Surgery on the tear duct of the eye involves unclogging or widening the duct in order to remove its blockage. This pathology is called dacryocystitis and requires immediate treatment. If you delay this, the inflammatory process will intensify, and then probing alone will not be enough.

Reasons for the development of dacryocystitis

Dacryocystitis is common in infants as congenital pathology. The tear ducts of newly born babies can become clogged due to abnormal developments skulls, intrauterine infections or cystic abnormalities. In 80% of cases, the problem resolves itself when the baby starts crying because the tears clear the ducts. But if the pathology is more serious, the help of doctors is required.

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

By the way! Women who are interested in beauty injections and circular suspenders, also often become victims of dacryocystitis. The tear ducts of the eye become clogged with materials used for procedures, or the blockage occurs due to narrowing of the ducts caused by another cosmetic procedure.

Symptoms of pathology

It is not difficult to determine dacryocystitis, especially if it occurs in acute form. The skin around the eyes turns red, painful swelling appears, the eyelid swells, and the palpebral fissure narrows. Outwardly, it looks as if the person was bitten by bees, because the swelling severe inflammation It can spread to the cheek and even to the nose. The patient himself experiences pain when pressing or touching the eye, and twitching spasms. He may have a headache and a fever, which indicates the presence of an infection.

With chronic dacryocystitis there are no sharp painful manifestations. This flow is different external signs: The skin around the eye becomes thinner and takes on a bluish tint. Also, chronic inflammation of the lacrimal canal often leads to infection of the surrounding membranes of the eye. That's why concomitant diseases are blepharitis, keratitis, conjunctivitis.

By the way! The appearance of an eyesore (a white film that impairs vision and looks unsightly) can also be caused by chronic dacryocystitis, which occurs without obvious painful symptoms.

In newborns, the pathology is manifested by a visible narrowing of the palpebral fissures. The baby cannot open his eyes due to swelling. And when he starts to cry, there are no tears. If this light form disease, then there are no other symptoms. In severe dacryocystitis, hyperemia around the eyes and noticeable swelling can be observed.

How are tear duct pathologies diagnosed?

Sometimes it is not enough to determine dacryocystitis alone. clinical manifestations. You can clarify the diagnosis and check how advanced the inflammation of the lacrimal canal is using diagnostic methods.

Color tests

A white swab is inserted into the nasal passage. A dye solution is instilled into the eye. If after 2 minutes the tampon remains clean (not stained), then the patient has problems with blockage of the tear ducts. But they can be managed conservatively. If the tampon is not stained even after 8-10 minutes, then the pathology is advanced, and it is necessary surgery.

Sometimes a simpler method without a tampon is used. A dye solution is dripped into the eye and the patient is asked to blink. Based on how quickly the dye ceases to be visible on the eye (flows down the tear ducts), the doctor determines the degree of dacryocystitis.

Dacryocystography

This diagnostic method allows not only to detect the presence of cysts in the tear ducts, but also to determine their location, as well as the force of gravity on tear drainage. The patient is preliminarily injected into the lacrimal canal. contrast agent(for example, lipiodol), and then take pictures in several projections using special equipment.

Biomicroscopy

It is carried out if there is a suspicion not only of inflammation of the lacrimal duct, but also of other eye pathologies associated with developmental abnormalities or loss of vision due to the same dacryocystitis. Often biomicroscopy helps to identify eye diseases that the patient did not even know about.

Bakposev

For bacteriological culture A morning smear is needed to check microflora. The patient is asked to come to the appointment immediately after waking up, without washing. Using a special loop, a smear is taken from the crease of the lower eyelid. If a pathogenic microflora is identified, treatment with antibiotics will be required.

Conservative treatment of dacryocystitis in newborns

If the situation is not critical and there is no obvious inflammation, they try to treat babies conservatively. But you need to start therapy as early as possible so as not to miss the moment and not cause dacryocystitis.

Massage

The simplest and most gentle method that even moms and dads themselves can handle. Massage of the lacrimal canal is performed on newborns to soften cystic formations and bringing them out. Parents are taught a simple technique, and then they themselves try to cope with the problem. The main thing is that everything is sterile so that an infection does not develop in the tear ducts.

Attention! Massage of the lacrimal canal with dacryocystitis is prescribed only if you are sure that it is not purulent inflammation! Otherwise, pus may spread into nearby tissues and cause phlegmon.

If a newborn has purulent obstruction of the lacrimal canal, treatment with antibiotics is first required, and only then massage or other procedures.

Probing

Or bougienage of the tear duct. The procedure is performed on an outpatient basis under local anesthesia. A special probe is inserted into the baby through the lacrimal opening, which breaks through all obstacles and expands the duct. All this lasts just a few minutes. The only thing that causes discomfort to the baby is the inability to move the head, because it is held in place to avoid injury to the thinnest tissues. Otherwise, newborns calmly tolerate probing of the lacrimal canal.

If the baby starts crying during the procedure, this is even a plus. Because this way the doctor can immediately assess the effectiveness of the intervention. If necessary, probing is repeated after 2-3 weeks. After such an operation, the child must be prescribed eye antibiotics.

Surgical treatment of dacryocystitis in newborns

For infants, surgery is indicated if conservative methods treatments do not show positive results over time, and the disease progresses. There are two types surgical treatment blocked tear ducts:

• using laser technologies;
• in a classic way.

Laser dacryocystorhinostomy is more modern and less traumatic. Therefore, whenever possible, this type of intervention is used. An endoscope with a laser is inserted into the tear duct, the beams of which reach the obstacle and destroy it. The operation is considered minimally invasive, there is almost no bleeding, and healing occurs quickly. Another important advantage: laser dacryocystorhinostomy can be performed under local anesthesia. The main disadvantage is the high price (from 30 thousand rubles)

Standard intervention for blocked tear ducts in newborns is carried out in two ways: externally or through the nose (endonasal). The purpose of the intervention: to create a wide opening between the lacrimal sac and the nasal cavity. With classic dacryocystorhinostomy, it is required general anesthesia. The operation is dangerous due to its complications (infection), as well as damage to nearby tissues and leaving scars.

After any operation, it is necessary to wash the lacrimal canal with special solutions (antibacterial, physiological) for 7-10 days. Therefore, the newborn has to stay in the hospital for some time.

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

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

Preventing blocked tear ducts

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

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

Why is tear duct probing necessary?

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

If at birth the nasolacrimal duct 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 come out of the nasolacrimal 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 first water, and then 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 injuries, inflammatory processes in the eyes or nose, as well as various diseases. This disease can affect both children and adults different ages. However, while acquired dacryocystitis often requires complex surgical interventions, the congenital form usually resolves spontaneously or as a result of rinsing and massage.

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 duct with the help of special tool- probe. The procedure is performed under local anesthesia and does not last 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 duct 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. They often recommend that parents wait up to 3-4 months to get rid of the problem with the help of 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

Dacryocystitis can be diagnosed in a baby only pediatric ophthalmologist, however, any attentive parent can suspect this disease. Obstruction of the lacrimal ducts 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 treated with antibiotic drops, if the nasolacrimal ducts are obstructed, such treatment will be ineffective.

A clogged tear gland is an ideal place for bacteria to grow, causing pus to leak from the eye.

The main symptoms of dacryocystitis are:

• constant lacrimation;
• redness of the eyes;
• 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 a child to see normally, pus has to be removed from the eyes quite often.

If unpleasant symptoms persist for three or more months, doctors refer the baby for probing of one or both nasolacrimal ducts. This, however, only applies to those cases where the obstruction is not due to complex pathologies. Probing is not prescribed for:

• congenital defects in the structure of the nasolacrimal duct;
• deviated nasal septum;
• blood clotting disorders;
• high temperature and general poor health.

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

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 the Vesta test. To do this, a dye is dropped into the problem eye, and a cotton swab is placed in the nose. If the nasolacrimal duct is open and the cause of purulent discharge is bacteria that cause conjunctivitis, the cotton wool will become colored. Otherwise, the ophthalmologist diagnoses dacryocystitis and refers the baby for probing.

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

• pediatrician - for assessment general condition body;
• a neurologist - to exclude diseases for 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 a deviated nasal septum.

The baby also needs to undergo a blood clotting test, and preferably - general tests urine and blood.

The probing procedure does not require special preparation: the child does not need to be kept from hand to mouth and undergo cleansing procedures. An anesthetic drug in the form of drops is injected directly into the eyes, after which you can begin cleaning the nasolacrimal ducts.

An ophthalmologist will refer the child for probing, but before the procedure the baby must be additionally shown to a pediatrician, neurologist and ENT specialist.

How is probing of the lacrimal duct performed?

The probing procedure is carried out in several stages:

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

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

Like probing, bougienage is absolutely safe and causes minimal harm to the baby. discomfort. The procedure is carried out under anesthesia, so children scream 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 carried out by a qualified pediatric ophthalmologist in a good clinic equipped with all the necessary equipment.

Caring for a child after probing

The effect of the procedure is usually noticeable within a few days. The eyes stop watering and fester, and the child’s condition finally returns to normal. The baby can be washed, bathed and all the usual procedures performed on him, but doctors recommend monitoring his eyes for at least another month. For 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 tear ducts.

The doctor who performed the probing must show which areas need to be massaged and with what intensity. Typically, circular movements or low-intensity pushes with the fingertips are recommended 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 your nails and wash your hands thoroughly or wear sterile gloves.
2. If pathological secretion has accumulated in the eyes, carefully squeeze out the pus and rinse them with chamomile decoction or a warm solution of furatsilin in a ratio of 1:5000. Make sure that the contents of the diseased eye do not get into the healthy eye or into the ear.
3. After the massage, drip your eye with an antibacterial solution. Levomycetin or Vitabact are 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 infants, in the sinuses of the nose there is not bone, but delicate cartilage, which is very easy to damage.

The intensity and sequence of movements when massaging the lacrimal duct must be demonstrated by a doctor.

If the parents followed all the doctor’s instructions, and within a month the discharge from the eyes did not disappear, it means that the child was given an incorrect diagnosis or the probe did not penetrate the nasolacrimal duct completely. In any case, you need to contact a specialist who will develop a further strategy for examination and treatment.

Possible complications

If probing is carried out correctly, the risk negative consequences is reduced to a minimum. The only thing possible complication- the occurrence of adhesions and overgrowth of the nasolacrimal duct. This is precisely what massage is aimed at preventing. If you do it conscientiously 3-4 times a day, the baby will not need repeated probing.

Great danger in postoperative period represent for the baby viral infections. Due to a common runny nose, 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, and reoperation not required. Within 1–2 days acceptable bloody discharge, 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, probed 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 correct implementation this manipulation, the risk of complications is minimal, and the likelihood favorable outcome maximum. However, before you decide to probe, you need to try to restore the patency of the nasolacrimal duct using conservative methods, using massage and rinsing. If, despite all efforts, the baby’s eyes continue to water, do not be afraid of the operation: it will go away very quickly and will cause only minor inconvenience to the child.

Treatment of dacryocystitis in adults and children varies greatly. While newborns only need to massage the lacrimal canal, this treatment method helps older children and adults much less often. Accordingly, doctors resort to surgical intervention.

In this article we will describe all the main methods of treating dacryocystitis in adults, or rather, we will talk about all operations for blockage of the lacrimal canal, including bougienage, dacryocystorhinostomy and dacryocystoplasty. We will also talk about when it is possible to use massage as a treatment and about some folk methods.

Dacryocystitis is an infectious and inflammatory disease. It develops as a result of blockage of the lacrimal canal, or its anatomical narrowing. In this case, there is no outflow of tear fluid to the lacrimal canals. Such stagnation leads to the accumulation of fluid in the lacrimal sac, as a result of which it becomes infected, leading to an inflammatory process. Dacryocystitis is most often diagnosed in adults aged 30 to 60 years, especially in women (which is associated with the anatomy female body: their nasolacrimal ducts are much narrower than those of men). With dacryocystitis, profuse lacrimation appears, the lacrimal sac becomes swollen, the palpebral fissure narrows, and when pressure is applied to the area of ​​the lacrimal sac, pus is released.

We talked very briefly about what dacryocystitis is. Further in our article we'll talk about dacryocystitis in adults, namely about its treatment. Because this disease is particularly dangerous, it can lead to serious complications, including fatal outcome. In addition, the process of development of the disease from simple inflammation to a purulent form is quite fast.

Treatment of tear duct obstruction in adults

Before starting treatment, it is necessary to determine the presence of this disease. To do this, you need to consult an ophthalmologist. Through examination, the doctor will be able to identify the disease, determine the degree of obstruction of the fluid in the lacrimal drainage system, its localization (after all, without an examination it is difficult to determine exactly where the narrowing of the lacrimal canal occurred). Based on the results of all actions, the specialist will prescribe the necessary treatment.

Dacryocystitis in adults is usually treated with surgery. The choice of surgery depends on the severity of the disease. At mild form diseases, it is also possible to use massage. Let's look at all types of treatment.

Acute dacryocystitis

Acute dacryocystitis has several treatment methods, including bougienage and some other procedures.

Bougienage

Bougienage of the tear duct

During bougienage, the doctor inserts a rigid probe into the lacrimal duct, with the help of which the patency of the nasolacrimal canal is restored. In addition, this procedure also includes washing the lacrimal canal, which is carried out with disinfectants and antibacterial agents.

Other procedures

When purulent inflammation (abscess) of the lacrimal sac forms, UHF therapy is prescribed, vitamins are prescribed, and dry heat is recommended to be applied to the affected area.

If these procedures do not lead to a positive result, then the purulent inflammation is opened. After which the wound is treated antimicrobial agents(for example, hydrogen peroxide, furatsilin). To avoid the development of infection, the eyes are instilled with antibacterial drops (chloramphenicol, miramistin) or antibacterial ointments (tetracycline, erythromycin) are used.

In addition to all of the above, the patient is prescribed antibacterial treatment to exclude development infectious complications(such as brain abscess, purulent form encephalitis).

Chronic dacryocystitis (advanced cases)

At running forms, especially when the patient is diagnosed with chronic dacryocystitis, it is used surgical treatment: dacryocystorhinostomy and dacryocystoplasty.

Dacryocystorhinostomy

This is the view surgical intervention, after which a new connection is created between the lacrimal sac and the nasal cavity. Dacryocystorhinostomy, in turn, is divided into several types: traditional (an incision is made on the skin of the eyelid or through nasal cavity), endoscopic and laser (inside the nasal cavity). Let's look at them in a little more detail:

1. Traditional. This type surgical intervention is used quite rarely. Doctors recommend using it only in certain cases, for example, with a tumor of the lacrimal sac, Down syndrome and other exceptional situations.
2. Endoscopic. A thin flexible tube with a camera (endoscope) is inserted into the tear duct. Subsequently, an incision is made in the blocked canal, which allows the creation of a new channel of communication between the tear duct and the nasal cavity. The positive aspect of this operation is the absence of visible seams or scars.
3. Laser. For such an intervention, an endoscope with a laser is used. A laser makes a hole in the nasal cavity, thus connecting it with the lacrimal sac. The advantages of laser dacryocystorhinostomy include the following: the time for the operation is reduced, as well as the duration of patient rehabilitation; the operation is accompanied by less bleeding; the patient experiences less painful sensations; after surgery there are no visible defects left.

However, where there are advantages, there are also disadvantages: such an operation is more expensive (therefore, not all patients can afford it); the highest surgical skills are required.

This surgical intervention allows you to restore the patency of the tear duct without making incisions on the face. The essence of the method is as follows:

• A thin conductor is inserted into the nasolacrimal duct, at the end of which an expanding balloon is attached.
• The balloon is brought closer to the blocked area, after which it is filled with liquid.
• As a result of filling, the balloon opens, which leads to expansion of the blocked area. After which the balloon is removed.
• In progress this operation under local anesthesia, so absolutely painless procedure difficult to name ( painful sensations present, but insignificant).

After balloon dacryocystoplasty, there are no scars or other defects, and patients can go home almost immediately. The patient is also prescribed antibiotics and antimicrobial eye drops. Also to positive aspects It can be attributed to the fact that after the procedure the risk of complications is significantly reduced.

• The patient is allergic to general anesthesia.
• the patient does not want to undergo abdominal surgery.
• the disease did not go away after dacryocystorhinostomy.

When can massage help?

If dacryocystitis has just begun to develop, then patients are offered conservative treatment methods, namely therapeutic massage lacrimal sac. Massage will help remove accumulated tear fluid. However, in severe forms of the disease, with extensive inflammatory processes massage is contraindicated.

Before starting the procedure, the eyes are instilled antibacterial drops. Then, using movements (vibrating and spiral-shaped) with pressure (not too weak, but not too strong), you need to massage the nasolacrimal canal. If pus is released during the procedure, this will mean that the massage was performed correctly. It is better to collect purulent discharge with cotton pads or tampons.

Traditional medicine

Experts may recommend that patients do the following:

• Warm up (using reflector lamps, cloth bags). It is advisable to perform the procedure several times a day.
• Apply steamed bags of chamomile or a cotton swab dipped in a chamomile solution. It should be borne in mind that the infusion should be warm, but in no case hot.
• Make compresses from calendula infusion.
• Instill Kalanchoe juice into the nasal passage (previously Kalanchoe juice must be diluted with saline solution, since pure juice very concentrated).
• For lotions, use an infusion of calendula flowers, mint leaves, dill, oregano, eucalyptus and sage (all herbs should be taken in equal proportions).
• Apply parsley compresses to the inflamed area.

Treatment prognosis

A positive treatment result when dacryocystitis is detected in adults depends on timely measures taken to combat the disease and strict adherence course prescribed by the doctor.

In most cases, treatment leads to positive results, but complications occasionally occur. To avoid negative consequences, patients are prohibited from using contact lenses, and most importantly, self-medicate. Deviation from the prescribed course of treatment can lead to deterioration of health, including loss of vision.

Sometimes after the birth of a child, young parents notice that when the baby cries, he does not produce tears. This condition may indicate obstruction of the lacrimal duct, which in medical circles is called dacryocystitis of newborns. With this pathology, the newborn baby's tear duct remains blocked, which leads to stagnation of tears, redness of the eyes, and inflammation of the eyelids. Dacryocystitis must be treated, otherwise on the tenth day of the child’s life, when pressing on the area of ​​the conjunctival sac, purulent discharge will occur. As a result, it may develop serious complication– purulent conjunctivitis. Therefore, it is often necessary to probe or bougienage the lacrimal canal in newborns.

Why do babies sometimes lack tears?

During intrauterine development, many of the child’s organs function somewhat differently than after birth, as they are protected from various external influences. The nasolacrimal duct, intended for the outflow of tears, is no exception, and is closed by a so-called gelatinous film. It protects the nasal passages, organs of vision, respiratory tract fetus from ingestion of amniotic fluid. At the birth of a baby, this film ruptures, and the newborn’s organs begin to adapt to life outside the mother’s womb. However, sometimes it happens that the film does not break. Then the nasolacrimal duct remains impassable and closed.

Treatment

As a rule, pediatric ophthalmologists do not immediately resort to the bougienage procedure. First, special drops are placed in the baby's eyes to prevent reproduction. pathogenic bacteria. Then the doctor attempts to artificially rupture the film for 3-4 days - massage the area of ​​the nasolacrimal duct. Of course, such a massage should be done by a qualified specialist, although sometimes this procedure Trusted to be carried out by young mothers trained by a doctor.

Bougienage procedure

If massage doesn't work positive result and the lacrimal canal does not break through, an operation is prescribed to bougienage it (probing). Even in the absence of purulent discharge, this procedure must be carried out no later than the first 3 months of the baby’s life. Many parents are afraid of surgical intervention in such a early age child, but there is no need to worry. The operation of probing the lacrimal canal is simple and is carried out within 10 minutes.

The bougienage procedure in newborns is performed under local anesthesia. Most often, painkillers 0.5% Alcaine drops are instilled into the baby's eyes. First, using special Sichel probes, the doctor expands the baby's tear ducts. A Bowman probe is then used to break through the gelatinous film and gently clear the tear duct. After this, the canal is washed with saline solution and disinfectants. In some cases, a scar quickly forms at the site of the film breakthrough. Then re-bougienage will be required. To avoid this, after the operation it is necessary to give the child a preventative massage for several days.

At the end of the probing procedure, the doctor can check the effectiveness of its implementation by prescribing the Vesta test. The essence of such testing is as follows: a cotton swab is placed in the newborn’s nasal passage, and a dye solution, collargol, is instilled into the eyes. The success of the operation is evidenced by traces of staining of the tampon that appeared after 5 minutes. If there is no dye on the cotton wool, a repeat examination and secondary probing will be required.

Features of the procedure

Any operation, including bougienage of the lacrimal canal, has its own nuances. Sometimes it is impossible to predict the baby’s body’s reaction to local anesthesia. In addition, over time, the gelatinous film covering the nasolacrimal duct hardens. If the probing procedure is carried out at the age of six months and later, then it will be much more difficult to break through the film. That is why it is recommended to bougienage the lacrimal canal in newborns at the earliest early stages development child's body. And parents are required to strictly follow all doctor’s recommendations. Then the child will not have any problems with vision.

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

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

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

Causes of the disease

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

Causes of tear duct obstruction include:

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

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

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

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

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

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

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

External medicines. IN in rare cases Using eye drops (for example, to treat glaucoma) may cause blockage of the tear ducts.

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

Risk factors

Known risk factors for tear duct obstruction include:

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

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

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

Glaucoma. Glaucoma medications sometimes cause tear duct obstruction.

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

Symptoms of tear duct obstruction

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

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

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

Diagnosis of the disease

Diagnostic tests to determine tear duct obstruction include:

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

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

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

Treatment of tear duct obstruction

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

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

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

Conservative treatment

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

Minimally invasive treatment

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

Surgical treatment

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

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

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

Complications of the disease

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

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

Disease prevention

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

Konstantin Mokanov