Dacryocystitis in newborns
The content of the article:
- Causes and risk factors
- Forms of dacryocystitis of newborns
- Symptoms of dacryocystitis in newborns
- Diagnostics
- Treatment of dacryocystitis of newborns
- Possible complications
- Prognosis of neonatal dacryocystitis
- Prevention
Dacryocystitis in newborns (from the Greek dakryon - a tear and kystis - a bag) - obstruction of the nasolacrimal canal.
The lacrimal ducts begin with the lacrimal openings located in the medial corners of the palpebral fissure. The lacrimal canals, connected to the lacrimal sac, depart from them, the cavity of the lacrimal sac passes into the nasolacrimal duct. If the mechanism of the outflow of the lacrimal fluid is disturbed, a pathogenic (usually streptococcal or staphylococcal) microflora develops in the lacrimal sac, which leads to inflammation. Dacryocystitis in newborns is the result of narrowing or complete blockage of the nasolacrimal duct outlet.
Source: o-glazah.ru
Normal lacrimation in children is usually formed in the second or third month of life, the release of the lumen of the lacrimal duct occurs on its own when the embryonic film that covers the lower part of the nasolacrimal canal breaks. If the patency of the lacrimal passages is not restored, dacryocystitis develops.
Dacryocystitis is a common disease that occurs in 2–7% of all newborns.
Causes and risk factors
The main cause of neonatal dacryocystitis is obstruction of the nasolacrimal duct. The reasons for this obstruction can be:
- congenital pathologies and anomalies of the nasal cavity (narrow or tortuous nasal passage, folds and diverticula of the lacrimal sac, curvature of the nasal septum, etc.);
- birth trauma (fracture of the upper jaw, etc.);
- the presence of rudimentary or gelatinous plugs that close the lumen of the nasolacrimal canal;
- chronic inflammatory processes in the maxillary cavity and in the tissues surrounding the lacrimal sac.
Forms of dacryocystitis of newborns
Depending on the duration and intensity of the course, the disease can be acute or chronic.
There are several clinical forms of chronic dacryocystitis of newborns:
- simple;
- catarrhal;
- purulent;
- phlegmonous.
Types of neonatal dacryocystitis, depending on the cause, type of infectious pathogenic agents and their sensitivity to antibacterial drugs:
- bacterial;
- viral;
- chlamydial;
- parasitic;
- post-traumatic.
Symptoms of dacryocystitis in newborns
Dacryocystitis of newborns manifests itself in the first weeks of a child's life with the following symptoms:
- lacrimation, tear fluid spills through the lower eyelid;
- hyperemia, swelling and soreness of the conjunctiva;
- the appearance of a mucous, purulent or mucopurulent exudate in the conjunctival cavity;
- Eyes "sour" (usually one-sided) after sleep.
Common symptoms of dacryocystitis in newborns are manifested by an increase in signs of intoxication: weakness, fever, general depression.
Diagnostics
Diagnosis of the disease begins with an objective study of the condition of the lacrimal passages: an examination of the eyelids, lacrimal openings, compression of the lacrimal sac, assessment of the nature and amount of discharge. If necessary, a study of the function of the lacrimal ducts is carried out.
To determine the patency of the lacrimal passages, a tubular test (Vesta color test) is performed. The procedure consists in the fact that a tampon is inserted into the nasal passage, and a few drops of a 3% solution of collargol are instilled into the conjunctival cavity. It is necessary to assess the rate of disappearance of the dye from the conjunctival cavity. If the patency of the lacrimal passages is not broken, the tampon is stained quickly, after a few minutes. If more than 5-10 minutes pass between the installation of the coloring matter and the staining of the tampon, the patency is impaired. If the tampon remains clean, there is no patency in the lacrimal passages.
It is possible to identify obstruction of the lacrimal passages with dacryocystitis in children using a passive nasolacrimal test. Its principle is that the liquid does not pass into the nose when the nasolacrimal canal is rinsed, but flows out in a stream through the lacrimal openings.
If it is necessary to clarify the level and degree of impairment of the patency of the lacrimal passages, dacryocystography is performed - an X-ray examination of the lacrimal passages with contrasting with iodolipol solution. To identify microbial pathogens, a scraping from the eyelid conjunctiva is examined (PCR analysis) and a bacteriological examination of a smear from the conjunctiva is performed.
Passive patency of the lacrimal passages is determined by diagnostic probing and flushing. To minimize the risk of complications, a rhinoscopy is performed before probing the lacrimal canals. If necessary, a maxillofacial surgeon, neurosurgeon, traumatologist, otolaryngologist, neurologist can be involved in the diagnosis.
Treatment of dacryocystitis of newborns
Treatment of neonatal dacryocystitis requires an individual approach, taking into account the duration and nature of the course of the disease, the risk of complications, the clinical form of dacryocystitis, the effectiveness of previous therapy, a rhinogenic factor, the presence of congenital anomalies in the development of the nasal cavity and maxillofacial region.
At the first stage of treatment, sparing methods of eliminating the embryonic film at the mouth of the nasolacrimal canal are used.
First of all, it is a finger massage of the area of the lacrimal sac projection, which is prescribed before each feeding of the child, 5-6 times a day, 10-12 movements. Massage for dacryocystitis in newborns is carried out with the index finger, placing it with a small pad in the direction of the bridge of the nose and slightly pressing. The degree of pressure must still be sufficient to pierce the film covering the nasolacrimal canal or to remove the gelatinous plug, thus freeing the nasolacrimal duct. Continuing to click on the selected point, they make jerky movements down the bridge of the nose. With these downward movements, the tear fluid is pushed into the nasal passage, breaking through the septum in the nasolacrimal duct. As soon as the finger reaches the bottom of the bridge of the nose, the reverse movement begins, returning it to the corner of the eye. The younger the child, the more effective the massage. After the massage, you must rinse your eyes with a disinfectant solution and drip eye drops.
Source: about-vision.ru
Drug therapy is used to combat pathogenic microorganisms and stop the spread of infection. It is recommended to start treatment with the use of non-allergenic antiseptics (solutions of Miramistin, Chlorhexidine, Pikloxidin, Furacilin). Eyes are washed with a sterile cotton swab with movements from temple to nose. Solutions prepared for washing should not be stored for more than a day.
In acute manifestations, after receiving the results of identification of the flora and its sensitivity to antibiotics, local antibiotic therapy (penicillins, aminoglycosides, cephalosporins) is prescribed. Ciprofloxacin is contraindicated in newborns; the use of Albucid (sodium sulfacil) is also undesirable. The combination of sulfanilamide and bactericidal drugs has the maximum effect.
If conservative therapy in the first 2-3 months of the baby's life did not bring the desired effect, probing of the tear ducts may be advisable.
For probing by the classical method, a hard probe is used, which allows you to remove the remaining film and expand the lacrimal-nasal canal, ensuring the normal outflow of tears.
Bougienage is a type of probing, in which a special probe is inserted into the lacrimal-nasal canal through the lacrimal opening, expanding its narrowed walls.
Probing is performed within minutes and is considered to be more gentle than surgery; in some cases it is done under local anesthesia. Due to the possible ingress of lavage fluid into the respiratory tract, resuscitation and anesthetic support is provided. Several procedures may be required.
Treatment of dacryocystitis by probing is effective in 90% of infants, especially when it is carried out early, before the age of 9 months. In the overwhelming majority of cases, after probing, lacrimation stops, and the substance to be separated disappears.
In the case of insufficient effectiveness of minimally invasive manipulations, surgical intervention is performed, but it is indicated for children from 5 years old. For primary dacryocystitis in newborns, a less traumatic operation is used - laser dacryocystorhinostomy.
Possible complications
The main complications of dacryocystitis in newborns most often arise due to late detection of the disease, inadequate treatment and are associated with the release of the infectious and inflammatory process outside the lacrimal sac:
- abscess and phlegmon of the lacrimal sac (or phlegmonous dacryocystitis);
- acute purulent peridacryocystitis;
- meningitis, cavernous sinus thrombosis, sepsis with hematogenous foci of purulent infection caused by the spread of purulent infection from the lacrimal sac into the cranial cavity.
Phlegmonous dacryocystitis is characterized by hyperemia, edema, infiltration, pain in the lacrimal sac and cheeks with complete or partial closure of the palpebral fissure. There is a sharp deterioration in the child's condition, up to life-threatening: a sharp increase in body temperature, leukocytosis, increased ESR.
When the infiltrate is opened, an external fistula (fistula) is formed outward. If the opening of the abscess occurs in the nasal cavity, an intranasal fistula of the lacrimal sac is formed.
Prognosis of neonatal dacryocystitis
With timely detection of the disease and proper treatment, the prognosis for dacryocystitis of newborns is favorable. The use of early probing of the nasolacrimal canal and therapeutic massage can stop the inflammatory process in the vast majority of cases. Sanitation of the lacrimal sac with the help of therapeutic lavages avoids the need for radical surgery and scar deformities. With the correct treatment, dacryocystitis has no long-term consequences.
Prevention
In order to prevent dacryocystitis, the eyes of the newborn should be washed every day after waking up, especially if mucous discharge has already been noticed. It is important to adequately and timely treat diseases of the child's ear, throat, nose.
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Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
