One of the problems in a newborn child that parents have to deal with is inflammation of the lacrimal sac, leading to obstruction of the lacrimal canal (dacryocystitis).
5% of newborns suffer from this disease.
A tear forms in the lacrimal gland (located outside the upper part of the orbit), enters the conjunctival cavity, from there it passes through the lacrimal ducts into the lacrimal sac and then through the lacrimal canal passes into the nasal cavity. The lacrimal sac is located between the inner corner of the eye and the nose, its continuation is the lacrimal canal, which is covered with folds to prevent the penetration of pathological microorganisms from the nasal cavity.
The lacrimal canal in newborns is about 8 mm long, its valves are underdeveloped, this contributes to the unhindered penetration of pathogenic bacteria (for comparison: in adults - 14 - 25 mm). In a child in the womb, the lacrimal canal is closed with a gelatinous membrane, which protects the canal from amniotic fluid.
Normally, during birth, the membrane breaks immediately at the first cry of the newborn. If for some reason this did not happen, the excreted fluid does not flow down the lacrimal canal, but accumulates in the lacrimal sac.
In case of infection, an inflammatory process may occur.
Over time, dacryocystitis develops - inflammation of the lacrimal sac, one of the methods of treatment of which is probing the lacrimal canal in a newborn.
Causes of obstruction of the lacrimal canal and the development of inflammation of the lacrimal sac
The causes of dacryocystitis, in addition to the intact gelatinous film, can be the anatomical narrowing of the lacrimal canal, congenital anomalies in the structure of the nasal cavity. This leads to blockage of the lacrimal canal by mucus and dead epithelial cells. In the future - to the dacryocyst. If in the first weeks after birth the patency of the tear duct is not restored on its own, it is necessary to intervene with a specialist and conduct probing (bougie) of the tear duct.
With the development of dacryocystitis, if no measures are taken and the lacrimal duct is not probed in the newborn, the process will develop further. There will be pain, hyperemia, edema with translucent purulent contents in the projection of the lacrimal sac. In case of refusal of help, the symptoms increase, the temperature rises, phlegmon of the lacrimal sac develops, which can open itself if the newborn is not probed by the lacrimal canal.
Symptoms of inflammation of the lacrimal sac in a newborn
When viewed from a child, lacrimation or tearing is observed with a calm state. These symptoms are observed only from the second month of life, when the lacrimal gland begins to produce a sufficient amount of tears. Up to two months of age, a newborn's secreted tear is enough only to moisten the membranes of the eye. In addition to these manifestations, severe edema (protrusion), redness in the corner of the eye, which can reach large sizes, purulent discharge from the eye are clearly visible. The defeat in inflammation of the lacrimal sac, as a rule, is a one-sided process.
Probing of the lacrimal canal in a newborn as one of the methods for diagnosing dacryocystitis
For diagnosis, several samples are performed.
1. The patency of the lacrimal canals is assessed by conducting a special tubular test. For this purpose, 3% collargol is instilled into the affected eye. Normally, the paint disappears within 5 minutes. If it takes about 10 minutes to absorb the paint, patency of the tear ducts is slowed, although there is swelling. When the paint lingers in the conjunctiva for more than 10 minutes - the test is negative, patency of the tear duct is significantly impaired.
2. Patency of the entire lacrimal system is checked by a nasal test. It is similar to a tubular test, but a cotton wool is laid in the nasal passage on the corresponding side, and by the time of its staining when the eye is instilled with a collargol, the patency of the tear system is judged: staining after 5 minutes - patency is normal, up to 10 minutes is slowed down, 10 or more minutes - no outflow, negative sample.
3. Be sure to examine the discharge from the lacrimal sac. The pathogen and its sensitivity to antibiotics are determined.
4. For diagnostic and therapeutic purposes, probing and washing of the lacrimal canal in a newborn is carried out.
Probing of the lacrimal canal in a newborn as one of the ways to treat dacryocystitis
The goal of treating dacryocystitis is:
- restoration of complete patency of the lacrimal canal;
- prevention of complications and reorganization of the entire conductive lacrimal system (anti-inflammatory and antibacterial therapy).
A lacrimal sac massage is preliminarily prescribed. The procedure is very effective if carried out correctly. But massage is indicated in the initial stages of the disease. If there is swelling, thickening, redness - massage can not be performed.
If the effect of treatment and properly performed massage for two weeks is absent, this is an indication for probing the lacrimal canal in a newborn. The most suitable age for this procedure is 1-3 months.
There are other indications for conducting a sounding of the lacrimal canal in a newborn:
- the presence of lacrimation and lacrimation;
- suspicion of anomalies of the lacrimal canal;
- chronization of the process.
Before probing the lacrimal canal of a newborn, an examination by a pediatrician is necessary to make sure that the child is healthy and the suppuration process is not associated with the presence of a viral or bacterial infection.
The procedure from the side looks frightening, is associated with some inconvenience on the part of the patient, but is generally painless. Medical manipulation is performed under local anesthesia. It is performed by an experienced doctor. It takes several minutes in time. The essence of probing the lacrimal canal is to rupture the film or formed cork in the newborn with the help of a special probe to restore the patency of the canal. The doctor inserts a rigid probe into the lacrimal canal (resembles a piece of wire - Bowman’s probe), “punches” it with a blockage and widens the canal opening.
In many cases, a single probe of the lacrimal canal in a newborn is enough to achieve the desired result. But in 40% of cases it is necessary to repeat it, sometimes several times with an interval of several days. With a later execution of the manipulation, its effectiveness decreases.
After probing, the lacrimal canal in the newborn is immediately washed. Then, for 3 months, treatment is prescribed and, if necessary, repeated washing.
In the absence of effect, a rather complicated operation is performed - dacryocystorhinostomy. The operation is performed to prevent serious complications at the age of 5 - 7 years.
Complications of dacryocystitis with untimely treatment
Dacryocystitis is dangerous because the purulent process is located in the immediate vicinity of the brain. If medical care is rendered out of time, this can lead to the formation of an abscess or phlegmon with fluctuations in the area of the lacrimal sac. This condition requires immediate intervention: the phlegmon is opened and a course of systemic antibacterial drugs is prescribed to prevent further complications.
With inadequate treatment or late treatment, it may develop:
- corneal ulcer;
- Severe conditions that threaten the life of the child associated with the spread of a purulent pathological process beyond the lacrimal sac until the development of cavernous sinus thrombosis, meningitis, sepsis, etc .;
- transition to a chronic course with the development of atony, fusion, dilatation (expansion) of the lacrimal ducts.
Prevention of complications of dacryocystitis
Timely examination by a neonatologist or pediatrician and immediate consultation of the child by a pediatric ophthalmologist for the diagnosis and detection of dacryocystitis is one of the conditions for successful treatment. The use of sounding and washing the lacrimal canal in a newborn leads to a quick relief of inflammation.
In no case should you treat a newborn yourself, without a doctor’s prescription. Often parents confuse manifestations of dacryocystitis with conjunctivitis and treat conjunctivitis. The cause of the disease is not eliminated. You can aggravate the situation and cause improper actions to cause complications. Probing of the lacrimal canal in newborns rarely causes complications. The older the child, the more painful the procedure and the more complications it causes, it often requires repeated treatment.
