Obstruction of the nasolacrimal canal in newborns is medically called dacryocystitis. Among infants, a disease in which mucopurulent or simply mucous discharge occurs is quite common. As a rule, it is possible to identify a predisposition to obstruction of the lacrimal duct in an infant immediately after birth.
Tears play a very important role in proper operation human eye. First of all, they perform the function of protecting the eyeballs from various small particles of dirt and dust entering them, and also maintain their appropriate humidity. After distribution on the surface of the eyes, tears pass through the lacrimal ducts through the nasal passage.
The cause of dacryocystitis is usually a gelatinous film or, as it is also called, a plug, which is located in the nasolacrimal duct. During the intrauterine life of the child, she performs protective function from penetration of amniotic fluid. At the birth of a child, at the moment of the first cry, the film should burst. But if this does not happen, the tear begins to accumulate and stagnate in the lacrimal sac, as a result of which an infection can develop. Also, the cause of obstruction of the lacrimal canal may be pathology of the nose and surrounding tissues, which can arise as a result of inflammation or injury.
If your baby is diagnosed with obstruction of the lacrimal duct, then most likely, the initial treatment will be drops and massage.
Massage for obstruction of the lacrimal canal
For the effectiveness of treatment of nasolacrimal duct obstruction with this method, it is recommended to carry out this procedure up to 10 times a day.
If treatment with massage and drops is unsuccessful, the newborn's lacrimal canal is probed. This is an effective and fairly simple operation, as a result of which the gelatinous film is pierced. As a rule, this surgical intervention resort only to the most extreme cases. In order to prevent relapse, it is recommended to massage the lacrimal canals for the first time after surgery.
Dear parents, try to correctly assess your child’s health status and take the necessary measures in a timely manner! Health to your children!
Dacryocystitis is a disease that is an inflammation of the lacrimal ducts with the epicenter in the lacrimal sac.
Determining the necessary measures for the treatment of dacryocystitis is based on determining the cause of the disease.
Ophthalmologists identify several reasons for the appearance.
Among the reasons for blocking of the tear ducts there is another one - age-related, but for children it is not relevant.
The influence of certain factors may increase the risk of the occurrence and development of blockage of the lacrimal duct and further inflammation in the lacrimal sac.
If detected in a timely manner, the disease responds well to treatment.
In rare cases, relapse is possible; it is more common in the acquired form of the disease.
If dacryocystitis is not recognized and treated in the first months of a baby’s life, then a number of serious complications And chronic diseases eye: abscesses, external fistulas of the lacrimal sac (phlegmon), damage to the cornea.
Some complications require surgery.
The main danger in case of advanced dacryocystitis is total loss vision.
Ophthalmologists divide dacryocystitis into primary (congenital) and secondary (acquired). In infants in the first weeks of life, the tear ducts end in a “blind sac,” which is a thin connective tissue.
The “blind bag” should break at the baby’s first screams or breaths. Otherwise, the duct remains closed and dacryocystitis occurs.
It is possible to recognize the symptoms of the disease in a timely manner by carefully monitoring the baby.
In newborns, treatment of dacryocystitis begins with massage of the lacrimal sacs and antibacterial therapy (use of drops with antibacterial and antiseptic effects).
In some cases, proper massage and local drug therapy allow us to achieve positive effect– mechanical removal of blockage of the lacrimal canaliculus and complete elimination of infection.
Method of performing lacrimal duct massage
The massage can be carried out by the parents themselves, after consulting an ophthalmologist. Doctors' recommendations boil down to the following: before each feeding, instill a 0.25 percent solution of Levomycetin into the eye, then vigorously massage the eyelids from top to bottom, moving towards the nose.
Albucid solution should not be used due to the formation of crystals.
Washing and probing are used in cases where conservative treatment with massage and antibacterial drops not effective.
In such a situation, ophthalmologists prescribe several manipulations: dilatation, probing and lavage of the lacrimal canal. Dilatation is the gentle widening of the canal.
Washing tear ducts prescribed if two to three weeks before conservative treatment the desired effect did not occur. This therapeutic manipulation is carried out every day or every other day for two weeks. Additionally use antibacterial agents and undergo hormonal therapy. Painkillers are used if necessary. Rinsing the tear ducts is recommended for infants from one month.
Surgical interventions are performed in a hospital. Retrograde probing is indicated for children from 2 months, probing through the lacrimal opening is carried out from 4 months. If the procedures are ineffective, children over two years old are prescribed endonasal dacryocystorhinostomy using a special pediatric technique using ultrasound instruments.
For the safety of the child, the intervention is performed under general anesthesia.
At the end of the procedure, a bandage is applied, bed rest is prescribed, and antibacterial therapy. Inpatient observation lasts a week after surgery. During this period, the child is monitored, preventive procedures are carried out, and dressings are performed. After discharge, in the case of a successful postoperative period, the baby is transferred to outpatient observation.
High efficiency in the treatment of dacryocystitis is achieved through a well-studied and proven technique surgical interventions. Probing is used in cases of congenital and acquired disease.
An important final stage in the treatment of dacryocystitis in children is the use of antibacterial and antiseptic agents as prescribed by a doctor. Compliance with all recommendations of the attending physician and careful care is the key to a successful recovery. Carrying out all necessary procedures for a baby is not an easy task, but for a complete recovery, parents of babies with blocked tear ducts and dacryocystitis need to be patient.
Before birth, the baby's tear ducts are closed with an embryonic (rudimentary) film, which prevents amniotic fluid from penetrating into them. As soon as the baby is born, the film breaks through and the eyes begin to “work” as they should. But in about 5% of children this does not happen, and after short time problems begin. If you consult a doctor at the stage of stagnation of tears, you can avoid complications, including swelling and suppuration. If the tear is cloudy, the eyelids “stick together”, and when you press on the corner of the eye, a purulent mucous substance is released - all the more time to rush to the doctor: pediatrician, otolaryngologist, ophthalmologist.
To clarify the diagnosis of obstruction of the lacrimal canal in an infant, the doctor performs the so-called Vesta test: instills a harmless solution of a dye - collargol - into the eyes. Cotton wicks are inserted into the spout. If colored spots appear on the tampons within 10-15 minutes, the nasolacrimal ducts are functioning as they should.
After diagnosis, the doctor will prescribe treatment, and special massage, which will help clean the canals and avoid their re-clogging, can be done at home.
Massage helps a lot initial stage treatment of children diagnosed with dacryocystitis. There is nothing particularly complicated about massage techniques. If you know the rules, everything will work out great. Just remember that massage baby face Requires caution, do not make significant efforts. And, of course, under no circumstances should you influence the eyeball.
Fact: it is easiest to “break through” the gelatinous plug in the nasolacrimal duct when the child is crying, since the tension creates the necessary internal pressure.
The main features of lacrimal duct massage in newborns:
Before starting the massage, thoroughly wash (ideally disinfect) your hands and pay attention to your nails - they should be as short as possible so as not to discomfort child. During the procedure, you can also use thin sterile gloves.
An ophthalmologist from a children's clinic can show you massage techniques - this will help avoid complications, and good result procedures are said by everyone who has been helped by massage of the lacrimal duct.
How to massage? Quite gently, but at the same time without stroking - this is wrong. As reviews from parents who consulted with their doctor show, stroking movements only stretch the lacrimal sac and worsen the situation, that is, the discharge is “stored” in the canal. The movements should be quite sharp, jerking, towards the wings of the nose. It is this technique that helps complete cleansing eyes, especially if pathological contents have already accumulated in it.
To visualize exactly how to perform the movements, look at the massage of the lacrimal canal in newborns in pictures. But step by step description actions.
If the lacrimal canal is still closed by the embryonic film, these actions will break through it, and the pathological contents can be removed from the canal. Breakthrough of the rudimentary film and/or release of the gelatinous plug occurs not due to the mechanical action itself, but due to pressure drops in the channel.
Massage rarely becomes the main means of treatment. Only with its help can you completely get rid of the problem only in 10-15% of cases. Thus, prerequisites- constant medical supervision and prescription of appropriate medications.
By the way: discharge from the lacrimal sac is sent to bacteriological examination to determine what antibacterial agents will be needed eye drops. It is better not to use albucid (sodium sulfacyl), which is familiar to many: it may crystallize, and it will further block the tear pathways.
If there is no improvement after two weeks, you no longer need to carry out home treatments so as not to complicate the situation. The only thing that can help in this case is probing the lacrimal canal, that is, piercing the film with a thin probe. This operation is carried out in outpatient setting and is not painful for small children. To avoid repetition adhesive processes, you need to learn how to massage the lacrimal canal in newborns. The procedure will need to be carried out for another week after probing.
If even piercing with a probe does not work, it means that the blockage of the lacrimal canal is due to a deviated nasal septum, possibly - improper development nasolacrimal duct or other reasons. One way or another, specialists will determine how further treatment will proceed.
Watery eyes may be a symptom dangerous disease, which requires prompt diagnosis and timely treatment. If you notice that your baby's eye is watering, you should consult a doctor, even if this symptom disappears on its own and quickly.
Watery eyes can be caused by several reasons.
There are also pathological conditions eyes that are dangerous to the baby's health.
If you have watery eyes, redness of the whites of the eyeballs and swelling of the eyelids, you should consult a doctor as soon as possible, as these symptoms are signs of conjunctivitis.
The disease is further characterized by the presence of pus in the corners of the eyes. The disease is dangerous not only because of the presence of infection, but also because high risk development of photophobia, as the child experiences painful sensations.
A baby can become infected with conjunctivitis if:
The latter infection is confirmed only when symptoms appear immediately after birth.
Conjunctivitis is divided into several types, and the classification of this disease is based on the factor affecting the eye:
The most common form of the disease in infants is bacterial conjunctivitis, which can be called:
If you infant the eye is festering, you should urgently consult a doctor to prevent damage to the cornea.
In the area inner corners The eye incisions contain tear ducts that are blocked by a protective membrane until the baby is born. During labor, this film breaks and the tear ducts open. If a failure occurs and the channels remain blocked, dacryocystitis develops, characterized by stagnation of tear fluid.
When an infection of various origins enters the eye, mucus is released, which causes lacrimation. The disease is characterized by the presence of pus and redness of the white of the eyeball. The symptoms of this disease are similar to those of conjunctivitis, but have their own peculiarity: with dacryocystitis, only one eye is affected.
When diagnosing the presence of closed lacrimal openings, which are the causes of tearing, it is necessary to give the child a massage. To do this, every 3 hours you should gently massage the area slightly below the inner corner of the eye. The pressure should be light and gentle. Thanks to this massage, the membrane will rupture, and stagnant tears will leave the canal on their own.
The massage technology is prescribed by the pediatrician after examining the baby. Medical consultation is a necessary measure, since an infection could develop due to tear stagnation, which will require additional treatment washing. In this case, it is advised to make strong tea or chamomile decoction to wash the sore eyeball.
The foreign body should not be removed independently. It is removed only by a doctor in order to subsequently diagnose the integrity of the eye cornea. After extraction, it is recommended to rinse with decoctions, which are selected based on the individual characteristics of the baby and the condition of the eyeball.
If a child is diagnosed with a traumatic disruption of the lacrimal ducts, anti-inflammatory drugs are prescribed. medications. Infectious diseases are treated with eye drops and ointments, which are placed under the eyelid at night.
At allergic reaction course is assigned antihistamines for oral administration.
If there is a complex lesion of the eyeball that causes lacrimation, you need to visit an ophthalmologist who can prescribe optimal treatment. Parents should not treat the baby themselves, as accidental mechanical damage may provoke the development of dangerous eye diseases, corneal damage or blurred vision. Also, you should not delay contacting a doctor, since with prolonged lacrimation, a change in the microflora occurs, which causes inflammation to develop.
Not all parents know the tricky word “dacryocystitis”. Meanwhile, this eye disease, which has another name - inflammation of the lacrimal sac, is not so rare in children of the first year of life - it accounts for 12.7-13.4% of all eye diseases found in children. Parents of a sick child, already 1-2 weeks after the birth of the baby, may notice that his eyes are constantly moisturized and tears are flowing from them. After some time, when pressing on the inner corner of the eye, purulent discharge appears, the child’s eyelashes stick together... Although this disease is not too dangerous, in advanced cases it can end complete blindness. Unfortunately, dacryocystitis cannot be prevented. But everything will be fine if you make a diagnosis in time and start treatment.
Ophthalmologists divide dacryocystitis into primary (congenital) and secondary (acquired).
Primary dacryocystitis occurs in the first weeks of life, due to the presence congenital pathology lacrimal apparatus. Most common reason development of dacryocystitis - obstruction of the nasolacrimal canal. A tear from the eye must enter the nose through special pathways that should normally be passable. In newborns they end in a “blind sac”. Normally, the “blind sac” is a connective tissue that is quite thin and breaks with the child’s first breaths or cry. If this does not happen, then the passage of the nasolacrimal duct is not restored and dacryocystitis develops. The disease can also be caused by congenital anomalies nasolacrimal duct, as well as pathology of the nose, sinuses, pharynx (runny nose, deviated nasal septum, adenoids). All of these conditions can also aggravate the course of the disease. Dacryocystitis can also be triggered by unfavorable factors external environment: dust, fluctuations in air temperature - and infections suffered by the child (flu, measles).
Secondary dacryocystitis develops into more late dates(after one year) and are caused by damage to the eyes, face, and nose. They are several times less common than the primary ones. The main causative agents of secondary dacryocystitis are staphylococci and pneumococci, less commonly - diplococci and coli, and very rarely - gonococcus and Pseudomonas aeruginosa.
If dacryocystitis is not recognized and treated in time, in the first months of the baby’s life, then chronic eye diseases may arise in the future: inflammation of the conjunctiva, abscesses, external fistulas of the lacrimal sac, lesions of the cornea, which are difficult to treat and require surgical intervention.
What should parents be wary of?
The main symptom of dacryocystitis is the presence of tears in the eye when the child is calm. Over time, tears begin to flow from the baby's eyes. There is slight redness of the conjunctiva. If, when pressing on the inner corner of the eye, where the lacrimal sac is located, mucopurulent discharge appears, then the diagnosis of “dacryocystitis” is beyond doubt. Gradually the discharge becomes purulent and profuse. The child begins to worry, sleeps poorly, refuses to eat, and his temperature rises. In this situation, parents should urgently consult a doctor. For staging correct diagnosis an examination by an ophthalmologist, otolaryngologist and pediatrician is necessary.
All children with suspected lacrimal duct disease undergo a comprehensive examination. In this case, it is very important for the doctor to find out from the mother how the pregnancy and childbirth proceeded, whether hereditary predisposition to dacryocystitis. Then a smear is taken from the child to test the bacterial flora and its sensitivity to antibiotics. This procedure helps to choose the right drugs that effectively act on a particular type of pathogen. To exclude diseases or disorders of the structure of the nose, rhinoscopy is performed (examination of the nasal cavity using a special apparatus). At the same time, pay attention to the condition of the nose, maxillary sinuses, polyps, adenoids, anatomical features(narrowness of the nasal passages, curvature of the nasal septum).
There are tests that help identify pathology of the nasolacrimal duct. They are carried out by otolaryngologists if the attending physician (pediatrician) suspects the child has an obstruction or dacryocystitis.
Tubular test. One or two drops of COLLARGOL solution are instilled into the child's eye and the eyeball is observed. If it turns white, then the tear duct is passing. A test is considered negative if the solution is retained and the eyeball remains stained for more than five minutes, which indicates pathology. The appearance of COLLARGOL in the nose a few minutes after instillation into the eye confirms the positivity of the test. To check, a probe with cotton wool is inserted into the nose under the lower turbinate to a depth of 2.5-3 centimeters.
Rinsing the lacrimal ducts. If the doctor has doubts about the results of previous tests, then lavage of the lacrimal ducts is prescribed. sterile solution FURACILLINA. Normally, when the head is tilted forward, a stream of liquid should flow out of the corresponding half of the nose. If the nasolacrimal duct is obstructed, fluid flows out through another duct.
After all diagnostic measures their results are compared and treatment tactics are developed. There are two directions in the treatment of dacryocystitis: conservative and surgical.
In case of congenital pathology, a small manipulation is sufficient to restore the patency of the nasolacrimal duct, therefore conservative methods are more often used for treatment.
Acquired dacryocystitis requires surgical intervention.
Conservative measures include massage of the lacrimal duct and lavage of the lacrimal ducts.
As surgical treatment used:
retrograde probing of the nasolacrimal duct (insertion of a small probe into the nose);
probing of the lacrimal ducts through the lacrimal punctum (introduction of a microsurgical probe);
endonasal dacryocystorhinostomy (creating a connection between the lacrimal sac and the lateral wall of the nasal cavity).
Each type of treatment corresponds to a certain age of the child, frequency and duration of procedures.
Treatment of newborns begins with massage of the lacrimal ducts. The procedure can be carried out by parents themselves, who have been trained by an ophthalmologist. Before each feeding, a 0.25% solution of LEVOMYCETIN is instilled into the eye, then the eyelids are massaged from top to bottom with vigorous movements, trying to squeeze the contents towards the nose. ALBUCIDE solution should not be instilled, as it forms crystals that create additional difficulties for the passage of the tubules. Treatment should be carried out under the supervision of a doctor who will assess the child’s condition and prescribe additional procedures. This massage is very useful. It improves the condition of the mucous membrane of the pouch and helps to change the composition of the microflora.
If the measures taken do not bring positive results, then after two to three weeks they move on to washing the lacrimal ducts. This medical procedure is carried out every one to two days for two weeks, using antibacterial and hormone therapy, as well as, if necessary, probes and painkillers. Rinsing the lacrimal ducts is recommended for children from one month.
Operative methods Treatments are carried out in a hospital. Retrograde probing is prescribed to children from 2 months, and probing through the lacrimal opening - from 4 months. If they are unsuccessful, children over 2 years of age are prescribed endonasal dacryocystorhinostomy. To carry it out, a specially developed children's technique using ultrasonic instruments is used. To prevent the child from resisting, during the intervention he is given general anesthesia. After the operation is completed, a dressing is made, bed rest and antibiotics are prescribed. During the week, the child is in the hospital, where he is monitored, procedures and dressings are performed. Then, if the postoperative period is successful, the child is transferred to outpatient observation by an otolaryngologist. In most cases, recovery occurs after surgery.
The technique of these surgical interventions has been well studied and tested. For many years it has been celebrated high efficiency surgical treatment both congenital and acquired dacryocystitis.
An important condition For successful treatment is careful care in postoperative period, compliance with all medical prescriptions. Of course, carrying out procedures on such a baby is not an easy task. Therefore, having set out to cure their child, parents must be patient and show willpower to help the treating doctor.
