Dacryocystitis of newborns

Dacryocystitis of newborns

Tatyana Rudneva

According to the World Health Organization, more than 160 million people in the world today have serious visual impairment. In the overwhelming majority of cases, visual disorders begin as early as childhood and are the result of congenital and hereditary pathology, including those caused by complications of the perinatal period, fetal disorders or hereditary factors.

Dacryocystitis of the newborn (congenital anomaly of the development of tear-conduction paths) is, as a rule, a consequence of the underdevelopment or delay of the reverse development of certain morphological structures in the prenatal period. Tearing pathways begin with the excretory ducts of the lacrimal gland and the lacrimal glands of the conjunctiva. The lacrimal fluid appears primarily in the upper-outer corner of the eye, thanks to the flashing movements of the eyelids, it washes the entire conjunctival cavity and the anterior eye section, then flows down the lacrimal lake along the inner edge of the eyelids adjacent to the conjunctiva of the eyeball.From the lacrimal lake, the liquid enters through the lacrimal points, which are located in the region of the lacrimal papillae, in the inner parts of the costal margin of both eyelids, and are turned to the lacrimal lake. Further, through the capillary lacrimal canaliculi, going first in the vertical, then in the horizontal direction, the liquid penetrates into the lacrimal sac. The lacrimal fluid ends its way in the nose, where a nasolacrimal duct opens between the inferior nasal concha, connecting the inferior nasal passage with the lacrimal sac.

Dacryocystitis of the newborn occurs quite often. According to various authors, this pathology occurs in 2–4% of all newborns.

A common cause of dacryocystitis is a gelatinous plug that closes the lumen of the nasal duct. It consists of mucus and dead fetal cells and is normally pushed out of it during the first respiratory movements of a child. However, sometimes this does not happen, which leads to the development of pathology. The latter occurs in those cases where the outlet of the nasal duct is closed rudimentary film. Congenital anatomical changes in the structure of various departments of the tear route can play a provocative role: multiple folds and diverticula,swelling of the nasal mucosa in the lower opening of the nasolacrimal canal, tubular stricture.

Symptoms: lacrimation, tearing, sometimes profuse purulent discharge (conjunctiva without signs of inflammation).

The main symptom of a violation of the tearing apparatus — tearing — is practically absent in the first weeks and months, since the child has very few tears and is only enough to moisten the conjunctiva and the cornea. Only with the beginning of the functioning of the lacrimal gland, that is, from the second month, can a lacrimal state or lacrimation be observed with the child's calm behavior.

Diagnosis of the disease

Based on the detection in children in the first days or weeks of life of the mucous or mucopurulent discharge in the conjunctival cavity of one or both eyes. Such a picture can often be associated with conjunctivitis, and therefore medication is prescribed, but it gives only a short-term effect, and then mucous or mucopurulent discharge in the conjunctival cavity of the eye, tears and tears reappear. The diagnosis becomes obvious if, when pressing on the region of the lacrimal sac from the lacrimal punctures (usually the lower one), mucous or purulent contents are secreted into the conjunctival cavity.Moreover, this symptom is not always detected in newborns immediately, as it affects the previous eye treatment with disinfecting solutions and antibacterial therapy. With a long course of the process, there is a strong stretching (dacryocysticele) of the lacrimal sac and a significant protrusion of tissues in its area.

Treatment

When choosing a method of treating newborns with diseases of the lacrimal ducts, it is necessary to take into account the structural features of the cavity of their nose. In newborns, the nasal cavity has a small height and is covered with a mucous membrane with small folds. In addition, they often have a curved nasal septum, the shells are thick, and the lower nasal passage is usually absent due to the fact that a relatively thick lower shell practically touches the bottom of the nasal cavity and closes the course.

At the first stage of treatment of children suffering from dacryocystitis, it is more expedient to use gentle methods of restoring the patency of the nasal duct. Among them is the finger massage of the projection area of ​​the lacrimal sac, which is jolted and in the direction from top to bottom. The calculation is made on the fact that the created pressure drops contribute to the removal of the gelatinous plug from the duct or the rupture of the existing rudimentary film.Massage should be carried out 5-6 times a day. Depending on the result of laboratory testing of the flora contained in the lacrimal sac, its sensitivity to antibiotics, the child is prescribed instillations of the corresponding antibacterial agents. In this situation, you should not use solutions of drugs that can crystallize and for this reason create obstacles to the outflow of tear fluid. An example in this regard is the 20% sodium sulfacyl solution.

A 20% solution of sodium sulfacyl can crystallize and interfere with the flow of tear fluid.

Massage technique

Step one.We put our index finger on the inner corner of the child's eye, with the pad of the finger in the direction of the nose. Massage is carried out with the index finger (but not the little finger!) And do not be embarrassed by the fact that your finger seems to be more than half the face of a newborn baby. Little finger to properly massage will not work!

Step two.Lightly press on this point. Lightly - this does not mean barely touch. This refers to the pressure, enough to break through the film covering the lacrimal canal.

Step three.Make a finger downward movement along the bridge of the nose (continuing to press on the skin). The movement should be quite sharp (just do not overdo it!) And sure. There can be no talk of stroking the nose bridge here. The physical meaning of your movement is this: the lacrimal tubule from the eye leads to the nasal cavity, where the lacrimal fluid flows. A child in this channel has a thin fabric partition. On top of this septum accumulated tear fluid and pus. With the help of massaging movements you are trying to push this tear fluid into the nasal cavity, breaking through the septum in the tear duct. That is why the movements should be quite sharp - the partition is elastic, and its smooth movements will only stretch and aggravate your problems, since in the future it will be even harder to break through.

Step Four.When your finger reaches the bottom of the nose bridge - slightly release the pressure without lifting your finger from the skin, and return it to its original position at the corner of the eye.

Step five.Then again press and repeat steps 2 and 3, and so on in a circle. It is enough to make 10–13 such movements at a time. No longer need to not stretch the septum in the channel.

If the massage is done correctly, then you will see how the tear and pus began to go out of the tubule into the eye.

If the vibratory massage of the lacrimal sac for two weeks does not give the desired result, then it is necessary to probe the nasolacrimal canal through the upper or lower lacrimal opening and then flush this passage with antiseptic solutions. To perform it, a Bowman No. 2 cylindrical probe is used, since a thinner instrument does not stretch, but breaks an obstacle, and a thicker one expands the tubule too much. The probe is gently advanced along the upper lacrimal canalicle up to the bone. Then, without displacing it from the inner wall of the bag, it is transferred to a vertical position and pushed down until the plate in its middle indicating the number somewhere in 1 cm reaches the levelsulcus supraorbitalis. After that, the probe is carefully removed and immediately, as already described above, washed the tear duct with a solution of furatsilin 1: 5000. If the sensing was successful, the fluid passes freely in the nose. In the future, it is recommended that the child be instilled into the conjunctival cavity and into the corresponding nasal passage disinfectant drops, such as Tobrex or Floxal, for 7–10 days.

In the Center for Eye Microsurgery,In Kiev, a specially created system is used to probe the nasolacrimal canal, which allows, after sensing, to flush the lacrimal ducts after leaving the canal. This is a more gentle method.

According to the American Academy of Ophthalmology, sensing the nasal duct as a method of treating neonatal dacryocystitis is effective in 90 percent of babies under 9 months of age.

It should be remembered: ifnewborn dacryocystitisif untreated, there may be serious complications in the future.This disease can lead to chronic conjunctivitis, involving the surrounding tissues in the inflammatory process, the spread of infection to the eye, or serious visual pathologies.

Timely recognition of congenital dacryocystitis and its treatment at an early age is very important, since at an older age more serious surgical intervention is required - dacryocystorhinostomy. The sensing of the nasolacrimal canal has a positive effect in almost all cases and is indicated even at the age of several years.

Tear bag phlegmon

Newborns with a lacrimal sac phlegmon deserve special attention.It is characterized by hyperemia and dense edema in the region of the lacrimal sac. The child's temperature rises, in the blood test - leukocytosis and increased ESR. Cellulitis can burst out, but can also lead to the spread of purulent process in the eye socket. Abscess and phlegmon of the lacrimal SAC can lead to the formation of fistulas, from which mucus and pus are constantly released. In most cases, the complication is manifested no earlier than at the age of 2–3 weeks.

The main reasons for the development of such a severe pathology are late treatment, delayed diagnosis and, as a result, chronic recurrent dacryocystitis. According to domestic authors, recently the lacrimal sac phlegmon develops already in the first days of a newborn's life. In the early neonatal period (the first week of life), in most cases, phlegmon is caused by a congenital malformation of the lacrimal sac itself - dacryocystustele (dilation of the lacrimal sac). This is the formation of a bluish color with no pulsation and signs of inflammation. In some cases, the dilation of the lacrimal sac disappears spontaneously, but is often complicated by the addition of a secondary infection and requires inpatient treatment.

The volume of inpatient care in the acute period of the disease includes the opening and drainage of the lacrimal sac cavity on the background of intensive antibiotic therapy, taking into account sensitivity to the pathogen. In the subacute period, in order to fully rehabilitate, the nasal duct is probed with subsequent instillations into the conjunctival cavity of the antibiotic in combination with steroids.

It is in childhood that the easiest way to cope with most diseases of the visual system, without resorting to surgical intervention. However, this requires timely diagnosis and early treatment. Often, too much depends on when a disease is detected. The first person to encounter a problem is most often a district pediatrician, and a positive result will depend on how much he knows the disease by sight.

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  • Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns

    Dacryocystitis of newborns