Surgical treatment of dacryocystitis

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Our eyes, as is known, are lubricated by tears which prevent eyes from drying as well as hamper the reproduction of disease-causing germs. Tears are produced by the lacrimal gland, they wash the eye bulb and come to the medial canthus (closer to the nose). In this place the upper and lower eyelids have lacrimal points - puncta, one on each eyelid. You can see them easily in the mirror, if you pull down, for example, your lower eyelid a bit. Through lacrimal puncta tears come to the nasolacrimal duct and through it to the nasal cavity. Normally, the nasolacrimal duct should be permeable. If, for any reason, it is blocked, tears accumulate, overflow the lower eyelid, and lacrimation happens. In this case conditions for the infection are formed, the eyes become inflamed and red.

The causes, leading to partial or full obstruction of the nasolacrimal duct in adults and children, are different as a rule.

In adults dacryocystitis nasolacrimal duct obstruction) more often appears as a result of age-related atherosclerotic changes, infections, etc. Dacryocystitis treatment starts with intense irrigation of the eyes by ophthalmologist using bleach solutions. In cases when medicinal treatment does not help, or the disease became chronic, it is necessary to resort to surgical intervention (endoscopic dacryocystorhinostomy).

In children, specifically in babies of first months of life, more often the nasolacrimal duct blockage is caused by the so called gelatin plug – retained embryonic membrane, closing the lower part of the nasolacrimal duct. Five per cent of healthy newborn babies have this problem. Other reasons of the nasolacrimal duct obstruction are rather rare in this age. This disorder is called dacryocystitis in newborns.

Dacryocystitis in children is an inflammation of the lacrimal sac, occurring in the first month of life of an infant because of the disorder of the lacrimal fluid outflow through the nasolacrimal duct.

External signs of dacryocystitis: red, inflamed eye; purulent discharge from the lacrimal punctum if you press on the lacrimal sac area; tearing, stagnation of tears. More often only one eye is inflamed – this is another characteristic, testifying that this is dacryocystitis rather than conjunctivitis (in case of conjunctivitis more often both eyes are inflamed).

In some babies by their 14th day of life the gelatin plug resorbs by itself, an inflammation abates. And the disease as such terminates without any consequences. But in some cases it does not happen, and then the assistance of a pediatric ophthalmologist is required.

The ophthalmologic Clinic SVIT ZORU offers treatment of dacryocystitis in newborns using different methods: massage, compresses, antibiotics, irrigation and probing of lacrimal ducts.

Treatment of dacryocystitis in newborns starts with a massage of lacrimal passages. The aim of the massage is to break down the gelatinous coating. Massage should be given 8-10 times per day. In order to minimize clinical phenomena, solutions of antibiotics and sulfanilamides are used. If the massage is ineffective, a tear duct probing will be done through a lacrimal punctum. Best age to do this procedure is 2-3 months. The principle of this surgical method of dacryocystitis treatment is as follows: the doctor inserts a special probe into lacrimal passages and clears nasolacrimal ducts. Tear duct probing (surgical treatment of dacryocystitis) is done under general anesthesia and, as a rule, is successful.

Treatment of dacryocystitis in newborns (tear duct probing) ideally should be administered before a child is 6 months old, after this age the gelatinous coating gradually develops into a connective tissue with cartilaginous elements. In a word, it becomes rougher and hard to treat. In some cases the operation «dacryocystorhinostomy» is required. It is made for children over 3 years old. During this operation the nasolacrimal duct is molded using the approach through the nasal cavity.

It should be noted: if dacryocystitis in newborns is left untreated, it can lead to serious complications in the future. Dacryocystitis in newborns can result in chronic conjunctivitis, with involvement of surrounding tissues into inflammatory process, spread of infection to the eye or serious ocular pathologies.

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