Bougienage of the lacrimal canal. Elimination of obstruction of the lacrimal canal using bougienage. What it is

Normally, after birth, a child undergoes a number of changes in the body, due to which newborn adapts to life outside mother's tummy. But sometimes some problems arise that require medical intervention. One of these problems is dacryocystitis - by this term doctors mean obstruction of the lacrimal duct. While the baby is in the womb, its tear duct is closed by a gelatin plug, which normally bursts during childbirth as soon as the baby screams.

Sometimes, for various reasons, this does not happen, and then we are dealing with a disease such as dacryocystitis, which occurs in 5% of newborns.

Unfortunately, the causes of this condition in no way depend on either the parents or the medical staff. That's why prevent they won't work.

The disease can develop due to the following reasons:

• maintaining the integrity of the plug in the tear duct after the birth of the baby;
• anatomical features of the structure of the lacrimal canal, namely its narrowing;
• abnormal structure of the nasal cavity.

All this leads to the fact that the excretory processes are disrupted, all the liquid collects in the lacrimal sac, the canals become blocked with mucous secretions and dead epithelium, resulting in inflammation.

Symptoms of the disease

Usually, symptoms of dacryocystitis are obvious, and it is hardly possible to miss them. But we still recommend that you familiarize yourself with the dangerous signals that you should pay attention to.

• Severe tearing. If a child does not cry, but his tears still flow, this is a clear sign of illness. A feature of the symptom is its objectivity, starting from the second month of life, when the child produces a sufficient amount of tears.
• Perceptible swelling in the corner of the eye, which may vary in size.
• Severe redness affected eye.
• Discharge of pus.
• One-sided nature, that is, dacryocystitis usually affects one eye.
• If left untreated, hyperthermia (increased body temperature) appears and phlegmon may occur - purulent inflammation.

If a child experiences similar symptoms, do not wait until they disappear on their own; contact an ophthalmologist immediately to avoid complications.

After a small patient contacts an ophthalmologist with suspected obstruction of the lacrimal duct, the doctor must first confirm or refute this diagnosis.

Several techniques are used for this.

Methods for diagnosing dacryocystitis:

• Tubular test. To understand whether a child has dacryocystitis, you need to make sure that the lacrimal ducts are obstructed. To do this, a colored solution called collargol is instilled into the affected eye. If the color disappears within 5 minutes, the diagnosis is not confirmed; if the absorption of the substance is slowed down to 10 minutes or more, the patency is absent or significantly impaired.
• Nasal test. The procedure is similar to the previous one, but it is estimated how quickly collargol is absorbed into a cotton swab placed in the nasal passage after instillation of the eye.
• Analysis of secretions from the lacrimal sac.

If, after the studies, the diagnosis of dacryocystitis is confirmed, an ophthalmologist will prescribe treatment. Depending on the patient’s condition, it can be either conservative or surgical.

Conservative treatment

As with most other diseases, before using surgery, the doctor tries to help the patient with conservative methods.

This tactic is especially relevant when it comes to a newborn baby.

To help a child without surgery, use:

• Massage. Parents can massage their babies themselves, without visiting the hospital. This is especially important given the fact that massage sessions will have to be performed up to 6 times a day. Before you begin, you need to cleanse your eye of all dirt and secretions. The session itself consists of circular movements with the little finger in the corner of the eye. After finishing, wipe the affected area again with a cotton swab soaked in furatsilin to remove pus.
• Drug treatment antibacterial drugs. Such products as Tobrex, Levomycetin, Vitabact, Vigamox and others are used.

Only if there is no improvement after conservative treatment, the doctor prescribes probing or bougienage of the lacrimal duct for the child.

Preparing for bougienage

Although bougienage is considered a procedure rather than an operation, it requires high precision from the doctor, and from parents a serious attitude towards preparing the child. Firstly, it is necessary to take into account the fact that probing is carried out under local anesthesia. And although this type of anesthesia is more harmless for the child’s body than general anesthesia, it is still worth strictly following the doctor’s instructions:

• Examine the child by an otolaryngologist to rule out the presence of a deviated nasal septum.
• Before carrying out the intervention, undergo a complete examination of the baby by a pediatrician to make sure that he is healthy and to exclude viral and bacterial infections. A general blood test is mandatory.
• Do not feed your baby several hours before the procedure to avoid digestive problems. Check with your doctor for the time period.
• Swaddle the newborn tightly in a previously prepared diaper so that it does not interfere with the operation.

The probing procedure is quite simple, do not be afraid and put it off - remember, the sooner the operation is performed (preferably within a year), the more likely it is that it will pass without any complications. The optimal age for probing is considered to be 1-3 months.

Probing procedure

So, the diagnosis of dacryocystitis has been established. So how is probing of the lacrimal duct performed in children under one year of age?

The procedure is carried out in 2 stages:

• Direct probing. The baby is swaddled tightly and the head is fixed. An experienced specialist instills an anesthetic into the eye and inserts a Bowmon probe - a wire-like device with which the plug in the tear duct is destroyed and the tear duct itself expands.
• Sanitation of the lacrimal system. To prevent inflammatory processes at the procedure site, antibacterial and anti-inflammatory therapy is carried out.

The whole procedure takes no more than five minutes and, in most cases, solves the problem of canal obstruction. But 40% of patients will still require repeat bougienage.

Recovery after surgery

Probing the lacrimal canal in newborns is, although not complicated, still an operation, and after it is carried out, it is necessary to follow some recommendations:

• Place antibiotic drops in the eye to prevent complications.
• Massage the tear ducts to completely remove the plug.
• Protect your baby from colds - they can trigger a relapse of the disease.

By following all the advice of your doctor, you will protect your child from complications.

Possible risks of surgery

As a rule, probing the lacrimal duct in newborns has no consequences.

Immediately after the procedure, the child may experience bloody discharge from the nose and difficulty breathing. Anesthesia can cause headaches, nausea, and vomiting. The child may be restless and capricious. All this is normal if it goes away on the day of surgery. If symptoms continue or worsen, consult a doctor immediately.

Irritation of the mucous membrane of the eye may occur; in rare cases, conjunctivitis may develop and body temperature may increase. And although such cases are rare, it is better to know about them in order to consult a doctor in a timely manner.

In general, this operation is considered absolutely safe, since during its implementation the integrity of the skin is not violated and general anesthesia is not used. The consequences of a late visit to the doctor can be much more dangerous.

Complications

If after reading this article you are still afraid of probing your baby’s tear duct, we recommend that you familiarize yourself with the complications that may arise if you do not contact a specialist in a timely manner, most often after a year.

How the consequences of untreated dacryocystitis may occur:

• corneal ulcer;
• threat to the baby’s life due to developing sepsis, meningitis, and other diseases;
• transition of the disease into a chronic form with serious consequences - atony, dilation, fusion of the lacrimal ducts.

Dacryocystitis is a condition of a newborn that can be easily corrected, especially at an early age. If you hear such a diagnosis from a doctor, do not panic - go through the bougienage procedure and forget about the problem once and for all.

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, but to eliminate the problem in a few minutes using a 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 as a result of injuries, inflammatory processes in the eyes or nose, as well as various diseases. This disease can affect both children and adults of all 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 using a special instrument - a 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. With repeated intervention, the probability of complete 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 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

Only a pediatric ophthalmologist can diagnose dacryocystitis in a baby, but 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 caused by 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.

A deviated 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 the 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 - to assess the general condition of the 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 urine and blood tests.

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 inserts a sterile thin probe into the nasolacrimal duct, widening it and clearing 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 gives the baby a minimum of 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, young patients need to instill antibacterial drugs and undergo 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

With proper probing, the risk of negative consequences is minimized. The only possible complication is the occurrence of adhesions and blocking 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.

Viral infections pose a great danger to the baby in the postoperative period. 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 is easily tolerated by children, and repeated surgery is not required. Bloody discharge is acceptable for 1–2 days, but the eye may continue to water for up to 2–3 weeks. If lacrimation continues 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. If this manipulation is performed correctly, the risk of complications is minimal, and the likelihood of a favorable outcome is 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.

The need to probe the lacrimal canal usually occurs with dacryocystitis - inflammation of the lacrimal sac. The disease provokes obstruction of the lacrimal duct. The result is a buildup of bacteria that causes inflammation. Dacryocystitis affects both adults and children, including newborns.

Causes of dacryocystitis in adults and children

The disease can occur in acute and chronic form. Both of them are accompanied by the same symptoms:

• swelling and redness;
• soreness in the area of ​​the inner corner of the eye;
• presence of discharge;
• unilateral lesion (usually).

In addition, pathology is divided into primary and secondary.

The diagnosis is made by obstruction of the nasolacrimal canal or blockage of the lacrimal openings.

Provoking factors are:

• Congenital anomalies, underdeveloped/narrowed tear duct;
• Injury;
• Runny nose, syphilitic lesion of the nose;
• Inflammation in the maxillary sinuses and nearby bones;
• Blepharitis;
• Tuberculosis and inflammation of the lacrimal gland and its sac;
• Atherosclerosis.

Diagnostics

The conclusion is made based on complaints and after examination. The following activities are prescribed:

• Vesta color test to determine the patency of the lacrimal ducts;
• Diagnostic probing to clarify the level of obstruction;
• Passive nasolacrimal test to confirm obstruction;
• Biomicroscopy of the eye;
• Fluorescein installation test;
• Contrast radiography with iodolipol solution;
• Bacteriological culture of the discharge to determine the causative agent of inflammation and its sensitivity to antibiotics;
• If necessary, consultation with other highly specialized specialists.

Treatment

Tactics are chosen depending on the form of the disease (primary, secondary). For example, with congenital dacryocystitis, efforts are directed toward eliminating the embryonic film that did not break through at birth.

For this purpose, massage, rinsing, and probing are prescribed. And in the secondary form, complex surgical interventions are required to restore lacrimation. Medications, massage, washing are conservative methods of treatment, and bougienage, probing, and operations are radical (surgical).

Medicines must be used simultaneously with surgical methods. They are prescribed before and after operations in order to eliminate infectious and inflammatory phenomena or prevent their occurrence in the postoperative period. In this case, a wide variety of anti-inflammatory drugs are used, ranging from paracetamol and antibiotics to synthetic hormones.

The acute course requires general and local use of antibacterial drugs. Their choice depends on the sensitivity of the inflammatory agent. For local use, antibiotic-based ointments or drops are prescribed (eg Vigamox, Tobrex, Oftafix). Levomycetin and gentamicin are used.

Ciprofloxacin is contraindicated during the neonatal period. You should not use albucid, as it causes a burning sensation, crystallizes and thickens the embryonic film, which needs to be gotten rid of. When using several drugs simultaneously, the interval between their use should be at least a quarter of an hour.

Massage

Massage plays an important role in both treatment and prevention. But the procedure cannot be performed in the presence of inflammation, because pus can get into the tissues surrounding the lacrimal sac and cause phlegmon. The doctor shows you how to do a massage correctly.

Before the procedure, wear sterile gloves or treat your hands with an antiseptic solution. then you need to squeeze out the discharge and clean your eyes with a solution of furatsilin. It is better to massage the tear duct before feeding.

In the first 2 weeks, the number of procedures per day can reach 10. Movements are performed with the index finger: press on the area of ​​the eye sac, moving from top to bottom, trying to break through the gelatin film with sharp but gentle pushes.

If everything is done correctly, pus is released, which is removed with cotton wool soaked in a decoction of herbs (chamomile, calendula, tea) or a solution of furatsilin. You can also use a pipette. Then the remedy is removed with boiled water. After the massage, use antibacterial drops prescribed by your doctor.

During this treatment, you must visit an ophthalmologist twice a week. After 14 days, he must evaluate the effectiveness of the therapy and, if necessary, change it. It is worth noting that massage as a treatment measure is effective only in children of the first year of life. It may be necessary to flush the tear ducts with a sterile saline solution containing an antibiotic. This procedure is performed by a doctor who first instills an anesthetic (0.25% dicaine solution) into the eyes.

Probing the tear duct

Doctors' opinions differ significantly regarding the advisability of this procedure in childhood. Some experts believe that it should be carried out no earlier than six months later if there are no results from the massage. Proponents of sounding recommend resorting to it 2 weeks after the start of conservative therapy if there is no effect.

The procedure is performed on an outpatient basis by an ophthalmologist for both adults and children. Local anesthesia is used first. Then a probe is inserted through the lacrimal opening. This device allows you to break through the film and expand the channel for high-quality outflow of tears.

The procedure is painless and takes only a few minutes. It is worth noting that the smaller the child, the better he tolerates such an event. In about a third of cases, probing has to be repeated several days later. In almost 90% of cases, it is possible to restore tear flow using this method. To exclude inflammation, antibiotic therapy (eye drops) is prescribed in the postoperative period.

Bougienage to widen the tear duct

This method is more gentle than a full-fledged operation. A bougie is inserted into the tubules - a special probe that removes obstacles and widens the duct. The bougie is administered as during the probing procedure. The event does not cause any discomfort and takes a few minutes.

As in the previous case, if after probing the tear duct there is still a tear, a repeat procedure may be required.

Surgical methods for treating inflammation

Surgical intervention is indicated in the absence of effect from medications, massage, probing and bougienage, as well as in some congenital developmental anomalies. Radical surgery is also used in cases of secondary dacryocystitis, in the presence of a chronic form of the disease and complications.

Inflammation of the lacrimal duct in newborns usually requires laser dacryocystorhinostomy. In older children and adults, an artificial passage is created through surgery that connects the nasal cavity and the eyes. In exceptional cases, the sac is also removed in adults.

The procedure can be performed in two ways: externally and through the nose. The latter option is preferable, as it is less traumatic and does not leave scars. The patient is given a local anesthetic. The operation itself is performed in the “sitting” position.

Inflammation of the nasolacrimal duct in adults, or dacryocystitis, occurs due to obstruction of the gland ducts. At the same time, the liquid stagnates in them, which leads to the proliferation of pathogenic microbes. The disease manifests itself as lacrimation and discharge of pus. Treatment will help avoid negative consequences: decreased vision, the appearance of a cataract.

Treatment of tear duct inflammation in adults

If the first symptoms of the disease occur (swelling, lacrimation, swelling, discharge of purulent exudate), you must immediately seek help from a doctor. If dacryocystitis passes without complications, then the prognosis for recovery is favorable. Treatment of pathology, as a rule, depends on the causes of its occurrence (viral and bacterial infection, post-traumatic syndrome) and the form of the disease.

Therapy for dacryocystitis is divided into two parts: restoration of the patency of the nasolacrimal canal and the use of anti-inflammatory drugs.

In the acute form of dacryocystitis in adults, systemic vitamin therapy, massage are performed, and dry heat is applied to the area of ​​the lacrimal sac. If pus has formed, the abscess is opened, the wound is washed with antiseptics (dioxidine solution, furatsilin, hydrogen peroxide). In addition, the doctor may place eye drops into the conjunctival sac. At the same time, antibacterial therapy is carried out with drugs containing cephalosporins, penicillins, and aminoglycosides.

If the acute form of the disease has become chronic, treatment is carried out by probing, balloon or endoscopic dacryocystorhinostomy - surgical methods through which an additional connection is formed between the nasal cavity and the lacrimal canal. This is done so that pus does not accumulate and the outflow of fluid is normalized. Often the patency of the nasolacrimal duct is restored with the help of bougienage.

Pharmacy drugs

Treatment of dacryocystitis with medications is a complex task, so it should be carried out under the supervision of a specialist to prevent the development of complications. In this case, drug therapy is usually accompanied by surgical intervention. The main groups of drugs for the treatment of dacryocystitis are:

1. Antibacterial drugs. May be available in the form of eye drops or tablets.
2. Anti-inflammatory drugs. Used in the form of drops for topical use and tablets for general effects on the body.
3. Homeopathic medicines. Available in the form of tablets for oral administration.

The most popular remedies for dacryocystitis are presented in the table:

Bougienage of the lacrimal duct in adults

In the treatment of dacryocystitis, bougienage is often performed - a gentle method of restoring the patency of the nasolacrimal canal. During this procedure, the blockage is removed using a special rigid probe (bougie). The outflow of tear fluid after surgery is no longer blocked and the patency of the ducts is quickly restored. In addition, this procedure includes washing the lacrimal canal, which is carried out with antibacterial and disinfectants. This method is used for frequent relapses of the disease.

Massage

Blockage of the tear duct in adults interferes with the healthy outflow of fluid, so to alleviate the patient’s condition, the doctor may prescribe a special massage. The patient can perform the procedure independently, pressing with a fingertip on the outer corner of the eye and gradually moving to the inner corner. A doctor can perform a massage: he will press on the lacrimal sac, releasing all the contents. Next, the pus is removed using a tampon soaked in a furatsilin solution.

Therapeutic massage should be performed 2 times a day - morning and evening. The duration of the procedure should be at least 5 minutes. Ophthalmologists recommend combining massage with the use of pharmaceutical drugs. This method has one contraindication – a severe form of the disease, which is characterized by the appearance of extensive inflammatory processes. Massage is prohibited in this case, because... Pus can get into the tissue that surrounds the tear ducts, causing cellulitis (inflammation).

Endoscopic dacryocystorhinostomy

When traditional treatment is ineffective, surgery is often used. Restoring the normal functioning of the nasolacrimal ducts is possible with the help of endoscopic dacryocystorhinostomy. Modern special minimally invasive equipment is used to perform the operation. During the procedure, a flexible special tube – an endoscope with a camera – is inserted into the tear duct. Using the device, an incision is made in the blocked tear duct. The rehabilitation period is 8 days.

The advantage of the operation is that it does not leave damage to the tear ducts and visible skin scars on the face. In addition, the use of microsurgical techniques can reduce discomfort during surgery. The disadvantage of the procedure is low efficiency and the appearance of repeated dacryocystitis. The average price for surgery in Moscow is 15,000 rubles. Dacryocystorhinostomy is performed in patients in the absence of an allergic reaction to anesthetic agents. Possible complications of the operation:

• infection of the tear duct;
• nose bleed;
• tube displacement.

Balloon dacryocystoplasty

To eliminate inflammation in the nasolacrimal ducts, balloon dacryocystoplasty is used. This is a safe operation that can be performed even on children as young as one year old. During the procedure, a thin special conductor equipped with an expanding microscopic balloon filled with liquid is inserted into the nasolacrimal canal through the corner of the eye. Using pressure, it opens and expands the duct, and then it is removed from the canal. The procedure is performed under local anesthesia.

Inflamed eyes with purulent discharge in a baby are a cause for concern for many parents. Conjunctivitis is a common cause of this problem. However, in some cases, these manifestations are symptoms of blockage of the lacrimal canaliculus - dacryocystitis. An effective method of treating the disease is probing (bougienage) of the lacrimal canal.

Causes of obstruction of the lacrimal ducts and indications for surgery

Obstruction of the tear ducts occurs in approximately 5% of newborns. What caused it? Each child's eyes, airways and nose are protected with a gelatin film while in the womb. At birth it usually bursts. If this does not happen, then a plug forms in the nasolacrimal canal.

This gelatin plug prevents normal tear production. 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 of purulent discharge, and swelling forms near the eyes. These phenomena lead to the development of dacryocystitis.

Dacryocystitis can also be caused by congenital or acquired deviated nasal septum. This causes the canal to become clogged with mucus and dead epithelial cells. Lack of proper treatment can cause serious harm to the child's health. Dacryocystitis is accompanied by the following symptoms:

• the baby constantly has tears flowing from his eye;
• swelling under the eye;
• purulent discharge that leads to eyelashes sticking together after sleep;
• swollen eyelids.

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

Preparing the 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 a deviated nasal septum, since in this case the procedure will not give the desired effect. Preparing a baby for sounding 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 patency, a Vesta test is performed. It consists of dropping a liquid with dye into the child’s eye and inserting a cotton swab into the nose. How severely the canal is clogged will be determined by the amount of colored liquid on the tampon.

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

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

How is eye surgery performed on 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. Local anesthesia is used for probing. Alcaine 0.5% is most often used as an anesthetic drug. The operation process is as follows:

1. the patient is placed on the operating table and an anesthetic is instilled into the eyes;
2. his position is fixed, the nurse holds his head;
3. a probe is inserted into the nasolacrimal canal to dilate the tear ducts;
4. then a thinner probe is inserted, which breaks through the gelatin film;
5. the ducts are washed with a disinfectant solution;
6. carry out the Vesta test.

Probing and rinsing the lacrimal canal of the eyes of a newborn

Post-operative care

The probing procedure is simple, but to avoid complications you should follow some rules. The child needs to instill antibacterial drops for 5-7 days. To prevent adhesions in the lacrimal sac, it is necessary to massage the lacrimal canaliculi. You can bathe your baby as usual, without stopping him from touching his eyes. You should protect him from colds.

Possible consequences of the procedure

Children usually tolerate the probing procedure well. However, each body reacts differently to surgery. Most often, complications after surgery occur due to violation of probing technique. A scar may form in the place where the tear duct was punctured, but other consequences of probing also occur:

• tears flow from the eyes for the first 14 days after surgery;
• bleeding 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 probing, tears may flow from the eye

You should immediately seek medical help if the following complications occur:

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

When may repeated surgical intervention be necessary?

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

Repeated intervention is carried out if the patient’s condition does not improve 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 to prevent blockage of the tear ducts. These tubes are removed after 6 months. Caring for the baby after a second procedure usually does not differ from that recommended after the first operation.

Is it possible to avoid probing?

The only way to avoid probing is to massage the tear ducts. The purpose of the procedure is to try to break through the gelatin film that leads to the blockage. Before carrying out the manipulation, you must wash your hands thoroughly to avoid additional infection getting into the baby’s eyes. The massage technique is as follows:

• Before the procedure, the child’s eyes should be wiped with a cotton swab soaked in Furacilin;
• lightly press on the area above the lacrimal sac and move to the base of the nose;
• repeat the manipulation 10 times;
• Wipe off any discharge that appears with a swab;
• Apply anti-inflammatory drops to the baby’s eyes (we recommend reading:).

Massage for newborns is carried out during feeding. Detailed instructions can be seen in 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 to eliminate dacryocystitis will be a probing procedure. The use of traditional methods of treating blockage of the lacrimal canal can lead to irreversible consequences and a threat to the life of the child.