Obstruction of the lacrimal duct - causes and treatment. Narrowing of the nasolacrimal canal and dacryocystitis in an infant. What to do? Stenosis of the lacrimal canaliculi in adults treatment

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

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

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

Causes of the disease

Causes of tear duct obstruction include:

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

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

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

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

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

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

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

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

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

Risk factors

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

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

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

Glaucoma. Glaucoma medications sometimes cause tear duct obstruction.

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

Symptoms of tear duct obstruction

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

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

Diagnosis of the disease

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

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

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

Treatment of tear duct obstruction

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

Minimally invasive treatment

Surgery

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

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

Dacryocystitis in newborns accounts for 6-7% of all cases of eye diseases. Violation of the outflow of tears provokes stagnation and inflammation of the lacrimal sac (dacryocystitis), and then conjunctivitis, due to which parents do not notice the true cause of the disease. At the same time, they struggle with the clinical consequences for months.

Constant crying is common for a newborn baby. But if you begin to notice problems in one or both eyes after sleep, signs of inflammation or discharge of pus, and the treatment you have chosen does not bring results, perhaps it is time to reconsider the diagnosis.

Obstruction of the lacrimal canal is observed in all newborns. This is an anatomical feature of embryo development. During the formation of the respiratory system in the mother's womb, the lacrimal canal is closed by a thin epithelial septum (film), which protects the baby's respiratory system from the ingress of amniotic fluid.

When the baby was born, took air into his lungs and cried for the first time, the film breaks under pressure, freeing the patency of the lacrimal canaliculi.

Tears are produced in a gland located under the upper eyelid. It washes the entire eyeball and accumulates in the corners of the eyes near the nose. There are lacrimal openings - these are two openings behind which there are lacrimal canals, the upper (absorbs 20%) and the lower (80%). Through these tubules, tears flow into the lacrimal sac and then into the nasal cavity.

A blockage, obstruction, stenosis, mucus plug or simply a narrow tear duct in a child that leads to stagnation of tears and subsequently becomes inflamed is called dacryocystitis.

There is congenital (primary) dacryocystitis in newborns, which manifests itself immediately after birth, and eventually goes away on its own in children up to one year old. And there is secondary (acquired) dacryocystitis, it does not appear immediately, does not go away after a year or longer, and is a consequence of blockage of the tubules after birth.

Tears are responsible for moisturizing the eye, nourishing the cornea, and contain dissolved immune complexes to fight bacteria that enter the eye from the air. Together with the lipid layer, tears form the eye film, which, in addition to protecting against drying out, reduces friction between the eyelid and the eyeball. Therefore, any narrowing or stenosis of the lacrimal canal disrupts the process of natural tear formation and natural circulation, which leads to complications.

Consequences of dacryocystitis in children:

• purulent, infectious conjunctivitis;
• decreased visual acuity;
• phlegmon of the lacrimal sac;
• the appearance of fistulas of the lacrimal sac;
• development and generalization of infection.

Causes

Obstruction of the lacrimal canal in a newborn or infant is explained by the lack of rupture of the protective film that was given to us at birth. Or the presence of accompanying adhesions or mucus plugs, which the newborn could not get rid of with the first cry.

Causes of dacryocystitis in newborns:

• anatomical underdevelopment of the lacrimal system;
• excessive tortuosity or narrowing of the tubules;
• anomaly in the location of the lacrimal sac;
• curvature of the bones of the facial skull;
• polyps, growths, tumors that physically block the outflow.

Dacryocystitis in older children occurs due to trauma, physical damage, inflammation, or as a complication of a more serious disease.

Symptoms of the disease

Blockage of the tear duct in children is often confused with the usual problem, and the wrong problem is treated for weeks. To distinguish conjunctivitis from dacryocystitis, you need to take a closer look at the newborn baby.

1. You may notice that your newborn's eyes will occasionally tear from one or both eyes for no apparent reason when the baby smiles. This suggests that the tears simply have nowhere to go, and the excess flows down the cheeks.
2. Then stagnation occurs. Dirty tears that washed the eyeball accumulate in the sac, forming a “swamp”. At this stage, the inflammatory process occurs, we see redness, swelling, swelling, all signs of conjunctivitis.
3. At the next stage of dacryocystitis, the newborn’s eyes begin to sour, at first only after sleep, then constantly.
4. Then they appear, and when you press on the swelling in the projection of the lacrimal sac, pus flows out of it.
5. Over time, the process worsens, and antibacterial treatment gives only temporary results.

Diagnostics

Only an ophthalmologist can accurately diagnose dacryocystitis in newborns. At the first stage, if you suspect that the child’s tear duct is clogged, you can contact pediatricians at an appointment or a visiting nurse, and then you need to visit an ophthalmologist.

At the appointment, the doctor will examine the newborn, prescribe the necessary procedures, tests, and tests. Using a dye (collargol or fluorescein solution) and the Vesta test, the presence of blockage is checked. In this case, drops of dye are dropped into the eye and the time of their appearance is noted, as well as the amount on a cotton swab in the nose.

Sometimes it is necessary to consult related specialists and examine an otolaryngologist to determine the structure of the nasal sinuses or septum. If necessary, ultrasound, computed tomography of the facial bones, and laboratory tests are prescribed.

When inflammation occurs, a bacteriological sample of discharge from the eye is taken to determine the flora and sensitivity to antibiotics.

Video: Health Guide: Dacryocystitis

How to treat dacryocystitis in children

Dacryocystitis of newborns involves three treatment options:

• conservative methods;
• wait-and-see tactics;
• surgical intervention.

Your doctor will determine which treatment method is right for you when examining your newborn. Do not self-medicate or use unconventional folk methods. A newborn is not a field for experimentation.

Conservative methods of treating dacryocystitis include medications and massage. Combining these two methods can significantly speed up the healing process and alleviate the condition of the newborn baby.

Use drugs only in children's dosages and strictly follow the rules and techniques of massage.

Drug treatment

Obstruction of the nasolacrimal duct in children is treated mainly with drops and ointments. The choice of antibacterial agent should be based on seeding and seeded microflora. Drops are instilled during the day and after a massage, and ointments are placed behind the lower eyelid at night. The dosage and method of administration are prescribed by the doctor.

Drops and ointments for dacryocystitis for the treatment of newborns:

1. "Albucid".
2. Vigamox.
3. Tobrex is often prescribed to infants.
4. "Levomycetin".
5. Gentamicin ointment.
6. Dexamethasone ointment.
7. Oftaquix.
8. A solution of furatsilin or chlorhexidine for washing and wiping the eyes.

Before use, the drops must be warmed to body temperature in the palm of your hand or in a water bath. Since opened medications must be stored in the refrigerator, it will be very unpleasant for the baby to drop cold medications into the eye.

Video: Dacryocystitis or sour eyes in infants

Massage

How to pierce the tear duct yourself without surgery? The main method of treating dacryocystitis in newborns is. The movements resemble pressure from the corner of the eye to the tip of the nose along the nasal septum. This physically pushes out any blockages and helps the tubules free up.

Massage technique for newborns with dacryocystitis:

1. First of all, you need to wash your hands, remove all jewelry, and trim your nails so as not to injure the newborn or cause an infection.
2. If purulent discharge is present, first, using a bottom-up motion, it is necessary to squeeze out the purulent contents. Wipe your eye with a cotton pad or gauze soaked in an antiseptic solution.
3. Then instill the antibiotics in drops and now push the drops from top to bottom through the tubules into the lacrimal sac and beyond. Drops must be instilled several times.
4. Repeat these movements ten times, two to three times a day. At night, place ointment behind the lower eyelid.

Video: How to massage the tear duct?

Operation

Surgery is the most radical method for dacryocystitis in young children and is used only if previous methods have not worked. Patency is then surgically restored. The procedure takes place in a hospital setting, under local or general anesthesia.

If, after conservative treatment of dacryocystitis, the lacrimal canal in the newborn has not opened, use:

• Artificial puncture of the lacrimal canal in newborns.
• Canal plastic surgery for structural anomalies.
• Bougienage, probing the lacrimal canal.

The most popular is probing. In this case, a small thin probe is inserted into the opening of the lacrimal canal, which breaks through plugs, breaks films, adhesions, and also expands the patency of the lacrimal ducts. The procedure takes a few minutes, is painless, but unpleasant for a newborn baby. In some cases, probing is repeated after a couple of months.

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

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

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

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

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

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

Symptoms

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

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

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

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

Diagnostics

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

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

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

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

Treatment methods

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

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

In more complex cases, the following procedures are prescribed:

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

Massage

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

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

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

Complications and prognosis

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

Prevention

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

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

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

Description

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

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

Causes of tear duct stenosis

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

Risk factors for tear duct stenosis

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

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

Symptoms of tear duct stenosis

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

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

Diagnosis of lacrimal duct stenosis

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

Treatment of lacrimal duct stenosis

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

Treatment includes:

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

Prevention of lacrimal duct stenosis

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