will prescribe treatment. Independently engage in diagnosis, selection medicines, not worth it.

Treatment

In order for the baby to recover as quickly as possible, the symptoms that accompany such a state of the body cease to cause him discomfort, the treatment must be effective and timely. It can come down to:

• Massage.
• I close my eyes.
• Probing.

The best method by which the tear ducts can be brought into proper condition is massage. It, like other methods of treatment, should be prescribed by a doctor who will clearly demonstrate to parents the technique of execution. Having mastered it, you can perform medical procedure at home.

For newborns, massage is the most harmless and painless procedure. It must be carried out when the baby is in good mood. Do not forget about hygiene. Therefore, you can start the massage only with clean hands and short nails. The following photo will help to clearly explain how it should be carried out.

The sequence of the massage is as follows:

• The child's eyes are washed with a decoction of chamomile or a solution of furacilin. This must be done from outer corner eyes to the inside.
• Clearing the eyes of pus, index fingers placed in the area of ​​\u200b\u200bthe corners of the eyes, while their pads should be directed to the bridge of the nose.
• With sharp, but not very rough movements, pressure is made with the fingertips from the starting point to the tip of the nose. For one procedure, the pressures performed should be on average about 10. If tears or pus come out of the eyes during the massage, this indicates that a positive result will soon follow.
• After the massage, the eyes are buried. When choosing drops, preference is given to those that do not crystallize. These drops provide an additional barrier to the release of tear fluid.

Massage is aimed at breaking through the film and contributing to its speedy disappearance. As a rule, its proper implementation leads to the elimination of the problem after 2 weeks. If there is still no improvement, then it must be solved surgically.

Sounding is a surgical procedure, the duration of which is no more than 10 minutes. It is carried out under local anesthesia and does not deliver little patient painful sensations.

The procedure begins with the fact that the specialist instills the baby's eyes with drops that are local anesthesia, expands the channels and pierces the film with a probe, then cleans the channel.

For this, it is used saline and disinfectant. In order to preserve the result of the procedure, to prevent re-narrowing of the canal, the doctor prescribes a massage lasting a week.

You should not refuse the probing procedure prescribed by the doctor, as well as delay it. The fact is that the film will become rougher over time, and its removal will require more effort. That's why optimal age for sounding is the period from 3 to 6 months.

Preventive measures

No matter how hard the parents try, unfortunately, it is not in their power to completely protect the child from all kinds of diseases, including obstruction of the lacrimal canal.

Yes, and there is no special prevention from dacryocystitis, because it is a pathology with which the baby is born. But, it is possible to prevent its complicated course. For this you need:

• Pay due attention to the hygiene of the baby.
• Engage in timely and correct treatment of diseases affecting the eyes (conjunctivitis, sinusitis).
• Avoid placing the child in a strong wind, frost, under the scorching sun.

Most main advice for parents who are faced with this problem, it is not to delay in identifying the causes and eliminating them. After all, in addition to the fact that it gives the baby discomfort, there is a high probability of manifestation of complications. It is not worth bringing to this, because the health of the child is the most important thing.

Inflamed eyes with purulent discharge in infants are a cause for concern for many parents. Common causes the occurrence of this problem are conjunctivitis. However, in some cases, these manifestations are symptoms of blockage of the lacrimal canaliculus - dacryocystitis. effective method treatment of the disease is probing (bougienage) of the lacrimal canal.

Dacryocystitis is a very common diagnosis among babies, so parents need to know what lacrimal canal probing is, how the operation is performed and who needs it

Causes of obstruction of the lacrimal canals and indications for surgery

Obstruction of the lacrimal ducts occurs in about 5% of newborns. What is it caused by? Every child, while in the womb, has eyes, Airways and the nose are protected with a gelatin film. It usually bursts at birth. If this does not happen, then a plug forms in the lacrimal canal.

This gelatin plug prevents normal tearing. The fluid does not enter the nasal canal and accumulates in the lacrimal sac. As a result, it can become deformed and inflamed. The proliferation of bacteria leads to the formation purulent discharge swelling around the eyes. These phenomena lead to the development of dacryocystitis.

Dacryocystitis can also be caused by a congenital or acquired deviated septum. This causes blockage of the channel with mucus and dead epithelial cells. Absence proper treatment can inflict serious harm child's health. Dacryocystitis is accompanied by the following symptoms:

• the baby constantly has a tear from the eye;
• swelling under the eye;
• purulent discharge that leads to gluing of eyelashes after sleep;
• swollen eyelids.

It looks like dacryocystitis of the lacrimal sac of the eye

After diagnosing dacryocystitis, a specialist may prescribe a lacrimal canal massage and the use of anti-inflammatory drugs for the baby. eye drops. Parents can make it at home on their own. In the absence of positive dynamics after the course of massage, the necessary and effective procedure is the probing of the lacrimal canal.

Preparing your baby for probing

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The operation is performed on children aged 1-4 months. Probing the lacrimal canal in newborns is no different from the procedure for older children. Before bougienage, the child should be examined by an otolaryngologist. He must exclude the curvature of the nasal septum, since in this case the procedure will not give the desired effect. Preparing a baby for probing includes the following steps:

• Checking the patient's blood for clotting.
• Analysis of the contents of the lacrimal sac.
• Examination by a pediatrician to exclude concomitant diseases.
• Consultation with an allergist to prevent allergic reactions when using anesthesia.
• To check the patency, a West test is performed. It consists in the fact that a liquid with a dye is instilled into the child's eye, and a cotton swab is inserted into the nose. How severely blocked the channel will show the amount of colored fluid on the swab.

A few hours before the operation, the newborn should not be fed so that he does not burp during the procedure.

Immediately before probing, the child should be tightly swaddled. This will prevent the baby from moving, which can interfere with the doctor. Before probing, you should not take medications that are incompatible with those used during surgery.

How is eye surgery performed in newborns?

Bougienage is carried out in a hospital setting. The duration of the operation is 5-10 minutes. After the procedure, the child usually does not need hospitalization. used for probing local anesthesia. Alkain 0.5% is most often used as an anesthetic drug. The operation process is as follows:

1. the patient is placed on operating table and instill an anesthetic in the eye;
2. fix his position, the nurse holds his head;
3. a probe is inserted into the lacrimal canal to expand the lacrimal ducts;
4. then a thinner probe is introduced, which breaks through the gelatinous film;
5. the ducts are washed with a disinfectant solution;
6. carry out the West test.

Probing and washing the lacrimal canal of the eye in a newborn

Care after surgery

The probing procedure is simple, but some rules should be followed to avoid complications. Within 5-7 days, the child needs to instill antibacterial drops. To prevent adhesive process in the lacrimal sac, it is necessary to massage the lacrimal ducts. You can bathe the baby as usual, do not forbid him to touch his eyes. It should be protected from colds.

Possible consequences of the procedure

Usually, children tolerate the probing procedure well. However, each body reacts differently to surgery. Most often, complications after surgery occur due to a violation of the probing technique. A scar may form in the place where the lacrimal canal was punctured, but there are other consequences of probing:

• tears flow from the eyes for the first 14 days after the operation;
• discharge of blood from the nose;
• nasal congestion for several days after the procedure;
• the formation of adhesions in the lacrimal canal if the doctor's recommendations are not followed.

The first couple of weeks after the probing, a tear may flow from the eye.

Should be contacted immediately medical assistance with the following complications:

• nausea and vomiting;
• increase in body temperature;
• severe redness of the eyes;
• profuse tearing does not go away within two weeks after the operation;
• purulent discharge from the eyes and the formation of conjunctivitis;
• bleeding from the lacrimal canal;
• lack of tears when crying.

When may a second surgical intervention be needed?

As a rule, one probing procedure is sufficient to restore the patency of the lacrimal ducts in children under one year of age. However, if the doctor's recommendations are not followed, postoperative period a recurrence of the disease may occur due to the formation of adhesions.

Re-intervention is carried out if the patient's condition has not improved within a month.

The second probing procedure follows the same pattern as the first. In some cases, silicone tubes are inserted into the child's tear ducts - such a device prevents blockage of the tear ducts. These tubes are removed after 6 months. Baby care after repeated procedure usually does not differ from that recommended after the first operation.

Can probing be avoided?

The only way to avoid probing is to massage the tear ducts. The purpose of the procedure is to try to break through the gelatinous film that leads to blockage. Before carrying out the manipulation, it is necessary to wash your hands thoroughly to avoid getting an additional infection in the baby's eyes. The massage technique is as follows:

• before the procedure, the child's eyes should be wiped with a cotton swab dipped in Furacilin;
• slightly press on the area above the lacrimal sac and draw to the base of the nose;
• repeat the manipulation 10 times;
• wipe the discharge with a swab;
• drip the baby's eyes with anti-inflammatory drops (we recommend reading:).

Massage for newborns is carried out during feeding. Detailed instructions you can watch the video below (see also:). Massage up to 6 times a day for 10-14 days. If it does not give the desired result, then the only way elimination of dacryocystitis will be a probing procedure. Application folk methods treatment of blockage of the lacrimal canal can lead to irreversible consequences and a threat to the life of the child.

Dacryocystitis is an inflammation of the nasolacrimal duct. Obstruction of the lacrimal canal in newborns is the direct cause of dacryocystitis. The disease is curable and responds well enough conservative therapy. Severe obstruction of the nasolacrimal ducts in infants is a reason for surgical treatment.

Causes of dacryocystitis

Dacryocystitis in newborns is always congenital. The cause of this pathology is the blockage of the nasolacrimal canal by a thin membrane. Normally, the membrane is preserved throughout the fetal development of the fetus and breaks through with the first breath of the baby. In 5% of children, the membrane is preserved after birth, which leads to the formation of obstruction of the lacrimal canal.
Risk factors for developing dacryocystitis:

• congenital narrowness of the nasal passages;
• anomalies in the development of the nasal passages and turbinates;
• incorrect laying of the teeth of the upper jaw;
• facial trauma during childbirth.

Whatever the cause of the development of dacryocystitis, the outcome is the same. The nasolacrimal canal is impassable, and a tear begins to accumulate in the inner corner of the eye. Stagnation of tears creates optimal conditions for the development of bacteria. Inflammation occurs, leading to the appearance of all the main symptoms of the disease.

With obstruction of the nasolacrimal canal and formed dacryocystitis, the following symptoms occur:

• standing tears in the inner corner of the eye;
• lacrimation;
• redness of the mucous membrane of the eye;
• swelling of the eyelids;
• discharge of pus when pressing on the lacrimal sac in the corner of the eye.

Eye involvement can be unilateral or bilateral. In the latter case, the obstruction of the lacrimal canal is often confused with the usual conjunctivitis. The doctor will be able to distinguish one disease from another during a personal meeting with the patient.

Consult an ophthalmologist when the first symptoms of dacryocystitis appear!

With uncomplicated dacryocystitis, the general condition of the child is not disturbed. Stagnation of tears does not prevent the baby from contacting the outside world and does not cause much concern. The child sleeps well, eats and develops according to age.

Complications

At long course obstruction of the nasolacrimal canal can lead to the development of complications:

• phlegmon of the lacrimal sac;
• purulent ulcer of the cornea;
• brain infection.

Phlegmon of the lacrimal sac is manifested by severe edema in the region of the inner corner of the eye. The lower eyelid turns red and swells, the baby becomes restless, often cries, refuses to eat. Possible increase in body temperature.

Phlegmon sooner or later inevitably opens up, and pus comes out. This condition is quite favorable, because in this case, the entire contents of the phlegmon will be outside the eye. It is much worse if the phlegmon opens up inside, and the pus enters the orbit and the cranial cavity. Such a complication is dangerous for the life of the child and requires immediate help specialist.

Treatment tactics

With dacryocystitis in an infant, you need to see a doctor as soon as possible. If the baby's nasolacrimal canal is clogged, the child needs the help of an ophthalmologist. The sooner the diagnosis is made and treatment is started, the more chances the baby has to avoid the development of complications.

Conservative therapy

Massage of the lacrimal canal in newborns - the basis conservative treatment with dacryocystitis. Massage is carried out every 2-3 hours with cleanly washed hands.

During the procedure, you need to follow some rules.

1. Lay the child on their back or on their side and fix their head.
2. Press your little finger on the lacrimal sac.
3. Make several massaging movements at the inner corner of the eye. Imagine that you are drawing a comma - and move from the corner of the eye towards the nose. Press firmly but gently on the lacrimal sac to avoid damaging the baby's delicate skin.
4. Repeat the procedure at least 5 times.

Massage is considered effective if after the procedure a few drops of pus are released from the baby's eyes. The discharge that appears should be carefully collected with a cotton pad soaked in a solution of furacilin or boiled water.

Simultaneously with the massage are prescribed antibacterial drugs in the form of drops. The medicine is instilled into the eye immediately after the lacrimal sac is massaged. The duration of treatment is at least 2 weeks.

What can not be done with dacryocystitis?

• Instill breast milk in the eyes.
• Rinse your baby's eyes with tea.
• Use antibiotics without a doctor's prescription.

Any of these actions can lead to additional infection and worsen the child's condition.

How can you help the baby? Rinse the eyes with a solution of furacilin, remove the crusts after sleep and make sure that the child's eyelashes do not stick together from pus. Careful care of the area around the eyes will help to avoid secondary infection and the development of complications.

Surgery

Probing of the lacrimal canal in newborns is carried out if conservative therapy has been ineffective. Within 2 weeks, parents are encouraged to regularly massage the child. If during this time the condition of the baby has not improved, the nasolacrimal canal is washed.

Probing is performed under local anesthesia. During the procedure, the doctor inserts a thin probe into the nasolacrimal canal and breaks through the membrane. Next, it is introduced into the lumen of the canal. antiseptic solution. After the procedure, antibacterial drops and a lacrimal sac massage already known to parents are prescribed.

Washing of the lacrimal canal is carried out at the age of 2-6 months. In some cases, more than one procedure may be required before the problem is completely fixed. In the interval between soundings, massage and instillation of antibacterial solutions continue.

After the baby reaches six months, the membrane film overgrows, and probing becomes ineffective. In such a situation, a full-fledged operation under general anesthesia. With anomalies in the development of the nasolacrimal canal, surgical intervention is performed at the age of 5-6 years.

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Obstruction of the lacrimal canal in newborns occurs, according to various sources, in 7-14% of children.

This is a condition in which the normal outflow of tear fluid is disrupted due to complete or partial blockage of the lacrimal canal.

The structure of the nasolacrimal canal in a newborn child

The tear fluid performs several important functions:

• Protects the eye from drying out;
• Participates in the refraction of light;
• Forms a tear film;
• Nourishes the cornea.

Tears are produced by a gland located in the lacrimal fossa at the upper outer edge of the eye socket. First, it enters the conjunctival cavity, and then, through the lacrimal ducts, into the lacrimal sac, located near the inner corner of the eye. Excess tears exit through the nasolacrimal canal into the nasopharynx.

In newborns, the nasal canal is relatively short - only 8 mm, while in adults the length of the canal ranges from 14 to 15 mm. This creates favorable conditions for infectious agents to enter the lacrimal sac. In addition, the lacrimal canal in newborns is underdeveloped, which also contributes to the invasion (penetration) of microorganisms.

Mechanism of obstruction formation

The entire period of intrauterine development, the nasolacrimal canal is closed by a thin film that prevents amniotic fluid from entering the nasopharynx. However, during the passage of the baby through birth canal or with the first cry, this film breaks and releases the entrance to the nasolacrimal canal. If this does not happen, dacryocystitis develops - inflammation of the lacrimal canal due to fluid stagnation.

The first sign of obstruction of the lacrimal canal in infants is increased lacrimation. If the patency of the canal is not restored in the first weeks after birth, infectious agents (viruses or bacteria) penetrate into the lacrimal sac and purulent inflammation develops.

In some babies, the tear film may break on its own during the first six months or a year. This is due to the growth and expansion of the nasolacrimal ducts, as a result of which the film stretches and breaks on its own. All this time, the child should be under the close supervision of an ophthalmologist. With proper observance of all medical recommendations, inflammation of the lacrimal sac can be avoided.

Reasons for the formation

The following factors can lead to obstruction of the nasolacrimal canal:

• Partial or complete absence nasolacrimal canal;
• Anomalies in the development of the lacrimal sac (for example, the presence of diverticula - pathological outgrowths);
• Incorrect location of the lacrimal sac;
• Traumatic damage to the lacrimal ducts (for example, with careless obstetric manipulations);
• Congenital narrowness of the nasolacrimal canal;
• Curvature of the nasal septum and other anomalies in the structure of the nasal cavity;
• Dacryocystocele - dropsy of the lacrimal sac.

Obstruction symptoms

Obstruction of the nasolacrimal canal can be detected even in the maternity hospital. However, in most cases, this problem manifests itself much later.

The very first sign of the disease is the appearance of causeless lacrimation in a baby.. Moreover, it can be both unilateral and bilateral (in case of simultaneous damage to two eyes).

Some time after the appearance of tears, the eyes begin to redden, dacryocystitis develops. At the same time, stagnation of the lacrimal fluid is formed, which is a favorable condition for the attachment of bacteria and their further reproduction.

Purulent discharge appears, which may be accompanied by gluing of eyelashes and fever. Usually the causative agents of dacryocystitis are streptococci, E. coli, staphylococci, less often - chlamydia and gonococci.

Sometimes indicated symptoms mistaken for . However, conjunctivitis, unlike dacryocystitis, often has bilateral localization. In addition, there are a number of other diagnostic features that allow differentiating these conditions. More details about them are given in the "Diagnosis" section.

When pressing on the lacrimal sac, drops of cloudy fluid are released from the lacrimal puncta. purulent fluid. The largest number such discharge is observed after the baby wakes up or during strong crying.

As dacryocystitis progresses, ectasia of the lacrimal sac occurs - its stretching and increase in volume. At the same time, the skin above it is hyperemic (red) and sharply stretched. In especially neglected cases, the bag can reach the size of a ripe cherry.

Overstretching of the mucous membrane of the lacrimal sac leads to its atrophy and inability to produce a mucous secretion.

Diagnosis of obstruction of the lacrimal canal

Diagnosis of dacryocystitis in infants is based on anamnesis data (questioning the mother about the course of the disease) and the use additional methods research:

Comprehensive diagnostics must necessarily include a detailed clinical analysis blood and urine, as well as consultations of related specialists (pediatrician, ENT doctor) to exclude other diseases.

Treatment of obstruction of the lacrimal canal in newborns

Under no circumstances should you start self-treatment dacryocystitis in newborns at home. And even more so, you don’t need to listen to the advice of grandparents, experienced neighbors and others. This may lead to serious consequences(transition of the disease to chronic form, phlegmon of the lacrimal sac, phlegmon of the orbit).

There are several tactics for managing a newborn who has been diagnosed with obstruction of the nasolacrimal canal: conservative (expectant) and operative. Let's dwell on each direction in more detail.

Medicines

In parallel with the massage, the doctor may prescribe antibacterial agents to prevent infection. The choice of antibiotic directly depends on the results of the microbiological study.

Usually these are eye drops that must be instilled into the conjunctival cavity several times a day after the massage.

Good antibacterial efficacy the following drugs: vigamox, tobrex, chloramphenicol (0.3%), oftaquix, gentamicin (0.3%).

Contrary to popular belief, the use of albucid is undesirable for a baby for two reasons:

• When instilled causes a burning sensation;
• It is characterized by crystallization (precipitation). And this can further aggravate the obstruction of the nasolacrimal canal.

If the doctor has prescribed several medications, they should be instilled with a break of at least 20 minutes.

Operation

If conservative methods of treatment do not have the desired effect, it becomes necessary surgical treatment- probing the nasolacrimal canal. At the same time, the opinions of doctors regarding the timing of this manipulation diverged.

Some believe that the most optimal time falls on the 4th - 6th months of a baby's life. Others believe that probing should be resorted to after two months of unsuccessful conservative therapy. In any case, the timing of the sounding will be selected individually, depending on each specific case.

Before the operation, the baby must be examined by an ENT doctor to exclude concomitant diseases.

Probing of the nasolacrimal canal is performed by a pediatric ophthalmologist surgeon in a polyclinic. Typically, local anesthesia is used.

The child is swaddled tightly, and a nurse fixes his head. First, the nasolacrimal canal is expanded using a Siegel conical probe, which is inserted into the lacrimal punctum.

Then a long Bowman probe is inserted into the canal, which pierces the embryonic film. After that, the channel is washed with some disinfectant solution. Probing takes only a few minutes and is absolutely safe for the baby.

In 30% of cases, it may be necessary to repeat the manipulation.

As statistics show, probing allows you to restore the patency of the nasolacrimal canal in 90% of cases.

FROM preventive purpose after the intervention, the child is prescribed antibacterial drops, UHF and massage.

If the operation was unsuccessful, the cause of the obstruction lies in the anomalies of intrauterine development (for example, due to the curvature of the nasal septum). Then more serious surgical intervention.

Massage of the lacrimal canal in newborns

Massotherapy: Usually, conservative treatment begins with a massage of the lacrimal canal in a newborn. This is necessary in order to contribute to the rupture of the film and, thus, restore the patency of the nasolacrimal canal.

The earlier the mother starts the massage, the higher the chances of recovery without surgery. The fact is that with age, the film becomes much more dense, and it will be more and more difficult to break through it with the help of massage.

The doctor conducts the first massage of the nasolacrimal canal in newborns on his own in order to teach the mother the correct technique.

It was found that the correct massage allows you to restore the patency of the lacrimal canal in a third of children whose age has not exceeded 2 months. With each subsequent month, the probability of self-rupture of the film decreases.

Massage rules for obstruction of the lacrimal canal in newborns:

• Wash your hands before the procedure boiled water with soap, clean your nails thoroughly and cut them short;
• Pus that will come out during pressure on the lacrimal sac must be removed with a sterile gauze swab dipped in furacilin or chamomile decoction;
• Try to remember all medical recommendations regarding massage, especially the force with which you need to press. Stroking too lightly will not have any effect, at the same time, too intense movements can harm the child.

How to massage the lacrimal canal to the baby:

Massage for blockage of the lacrimal canal in newborns should be repeated 4-5 times and performed at least six times a day. Now you know how to properly massage the lacrimal canal for dacryocystitis in newborns.

The best time to massage is when the baby is crying.. The fact is that then the child strains all his muscles, especially facial ones, which can contribute to the rupture of the embryonic film.

Obstruction of the nasolacrimal canals is a fairly common pathology: about 7% of newborns suffer from it. This disease can develop in older children and even adults, but infants are most susceptible to it. Many mothers, noticing sour eyes in a baby, panic. They are afraid to go to the doctor, trying to heal the child with many months of washes and massages. Experts, however, recommend not to torment babies with daily unpleasant procedures, and fix the problem in a few minutes using the probing procedure.

Why is lacrimal canal probing needed?

A child in the womb does not have a free communication between the nasal cavity and the nasolacrimal duct. The exit opening is closed by a thin membrane, which in most children disappears by the time of birth. In this case, the nasolacrimal canal is usually clogged with a gelatin plug, which prevents amniotic fluid from entering the baby's body. When a child is born into the world, begins to breathe and scream, this mucous lump comes out of the duct, enters the nose and is removed by obstetricians.

If at birth the nasolacrimal canal is not freed from the natural plug, the baby develops dacryocystitis

However, it also happens that due to anatomical features or anomalies, the plug does not exit the lacrimal-nasal canal. Because of this, stagnation occurs in it. After some time, the newborn develops dacryocystitis - complete or partial obstruction of the lacrimal ducts. The baby's eyes are watery at first, and then they begin to fester and become inflamed.

In 80% of cases, dacryocystitis disappears spontaneously by 3-4 months, and massage and instillation of drops only accelerate this process.

Dacryocystitis can be either congenital or acquired due to trauma, inflammatory processes in the eyes or nose, and various diseases. This ailment can affect both children and adults. different ages. However, if acquired dacryocystitis often requires complex surgical interventions, then the congenital form usually disappears spontaneously or as a result of washings and massages.

If, after conservative treatment, the baby’s eyes continue to fester, doctors refer the child for probing - mechanical restoration of the patency of the nasolacrimal canal with the help of special tool- probe. The procedure is performed under local anesthesia and does not take long. However, probing does not guarantee a cure: after a certain period of time, the discharge may reappear. At re-intervention probability full recovery is 95–98%.

Constant tearing is the first sign of dacryocystitis

Over time, the gelatin plug in the nasolacrimal canal hardens. Therefore, the older the child becomes, the more traumatic and painful the probing procedure will be for him.

As a rule, doctors are in no hurry to send babies with “sour” eyes for probing. Often they recommend that parents wait up to 3-4 months to get rid of the problem with massages and eye drops. If by this time there is no improvement, probing is performed, which usually completely eliminates all symptoms.

Indications and contraindications for the procedure

Diagnosis of dacryocystitis in a baby can only be pediatric ophthalmologist However, any attentive parent can suspect this disease. Lacrimal duct obstruction is often confused with conjunctivitis. These diseases are really similar: their main symptom is purulent discharge from the eyes. However, if conjunctivitis can be easily eliminated with antibiotic drops, then with obstruction of the nasolacrimal canals, such treatment will be ineffective.

A clogged tear gland is an ideal breeding ground for bacteria, causing pus to ooze out of the eye.

The main symptoms of dacryocystitis are:

• constant tearing;
• eye redness;
• purulent discharge;
• swelling of the inner edge of the eye;
• discharge of pus when pressing on the lacrimal sacs.

As a rule, after sleeping or crying, the intensity of the discharge increases. In order for the child to see normally, pus has to be removed from the eyes quite often.

If a unpleasant symptoms persist for three or more months, doctors send the baby to probe one or both nasolacrimal canals. This, however, applies only to cases where the obstruction is not due to complex pathologies. Probing is not prescribed for:

• congenital malformations of the structure of the nasolacrimal canal;
• deviated nasal septum;
• blood clotting disorders;
• high fever and general malaise.

Since the procedure is performed under local anesthesia, before starting it, you need to make sure that the baby is not allergic to the anesthetic drug.

twisted nasal septum can also cause dacryocystitis, but probing will not help with this pathology

Diagnostics and preparation for probing

Before making a final diagnosis, the doctor usually performs a West test. To do this, a dye is instilled into the problematic eye, and a cotton swab is placed in the nose. If the nasolacrimal duct is open and the cause of the purulent discharge is the bacteria that causes conjunctivitis, the cotton wool will become stained. Otherwise, the ophthalmologist diagnoses dacryocystitis and sends the baby for probing.

Before the procedure, the child must be examined by the following doctors:

• pediatrician - for evaluation general condition organism;
• neurologist - to exclude diseases in which anesthesia is contraindicated, as well as to assess the neurological status;
• otolaryngologist - to assess the structure of the nasal passages and detect pathologies such as deviated septum.

And also the baby needs to be tested for blood clotting, and preferably - general analyzes urine and blood.

The probing procedure does not require special preparation: the child does not need to be kept starving and cleansing procedures do not need to be done. An anesthetic drug in the form of drops is injected directly into the eyes, after which you can proceed to clean the nasolacrimal canals.

An ophthalmologist directs the child to probe, however, before the procedure, the baby must be additionally shown to the pediatrician, neurologist and ENT

How is the probing of the lacrimal canal

The probing procedure is performed in several stages:

1. The child is swaddled and his head is fixed. Complete immobility is needed so that the baby does not twitch while the doctor works with a probe in his eyes.
2. An anesthetic is instilled into the eyes (in some cases, mask anesthesia may be necessary).
3. The doctor inserts a sterile thin probe into the nasolacrimal canal, expanding it and clearing the soft plug.
4. The insertion site of the probe is washed with an antiseptic solution.
5. The child is released from diapers and given to parents.

The whole procedure takes 5 to 10 minutes. If the child is more than 6 months old, then the cork has already hardened, so instead of probing, bougienage is performed. For this, the nasolacrimal canal is not cleaned, but pierced, making a through puncture in the cork.

Like probing, bougienage is absolutely safe and gives the baby a minimum discomfort. The procedure is performed under anesthesia, so the children cry not from pain, but from tight swaddling and fear of doctors.

Probing is a low-traumatic operation

To minimize the risk of complications, probing should be performed by a qualified pediatric ophthalmologist in a good clinic equipped with all the necessary equipment.

Child care after probing

The effect of the procedure is usually noticeable after a few days. The eyes stop watering and festering, and the child's condition finally returns to normal. The baby can be washed, bathed and performed with him all the usual procedures, but doctors recommend watching the eyes for at least another month. The first 7 days after probing, small patients need to instill antibacterial drugs and do a special massage aimed at improving the patency of the lacrimal canals.

The doctor who performed the probing should show exactly which places and with what intensity you need to massage. Usually recommended are circular movements or pushes with the fingertips of small intensity in the direction from the upper part of the inner corner of the eye along the nose to the mouth.

During the massage, you must adhere to the following rules:

1. Before the procedure, cut off your nails and wash your hands thoroughly or put on sterile gloves.
2. If a pathological secret has accumulated in the eyes, gently squeeze out the pus and rinse them with a decoction of chamomile or a warm solution of furacilin in a ratio of 1:5000. Make sure that the contents of the diseased eye do not get into the healthy one or into the ear.
3. After the massage, drip the eye with an antibacterial solution. Levomycetin or Vitabact is suitable.
4. Massage up to 5 times a day. It is best to do it before feeding: after eating, many children fall asleep, and the drops have an antibacterial effect during sleep.
5. Make all movements very carefully and carefully: in babies in the sinuses of the nose, there is not a bone, but a delicate cartilage, which is very easy to damage.

The intensity and sequence of movements during the massage of the lacrimal canal should be demonstrated by the doctor

If the parents complied with all the doctor's instructions, and within a month the discharge from the eyes did not disappear, then the child was diagnosed incorrectly or the probe did not break through the nasolacrimal canal to the end. In any case, you need to contact a specialist who will develop a further strategy for examination and treatment.

Possible Complications

With properly performed probing, the risk negative consequences is reduced to a minimum. The only thing possible complication- the occurrence of adhesions and overgrowth of the nasolacrimal canal. It is to prevent this that massage is aimed. If you do it conscientiously 3-4 times a day, the baby will not need re-probing.

The greatest danger in the postoperative period is for the baby viral infections. Due to a common cold, pathogenic microorganisms can penetrate into the injured opening of the nasolacrimal duct, which usually provokes a relapse of the disease. Therefore, for 1-2 months after probing, it is better for the baby to avoid children's groups and crowded places.

In most cases medical intervention easily tolerated by children reoperation not required. within 1-2 days are acceptable sanious secretions, and the eye may continue to water for up to 2-3 weeks. If lacrimation persists after this period, the child should be re-examined and possibly probing again. As a rule, after the second operation, the problem is completely eliminated.

Video: dacryocystitis in children - causes and treatment

Probing is an easy and effective surgical intervention. At proper conduct this manipulation, the risk of complications is minimal, and the probability favorable outcome maximum. However, before deciding on probing, you need to try to restore the patency of the nasolacrimal canal conservative methods, with the help of massage and washing. If, despite all efforts, the baby's eyes continue to water, do not be afraid of the operation: it will pass very quickly and cause only minor inconvenience to the child.