How to open the tear duct in newborns. The structure of the nasolacrimal duct in a newborn baby. If massage doesn't help

In the maternity hospital, and then at home, the pediatrician will tell and show the young mother how to behave and how to care for the child. A newborn requires special knowledge and skills. These very simple and very pleasant procedures must be repeated every day for the baby’s trouble-free growth. These manipulations are very different and they begin with morning washing.

But one day a young mother may notice that the baby has sour eyes. Some young mothers will not attach due importance to this phenomenon, while others, on the contrary, will begin to worry greatly. Of course, this symptom should under no circumstances be left without parental attention, but you shouldn’t get hysterical either: dacryocystitis is quite common in newborns and infants.

What is dacryocystitis?

Tear fluid is known to perform a lot important functions. The tear protects the baby's eye from drying out. Performing the functions of an auxiliary lens, a tear participates in the refraction of light. Forms the tear film and also nourishes the cornea with minerals. Tears are produced by the lacrimal gland, which is located in the lacrimal fossa in upper area outer edge of the eye. First, the tear enters the conjunctival cavity, then through the lacrimal canaliculi it enters the lacrimal sac, located in the inner corner of the eye. This does not happen with obstruction of the lacrimal duct in newborns.

It is useful to know that human tears perform a number of important chemical and physiological functions that many of us are not aware of. In fact salty tear moisturizes and moistens the eyeball, constantly nourishes the apple useful substances, and also disinfects, protecting against harmful microorganisms. When a tear finishes its function, it needs to somehow leave the eye. For this purpose, there are lacrimal openings and lacrimal canals. The lacrimal sac and the nasolacrimal canal form the lacrimal ducts.

When the baby is in the womb , its lacrimal ducts are closed. The channels are covered with a special gelatin-like film, which also protects Airways from liquid getting into them. When the baby takes his first breath, the film breaks with the baby’s first cry, and the newborn’s tear duct also opens. However, there are pathologies when this does not happen. Doctors talk about congenital blockage nasolacrimal duct or dacryocystitis.

The disease can be either acquired or secondary, that is, it can develop in older children, and sometimes even in adults. Conjunctivitis preceding dacryocystitis is often the cause of such a disorder, and sometimes lies in other causes: for example, prolonged or chronic rhinitis, injuries, in age-related changes or neoplasms. It is important to know that dacryocystitis develops only as a complication against the background of other diseases.

Excessive tears in humans is excreted through the nasolacrimal duct, entering the nasopharynx. In a newborn, the length of the nasal canal is very short - approximately 8 mm. For comparison: in adults, the length of the canal ranges from 12 to 14 mm. The connection with the nasopharynx creates very favorable conditions for the development of infection and the entry of various microorganisms into the lacrimal canal. The lacrimal duct in newborns is very underdeveloped, which facilitates the invasion of microorganisms.

Symptoms of dacryocystitis

Doctors call the first sign of a blocked tear duct in a baby increased lacrimation. If patency is not restored within a few weeks after birth, the lacrimal sac is gradually penetrated. various kinds viruses or bacteria, and then purulent inflammation develops.

In approximately 7% of infants, the tear film breaks spontaneously within six months. This is due to the growth and expansion of the nasolacrimal ducts, the film stretches and ruptures on its own, and the problem of obstruction of the lacrimal duct disappears. Do not forget that all this time the baby must be under the supervision of an ophthalmologist.

Typically the following symptoms may appear:

• the appearance of a purulent color in the eye of a newborn;
• redness or conjunctiva, as well as skin irritation in the corners of the eye;
• swelling and painful swelling of the eyelids;
• involuntary lacrimation;
• discharge of pus when pressed.

If at birth the septum still remains intact, and the canal remains blocked for secreted fluid, then this fluid accumulates in the baby’s lacrimal sac - and stagnation forms, which leads to inflammation . The eyes of a newborn are constantly watering due to inflammation.

A humid environment is very favorable for the development of microorganisms and bacteria. There are a great many of them in the air inhaled by the baby. Soon, an inflammatory process begins in this tear sac.

At this stage, the disease may be accompanied by discharge in the form of pus in the corners of the eyes (the baby’s eyes turn sour and fester). To make sure that the disease is present and that this is a blockage of the canal in a newborn, you can lightly press on the area of ​​the lacrimal sac or lacrimal openings: with dacryocystitis, a yellowish lacrimal-purulent fluid will begin to be released from the canals due to light pressure.

If the disease is not congenital, then at correct observance instructions and medical recommendations, dacryocystitis can be avoided. The main causes of blockage of the nasolacrimal duct are the following factors:

Blocked tear duct: treatment

Almost all doctors say that treatment of dacryocystitis it is necessary to start at the very early stages. Although there is a group of specialists who believe that there is no need to rush, and that the optimal period for treatment is 2-4 months of age for the baby.

Next we will talk about different methods treatment for each stage of dacryocystitis. Here we will stop and tell you in more detail. Exists high probability the fact that a septum that does not burst at birth should resolve on its own within a few days after the birth of the child, and therefore it is usually advisable not to take any action during this period. But if symptoms of canal blockage appear much later, the baby should be urgently shown to a specialist and, strictly following the instructions, begin to treat dacryocystitis.

Massage for blocked tear ducts

It is important to understand that upon detection of purulent discharge from the eyes The baby's parents should urgently show him to a pediatric ophthalmologist. The doctor will definitely take the tears for a Vesta test (for an accurate diagnosis) and select suitable eye drops for the baby. And he will definitely show mom and dad how to massage the eye canals. The ophthalmologist will explain what needs to be done to avoid puncturing the film if possible. Using massage movements, you can stretch the very film that prevents the outflow of tear fluid.

Massage is a series of very simple actions and is carried out completely painlessly for the baby. Before starting the procedure, be sure to wash your hands with soap and cut your fingernails. Nails should be cut at the root, right down to the fingertip. First, you should put your baby on the sofa or changing table - a place where you will be comfortable. Place one drop of the medicine prescribed by the ophthalmologist into the corner of the eye closer to the nose. Wait a few minutes for the components of the medicine to take effect and begin massaging. Holding the newborn's head with one hand, use the little finger of the other hand to massage the corner of the eye in a circular motion with light, gentle pressure.

Pressing on the eyeball is strictly prohibited! Massage only the corner of the eye, the so-called lacrimal punctum, and make light jerky and circular movements in a downward direction. When you complete the procedure, the baby’s eye should be washed with a cotton pad soaked in saline solution. You can also soak it in a decoction of calendula and chamomile or in freshly brewed tea. Massage movements should be made only in the direction from the outer to the inner corner of the eye.

We warn you right away that the baby will squirm and cry. You must understand that a newborn does not understand what is happening to him, and therefore reacts as a baby should. You must remember that there is no danger to the baby, and you are trying to help. Carry out the procedure calmly, talk to the baby, stroke it and pay attention to yourself.

The duration and number of massage procedures will be determined by the ophthalmologist.

Probing for obstruction of the lacrimal duct

There are cases when even correct and regular massage strictly according to the instructions did not lead to desired result(in other words, the patency of the canals has not been restored) or the disease is already advanced. Then need to probe the channel.

If you cannot do without probing the nasolacrimal canal, you must remember that this is a very unpleasant, even painful procedure for the baby. However, it is very effective and is performed under local anesthesia. The ophthalmologist inserts a probe through the baby's nasolacrimal duct and dilates it. Through the expanded channel, with the help of a second probe, the same film in the nasolacrimal compartment is pierced. It is also necessary to spend a week massage treatments nasolacrimal canal, and also instill drops into the eyes to avoid neoplasms and adhesions during healing after the probing procedure.

If dacryocystitis is caused in a baby congenital pathologies or physiological abnormalities of the nasolacrimal ducts, Treatment is only surgical. Surgical operations are performed no earlier than 4-5 years of age.

Diseases with similar symptoms

• Conjunctivitis.
• Blood in tear fluid.
• Allergic reactions.

The diseases described above are often confused with blocked tear ducts in newborns, because the symptoms are very similar. Young, inexperienced mothers often mistake contamination for conjunctivitis and most often limit themselves to pharmaceutical medications, as well as local anti-inflammatory and antiseptic treatment. Ordinary conjunctivitis can be quickly cured with proper treatment by specialists, but obstruction of the lacrimal duct cannot.

For conjunctivitis There is no phenomenon of tearing, and there is also no purulent discharge or redness of the skin. Doctors are inclined to believe that obstruction is still a congenital disease, and conjunctivitis is infectious and acquired. Under no circumstances should you self-medicate. Remember that at the first symptoms of obstruction and inflammatory process the child urgently needs to be shown to a pediatric ophthalmologist who can diagnose accurate diagnosis.

conclusions

We now know that tear duct obstruction occurs approximately in 8−15% of children. This pathological condition, associated with inflammation, in which the baby’s outflow of tear fluid ceases to function normally. This occurs due to partial or complete blockage of the tear duct.

During the period of intrauterine development of the fetus, the nasolacrimal canal is tightly closed with a thin film. The film prevents amniotic fluid from entering the respiratory tract and nasopharynx. As the newborn passes through the birth canal during childbirth, as well as with the baby’s first breath, the film breaks. Thus, the entrance to the nasolacrimal duct is cleared. There are cases when this does not happen, then the newborn may develop dacryocystitis - a disease caused by stagnation of fluid, which leads to inflammation of the nasolacrimal duct.

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Obstruction of the lacrimal duct in newborns occurs, according to various sources, in 7-14% of children.

This is a condition in which the normal outflow of tear fluid is disrupted due to complete or partial blockage of the tear duct.

The structure of the nasolacrimal duct in a newborn baby

Tear fluid performs several important functions:

• Protects the eye from drying out;
• Participates in the refraction of light;
• Forms the tear film;
• Nourishes the cornea.

Tears are produced by a gland located in the lacrimal fossa at the upper outer edge of the eye socket. First, it enters the conjunctival cavity, and then, along the lacrimal canaliculi, into the lacrimal sac, located near the inner corner of the eye. Excess tears exit through the nasolacrimal duct into the nasopharynx.

In newborns, the nasal canal is relatively short - only 8 mm, whereas in adults the length of the canal ranges from 14 to 15 mm. This creates favorable conditions for infectious agents to enter the lacrimal sac. In addition, the lacrimal canal in newborns is underdeveloped, which also contributes to the invasion (penetration) of microorganisms.

Mechanism of obstruction formation

The entire period of intrauterine development, the nasolacrimal canal is covered with a thin film, which prevents amniotic fluid from entering the nasopharynx. However, as the baby passes through the birth canal or with the first cry, this film breaks and frees the entrance to the nasolacrimal canal. If this does not happen, dacryocystitis develops - inflammation of the lacrimal canal caused by fluid stagnation.

The first sign of obstruction of the lacrimal canal in an infant is increased tear production. If in the first weeks after birth the patency of the canal is not restored, infectious agents (viruses or bacteria) penetrate into the lacrimal sac and purulent inflammation develops.

In some babies, the tear film may rupture on its own within the first six months to a year. This is due to the growth and expansion of the nasolacrimal ducts, as a result of which the film stretches and ruptures on its own. All this time, the child should be under close supervision of an ophthalmologist. If all medical recommendations are correctly followed, inflammation of the lacrimal sac can be avoided.

Reasons for formation

The following factors can lead to obstruction of the nasolacrimal duct:

• Partial or complete absence nasolacrimal duct;
• Anomalies in the development of the lacrimal sac (for example, the presence of diverticula - pathological outgrowths);
• Incorrect location of the lacrimal sac;
• Traumatic damage to the lacrimal ducts (for example, due to careless obstetric manipulations);
• Congenital narrowness of the nasolacrimal duct;
• Deviated nasal septum and other anomalies in the structure of the nasal cavity;
• Dacryocystocele is hydrocele of the lacrimal sac.

Symptoms of obstruction

Obstruction of the nasolacrimal duct can be detected even in maternity hospital. However, in most cases, this problem makes itself felt much later.

The very first sign of the disease is the appearance of causeless lacrimation in the baby.. Moreover, it can be either unilateral or bilateral (in the case of simultaneous damage to both eyes).

Some time after tears appear, the eye begins to turn red and dacryocystitis develops. In this case, stagnation of tear fluid is formed, which is a favorable condition for the attachment of bacteria and their further reproduction.

Appear purulent discharge, which may be accompanied by eyelash sticking and fever. Typically, the causative agents of dacryocystitis are streptococci, Escherichia coli, staphylococci, and, less commonly, chlamydia and gonococci.

Sometimes indicated symptoms are mistaken for . However, conjunctivitis, unlike dacryocystitis, often has bilateral localization. In addition, there are a number of other diagnostic signs, allowing to differentiate these conditions. More details about them are described in the “Diagnostics” section.

When pressing on the lacrimal sac from lacrimal openings Drops of cloudy purulent fluid are released. Largest quantity Such discharge is observed after the baby wakes up or during strong crying.

As dacryocystitis progresses, ectasia of the lacrimal sac occurs - its stretching and increase in volume. At the same time, the skin over it is hyperemic (red) and sharply stretched. In particular advanced cases the bag can reach the size of a ripe cherry.

Overstretching of the mucous membrane of the lacrimal sac leads to its atrophy and inability to produce mucous secretion.

Diagnosis of lacrimal duct obstruction

Diagnosis of dacryocystitis in infants is based on anamnesis (questioning the mother about the course of the disease) and use additional methods research:

Comprehensive diagnostics must necessarily include a detailed clinical analysis blood and urine, as well as consultations related specialists(pediatrician, ENT doctor) to exclude other diseases.

Treatment of lacrimal duct obstruction in newborns

Under no circumstances should you start self-treatment dacryocystitis in newborns at home. And even more so, you don’t need to listen to the advice of grandparents, experienced neighbors and others. This may lead to serious consequences(transition of the disease to chronic form, phlegmon of the lacrimal sac, phlegmon of the orbit).

There are several tactics for managing a newborn who has been diagnosed with obstruction of the nasolacrimal duct: conservative (expectant) and surgical. Let's look at each direction in more detail.

Medicines

In parallel with the massage, the doctor may prescribe antibacterial agents to prevent infection. The choice of antibiotic directly depends on the results of microbiological testing.

Usually these are eye drops that need to be instilled into the conjunctival cavity several times a day after a massage.

good antibacterial effectiveness have the following drugs: Vigamox, Tobrex, chloramphenicol (0.3%), Oftaquix, gentamicin (0.3%).

Contrary to popular belief, the use of albucid is undesirable for a baby for two reasons:

• When instilled it causes a burning sensation;
• It is characterized by crystallization (precipitation). And this can further aggravate the obstruction of the nasolacrimal duct.

If the doctor prescribed several medicines, they need to be instilled with a break of at least 20 minutes.

Operation

If conservative treatment methods do not have the desired effect, it becomes necessary surgical treatment- probing the nasolacrimal duct. At the same time, the opinions of doctors regarding the timing of this manipulation differed.

Some believe that the most optimal time falls on the 4th – 6th months of the baby’s life. Others believe that probing should be resorted to after two months of unsuccessful conservative therapy. In any case, the timing of the sounding will be selected individually depending on each specific case.

Before the operation, the baby must be examined by an ENT doctor to rule out concomitant diseases.

Probing of the nasolacrimal duct is performed by a pediatric ophthalmologist in a clinic setting. As a rule, local anesthesia is used.

The baby is swaddled tightly and his head is fixed by a nurse. First, the nasolacrimal canal is expanded using a conical Siegel probe, which is inserted into the lacrimal punctum.

Then a long Bowman probe is inserted into the canal, which pierces the embryonic membrane. After this, the canal is washed with some disinfectant solution. Probing takes only a few minutes and is absolutely safe for the baby.

In 30% of cases, the manipulation may need to be repeated.

Statistics show that probing allows you to restore the patency of the nasolacrimal duct in 90% of cases.

WITH for preventive purposes After the intervention, the child is prescribed antibacterial drops, UHF and massage.

If the operation is unsuccessful, the cause of the obstruction lies in intrauterine developmental anomalies (for example, due to a deviated nasal septum). Then something more serious may be required. surgery.

Massage of the lacrimal canal in newborns

Massotherapy: Conservative treatment usually begins with massage of the lacrimal canal in a newborn. This is necessary in order to facilitate the rupture of the film and, thus, restore the patency of the nasolacrimal duct.

The sooner the mother starts massage, the higher the chances of recovery without surgery. The fact is that with age the film becomes much denser, and it will be more and more difficult to break through it with the help of massage.

The doctor performs the first massage of the nasolacrimal duct in newborns on his own to teach the mother the correct technique.

It was found that proper massage can restore the patency of the lacrimal canal in a third of children whose age did not exceed 2 months. With each subsequent month, the likelihood of the film breaking on its own decreases.

Rules for massage for obstruction of the lacrimal canal in newborns:

• Before the procedure, wash your hands with boiled water and soap, thoroughly clean your nails and cut them short;
• The pus that will come out when pressing on the lacrimal sac must be removed with a sterile gauze swab soaked in furatsilin or chamomile decoction;
• Try to remember all the doctor's recommendations regarding massage, especially the strength with which to apply pressure. Stroking too lightly will have no effect, while too much stroking may harm the baby.

How to massage the tear duct for a baby:

Massage for blockage of the lacrimal canal in newborns should be repeated 4-5 times and performed at least six times a day. Now you know how to properly massage the lacrimal canal for dacryocystitis in newborns.

It is best to massage while the baby is crying.. The fact is that then the child tenses all his muscles, especially facial muscles, which can contribute to the rupture of the embryonic film.

Tear fluid is essential for cleansing and preventing drying. eyeball. Tears collect in the inner corner of the eyelid and flow into the nose. In newborns, the tear duct may become blocked, causing inflammation of the eye.

The baby's lacrimal cavity is underdeveloped. As the child grows, the canal increases in length. Before the baby is born, the transition from the eyes to the nose is covered with a small film that prevents amniotic fluid from entering the respiratory tract.

At birth, the film breaks and opens a passage for tears to flow into the nasopharynx. But in 8% of children this does not happen and a tear stagnates in one eye. In 1% of patients, the film does not disappear in both channels.

Before birth, instead of a thin membrane, a thick film consisting of unnecessary cells and secretion may form in the tear duct. At the same time, it becomes more difficult to break through the channel. The length of the lacrimal cavity in a newborn is only 8 mm, which increases the risk of bacterial infection of the lacrimal sac. This disease is called dacryocystitis.

The risk of pathology does not depend on the sex of the child and is not inherited. Treatment initially takes place at home. But there are a number of reasons why dacryocystitis in newborns requires surgical intervention: absence of a cavity, disruption of the structure of the lacrimal sac, congenital narrowing, curvature of the nose, trauma due to difficult childbirth.

Symptoms of a blocked tear duct

Blockage of the tear duct in newborns appears within 24 hours after birth. Sometimes dacryocystitis becomes noticeable later.

Symptoms of blockage include the following:

• stagnation of tears;
• lacrimation;
• redness of the eyeball;
• swelling of the eyelid;
• the appearance of white or green pus in the lacrimal sac;
• sticking of eyelashes after sleep.

A newborn baby cries without tears. The appearance of a flowing tear should alert parents.

Tearfulness may come and go. Redness of the conjunctiva does not always occur. Occurs after the appearance of purulent discharge and infection of the conjunctiva. The more severe the condition, the greater the redness and swelling of the eyelids. With the right and timely treatment These symptoms may not appear.

The appearance of pus is a symptom of dacryocystitis or conjunctivitis. But when the lacrimal duct is blocked, pus accumulates in the inner part of the eyelid, and when you press on the lacrimal sac with your finger, the amount of discharge increases. There is more pus when the child cries or screams for a long time.

If left untreated, bacteria can multiply rapidly, causing the lacrimal sac to enlarge and stretch. In advanced cases, the swelling increases to the size of a cherry and interferes with the child. Stretching of the eyelid leads to atrophy and does not allow the production of tears to cleanse the eye, which leads to worsening of the condition. The appearance of a fistula or phlegmon is severe complication dacryocystitis.

Massage for newborns

Blocked tear duct in newborns can be treated in 99% of cases conservative methods without surgical intervention. Massage is the most popular and effective. The ophthalmologist or pediatrician teaches parents the technique during the appointment.

Attention should be paid to the pressing force. Strong pressure will cause pain and discomfort to the child, weak pressure will not lead to results. Massage must be performed 4-6 times a day to achieve results. Correct Actions increase the pressure in the tear duct and remove the film.

Before the massage, it is necessary to trim your nails so as not to injure the child. Wash your hands with soap to avoid eye infection. Pre-purulent discharge is removed soft cloth or a swab soaked in a solution of furatsilin. Eye cleansing is carried out from the outer part of the eyelid to the inner. Gauze will damage the delicate mucous membrane of the newborn.

After preparation, the massage is performed according to the following rule:

1. Determine the tubercle in the inner part of the lacrimal sac that protrudes as much as possible above the surface of the skin and is distant from the eye.
2. Press this point not hard, but noticeably enough to create pressure in the tear duct.
3. Run your finger from top to bottom towards the child’s nose, applying force.
4. Repeat 5-10 times.
5. If pus appears in the eye, cleanse it again and continue the massage.
6. At the end of the procedure, antibacterial drops are instilled into the eyes.

Massage can be performed more than 4 times a day, but use the drops strictly according to the instructions. The medications that are best suited for the child should be prescribed by an ophthalmologist or pediatrician. It is advisable to take a pathogenic flora sensitivity test to identify the group of bacteria that caused the eye infection.

A common treatment for a blocked tear duct in a newborn is massage. The photo shows one of the technology options

Treatment is carried out for at least 2 weeks. If the massage technique is followed, the disease resolves in 99% of children under the age of 1 year, 30% of newborns recover by the age of 2 months. The older the child gets, the longer it takes to get results.

Drug therapy

Drug treatment is prescribed by an ophthalmologist to eliminate bacterial infection of the eye sac and relieve inflammation. In medical practice they use eye drops. They are easy to use and are available for any age.

After testing for sensitivity to pathogenic flora, the doctor selects drops that will be effective. If tests are not possible, antibiotics are prescribed. wide range actions.

Drugs prescribed for the treatment of dacryocystitis:

A drug	Description of the drug
Vitabact	Possesses antimicrobial effect, is widely used in ophthalmology. Approved for use from 1 month. The drug is instilled 4 times a day, 2 drops. The course of treatment is up to 2 weeks. Longer use is allowed as prescribed by a doctor.
Tobrex	The manufacturer recommends use in children over 1 year of age. But pediatric ophthalmologists prescribe these drops when Vitabact is ineffective.
Solution 0.25% Levomycetin	Has a broad antibacterial effect. The drug is prescribed for 2 weeks, 1 drop every 4 hours. Antimicrobials, including Levomycetin, should be used as prescribed by a pediatric ophthalmologist or pediatrician.
Collargol	Approved for use in children under 1 year of age. The composition contains silver, an overdose of which is dangerous. This drug can only be used with a prescription.
Albucid	Safe for children, but not prescribed for newborns due to pain during the procedure. Drops can also crystallize, which can aggravate the problem.
Furacilin solution	Used to wash the eye and remove accumulated pus. Grind 1 tablet and dissolve in half a glass of water.

If the drug must be stored in the refrigerator, then before use you should warm the drops in your hands or in a water bath.

Probing

If after the drug treatment and the massage does not result in results, the doctor will suggest probing. The decision to perform this procedure is made by a qualified ophthalmologist. You must first make sure that the mother’s massage technique was correct.

If there is no improvement within a month, the child is prepared for the probing procedure:

• Consultation with an otolaryngologist is required to exclude pathologies of the nasal septum.
• A general blood test is prescribed.
• Consultation with a pediatrician to exclude acute viral infections.
• You should not feed your baby 1 hour before the procedure to prevent regurgitation.
• The newborn is swaddled tightly so that he cannot interfere with the probing.

This method should be carried out in the first six months of the child; at an older age, the film becomes dense and difficult to tear. The procedure is not used in acute forms of the disease with big amount pus. Probing is carried out for 20 minutes. After the operation, the child is undergoing outpatient treatment.

The procedure consists of the following steps:

After the procedure on last stage the disinfectant solution goes into the nose. To prevent repeated probing, it is necessary to avoid for 2 months viral diseases. The attending physician prescribes eye drops to exclude reinfection. Additionally, a massage is performed to consolidate the achieved result.

Probing the lacrimal canal in a child:

Laser surgery

In newborns, laser surgery is a gentle surgical intervention to restore the outflow of tear fluid into the nasal canal. This method is used for chronic, frequently recurring blockages of the tear duct. As a result, a new cavity is formed between the nose and the lacrimal sac.

At infectious diseases eyes this operation is not performed. Extranasal dacryocystomy is prescribed in childhood according to strict indications. Access to the lacrimal duct is through the nose.

During the operation, the following actions are carried out:

1. Local anesthesia is applied to the areas that will be involved in the operation.
2. An endoscope is inserted from the nasal passage, allowing you to monitor the progress of the operation on the monitor.
3. Using a laser, an incision is made and a new passage is formed between the eye and nose.
4. The mucous membrane is pressed with several sutures to prevent tissue overgrowth.

This method is characterized by high speed and lack of cosmetic defects. Reduces the risk of injury. The hole has the optimal shape and size. The operation can be performed on both sides.

To treat dacryocystitis with a laser, modern equipment and highly qualified surgeons are required. If you are allergic to painkillers, surgery will not be possible.

Surgical intervention

Blocked tear ducts in newborns can be treated without surgery. But if conservative methods do not bring results, then they resort to surgical intervention. The method is effective for severe pathologies of the nasopharynx, curvature of the nose, partial or complete absence of the lacrimal canal.

The operation includes:

1. Use of local anesthesia. Cotton swabs soaked in lidocaine are applied to the lacrimal cavity, nasociliary nerve and posterior ethmoidal nerve.
2. The skin and soft tissues are incised.
3. The periosteum is separated.
4. Using a chisel, a bone window is formed.
5. Use pliers to trim the edge.
6. A direct passage into the nasal cavity is formed.
7. The mucous membranes are pressed to the edges to prevent fusion.

Surgical intervention for blocked tear duct is different high degree traumatic. The incision takes a long time to heal and may leave a scar. Applicable in the absence effective treatment in other ways.

Traditional methods

In addition to medicinal methods of treatment, folk ones are used.

There are plants that have positive influence on the tear duct plug:

Kalanchoe juice

For treatment Fresh Juice Kalanchoe is diluted with saline solution in a 1:1 ratio. This plant relieves inflammation and has a disinfectant effect.

Before using Kalanchoe you need to properly prepare:

• For this clean leaves, wrapped in a piece of cotton, left for several days in the refrigerator.
• After that, they are crushed and the juice is squeezed out.
• The prepared diluted solution is instilled 3 drops into each nostril. Sneezing after the solution increases the pressure in the tear duct and helps break through the film.

Eyebright

The plant is used for eye diseases. Reduces inflammation, has antimicrobial effect and promotes healing.

Preparation and use:

The prognosis for timely treatment of blockage of the tear duct is favorable. Conservative methods bring results on average within 2 months of treatment for a newborn. At long absence result, bougienage, laser or surgical intervention is used.

Article format: Svetlana Ovsyanikova

Video on the topic: blockage of the tear duct in newborns

Massage of the lacrimal canal in a newborn:

Proper eye massage for blocked tear ducts:

Obstruction of the nasolacrimal ducts is a fairly common pathology: it affects about 7% of newborns. This disease can develop in older children and even adults, but infants are most susceptible to it. Many mothers, noticing their baby's eyes turning sour, panic. They are afraid to go to the doctor, trying to heal the child with many months of rinsing and massages. Experts, however, recommend not torturing infants with daily unpleasant procedures, but to eliminate the problem in a few minutes using a probing procedure.

Why is tear duct probing necessary?

A child in the womb does not have free communication between the nasal cavity and the nasolacrimal duct. The exit hole is closed by a thin membrane, which in most children disappears by the time of birth. In this case, the nasolacrimal duct is usually blocked with a gelatin plug, which does not allow amniotic fluid enter the baby's body. When a child is born, begins to breathe and cry, this mucous lump comes out of the duct, enters the nose and is removed by obstetricians.

If at birth the nasolacrimal duct is not freed from the natural plug, the baby develops dacryocystitis

However, it also happens that due to anatomical features or anomalies, the plug does not come out of the nasolacrimal canal. Because of this, stagnation occurs in it. After some time, the newborn develops dacryocystitis - complete or partial obstruction of the lacrimal ducts. The baby's eyes first water, and then begin to fester and become inflamed.

In 80% of cases, dacryocystitis disappears spontaneously by 3–4 months, and massage and instillation of drops only accelerate this process.

Dacryocystitis can be either congenital or acquired due to injuries, inflammatory processes in the eyes or nose, as well as various diseases. This disease can affect both children and adults different ages. However, if acquired dacryocystitis often requires complex surgical interventions, then congenital form usually goes away spontaneously or as a result of washing and massage.

If after conservative treatment The baby's eyes continue to fester, doctors refer the child for probing - mechanical restoration of the patency of the nasolacrimal duct using a special instrument - a probe. The procedure is carried out under local anesthesia and it doesn't last long. However, probing does not guarantee a cure: after a certain period of time, the discharge may reappear. With repeated intervention, the probability of complete recovery is 95–98%.

Constant tearing is the first sign of dacryocystitis

Over time, the gelatin plug in the nasolacrimal duct hardens. Therefore, the older the child becomes, the more traumatic and painful the probing procedure will be for him.

As a rule, doctors are in no hurry to send babies with “sour” eyes for probing. They often recommend that parents wait up to 3-4 months to get rid of the problem with the help of massages and eye drops. If by this time there is no improvement, probing is performed, which usually completely eliminates all symptoms.

Indications and contraindications for the procedure

Dacryocystitis can be diagnosed in a baby only pediatric ophthalmologist, however, any attentive parent can suspect this disease. Obstruction of the lacrimal ducts is often confused with conjunctivitis. These diseases are really similar: their main symptom is purulent discharge from the eyes. However, if conjunctivitis can be easily treated with antibiotic drops, if the nasolacrimal ducts are obstructed, such treatment will be ineffective.

clogged lacrimal gland- an ideal place for bacteria to multiply, causing pus to come out of the eye

The main symptoms of dacryocystitis are:

• constant lacrimation;
• redness of the eyes;
• purulent discharge;
• swelling of the inner edge of the eye;
• discharge of pus when pressing on the lacrimal sacs.

As a rule, after sleeping or crying, the intensity of the discharge increases. In order for a child to see normally, pus has to be removed from the eyes quite often.

If unpleasant symptoms persist for three or more months, doctors refer the baby for probing of one or both nasolacrimal ducts. This, however, only applies to those cases where the obstruction is not caused by complex pathologies. Probing is not prescribed for:

• congenital defects in the structure of the nasolacrimal duct;
• deviated nasal septum;
• blood clotting disorders;
• high temperature and general poor health.

Since the procedure is performed under local anesthesia, before starting it you need to make sure that the baby is not allergic to the painkiller.

Twisted nasal septum can also cause dacryocystitis, but probing will not help with this pathology

Diagnostics and preparation for probing

Before making a final diagnosis, the doctor usually performs the Vesta test. To do this, a dye is dropped into the problem eye, and a cotton swab is placed in the nose. If the nasolacrimal duct is open and the cause of the purulent discharge is bacteria that cause conjunctivitis, the cotton wool will become colored. Otherwise, the ophthalmologist diagnoses dacryocystitis and refers the baby for probing.

Before the procedure, the child must be examined by the following doctors:

• pediatrician - for assessment general condition body;
• a neurologist - to exclude diseases for which anesthesia is contraindicated, as well as to assess the neurological status;
• otolaryngologist - to assess the structure of the nasal passages and detect pathologies such as a deviated nasal septum.

The baby also needs to undergo a blood clotting test, and preferably - general tests urine and blood.

The probing procedure does not require special preparation: the child does not need to be kept from hand to mouth and undergo cleansing procedures. An anesthetic drug in the form of drops is injected directly into the eyes, after which you can begin cleaning the nasolacrimal ducts.

An ophthalmologist will refer the child for probing, but before the procedure the baby must be additionally shown to a pediatrician, neurologist and ENT specialist.

How is probing of the lacrimal duct performed?

The probing procedure is carried out in several stages:

1. The baby is swaddled and his head is fixed. Complete stillness is needed so that the baby does not twitch while the doctor works with a probe in his eyes.
2. An anesthetic drug is instilled into the eyes (in some cases, mask anesthesia may be necessary).
3. The doctor inserts a sterile thin probe into the nasolacrimal duct, widening it and clearing the soft plug.
4. The insertion site of the probe is washed with an antiseptic solution.
5. The child is freed from diapers and given to his parents.

The whole procedure takes from 5 to 10 minutes. If the child is more than 6 months old, then the plug has already hardened, so instead of probing, bougienage is performed. To do this, the nasolacrimal duct is not cleaned, but pierced, making a through puncture in the plug.

Like probing, bougienage is absolutely safe and causes minimal harm to the baby. discomfort. The procedure is carried out under anesthesia, so children scream not from pain, but from tight swaddling and fear of doctors.

Probing is a low-traumatic operation

To minimize the risk of complications, probing should be carried out by a qualified pediatric ophthalmologist in a good clinic equipped with all the necessary equipment.

Caring for a child after probing

The effect of the procedure is usually noticeable within a few days. The eyes stop watering and fester, and the child’s condition finally returns to normal. You can wash your baby, bathe him and do everything with him usual procedures, however, doctors recommend monitoring your eyes for at least another month. For the first 7 days after probing, small patients need to instill antibacterial drugs and do a special massage aimed at improving the patency of the tear ducts.

The doctor who performed the probing must show which areas need to be massaged and with what intensity. Typically, circular movements or low-intensity pushes with the fingertips are recommended in the direction from the upper part of the inner corner of the eye along the nose to the mouth.

During the massage you must adhere to the following rules:

1. Before the procedure, cut your nails and wash your hands thoroughly or wear sterile gloves.
2. If pathological secretion has accumulated in the eyes, gently squeeze out the pus and rinse them with chamomile decoction or warm solution furatsilin in a ratio of 1:5000. Make sure that the contents of the diseased eye do not get into the healthy eye or into the ear.
3. After the massage, drip your eye with an antibacterial solution. Levomycetin or Vitabact are suitable.
4. Massage up to 5 times a day. It is best to do it before feeding: after eating, many children fall asleep, and the drops have an antibacterial effect during sleep.
5. Make all movements very carefully and carefully: in infants, in the sinuses of the nose there is not bone, but delicate cartilage, which is very easy to damage.

The intensity and sequence of movements when massaging the lacrimal duct must be demonstrated by a doctor.

If the parents followed all the doctor’s instructions, and within a month the discharge from the eyes did not disappear, it means that the child was given an incorrect diagnosis or the probe did not penetrate the nasolacrimal duct completely. In any case, you need to contact a specialist who will develop a further strategy for examination and treatment.

Possible complications

If probing is carried out correctly, the risk negative consequences is reduced to a minimum. The only thing possible complication- the occurrence of adhesions and overgrowth of the nasolacrimal duct. This is precisely what massage is aimed at preventing. If you do it conscientiously 3-4 times a day, the baby will not need repeated probing.

Great danger in postoperative period represent for the baby viral infections. Due to a common runny nose, pathogenic microorganisms can penetrate into the injured opening of the nasolacrimal duct, which usually provokes a relapse of the disease. Therefore, for 1–2 months after probing, it is better for the baby to avoid children’s groups and crowded places.

In most cases, medical intervention is easily tolerated by children, and repeated surgery is not required. Within 1–2 days acceptable bloody discharge, and the eye may continue to water for up to 2-3 weeks. If lacrimation continues after this period, the child should be re-examined and, possibly, probed again. As a rule, after the second operation the problem is completely eliminated.

Video: dacryocystitis in children - causes and treatment

Probing is an easy and effective surgical intervention. At correct implementation With this manipulation, the risk of complications is minimal, and the likelihood of a favorable outcome is maximum. However, before you decide to probe, you need to try to restore the patency of the nasolacrimal duct using conservative methods, using massage and rinsing. If, despite all efforts, the baby’s eyes continue to water, do not be afraid of the operation: it will go away very quickly and will cause only minor inconvenience to the child.

Tear duct obstruction is a common ophthalmic disease, which occurs in both adults and children. In medicine, this disease, accompanied by blockage of the lacrimal canal, is also called dacryocystitis. Due to the similarity of symptoms, tear duct obstruction is often confused with other eye diseases, so at the first signs an examination is required to establish an accurate diagnosis.

According to statistics, dacryocystitis is most often diagnosed in women, whose age ranges from 30 to 60 years; in men, the disease occurs much less frequently. Learn more about treating a blocked tear duct and we'll talk in this article.

Causes of obstruction

• genetic predisposition;
• abnormal development of the patient's skull;
• changes in the body caused by age;
• development of inflammatory or infectious process, affecting organs vision;
• mechanical damage to the front part;
• development of tumors in the lacrimal sac or nose;
• formation of stones or cysts in drainage system, which provokes disruption of the lacrimal canal;
• consequences of the use of external or internal medications.

On a note! It often occurs in people who have previously had to deal with cancer treatment. According to statistical data, taking antitumor drugs medicines and irradiation of the patient's face increase the likelihood of developing dacryocystitis.

Characteristic symptoms

Blockage of the tear duct can occur in one eye or in both eyes at once. As a rule, the symptoms of the pathology are caused by the development of an infectious process that develops against the background of blockage of the canal. Among all the signs of dacryocystitis, it is worth highlighting the following:

• decreased visual acuity;
• blood impurities in the lacrimal sacs;
• the appearance of purulent discharge from the affected eye;
• swelling of the organs of vision, which is often accompanied by painful sensations;
• development of an inflammatory process affecting the lacrimal sac and eyeball;
• the appearance of “wet eyes” syndrome, which is characterized by excess tear fluid.

Many people confuse dacryocystitis with ordinary inflammation due to the similar clinical picture. It is necessary to learn to distinguish dacryocystitis from other ophthalmological pathologies. The main thing you need to know is the main symptom accompanying dacryocystitis. We are talking about swelling of the eyelids, their redness, as well as painful sensations accompanying the disease. Often, when you press on the tear duct, purulent discharge appears. If you notice the above symptoms, you should seek help from a doctor as soon as possible. Dacryocystitis cannot be ignored, since untimely treatment can lead to serious complications.

Diagnostic features

At the first suspicion, you should consult a doctor for diagnostic examination. In this case, the diagnosis is carried out by an ophthalmologist, who carries out several tests to make an accurate diagnosis. laboratory tests. First of all, the doctor must conduct a collarhead test, with which you can identify the location of the source of inflammation, the main thing is to determine what kind of disease has affected the patient’s eyes - dacryocystitis or conjunctivitis.

In addition to the collarhead test, the doctor may prescribe additional diagnostic procedures:

• sample of the patient's lacrimal duct;
• sowing of purulent contents released during palpation;
• radiography of the eyes;
• biomicroscopic analysis.

Based on the results obtained, the doctor will be able to make an accurate diagnosis. Only after this is a course of therapy prescribed in accordance with the severity of the disease, the degree of damage and the age of the patient.

Treatment methods

Depending on the factor that triggered the development of dacryocystitis, the course of treatment may differ slightly. For achievement maximum effect doctors use A complex approach, which includes not only taking medications, but also performing special massage, accelerating the recovery process. IN in rare cases, for example, if traditional therapy does not help or if the cause of the pathology is a tumor, doctors resort to surgical treatment. Let's consider each of these methods separately.

Pharmacy drugs

Often medicinal method treatment is used after surgery for quick recovery. The main task of using drugs is to relieve the main symptoms of the pathology, as well as to prevent relapses. Below are the most common medications used for tear duct obstruction.

Table. Drug treatment of dacryocystitis.

Name of the drug, photo	Description
	An effective antibacterial drug with anti-inflammatory, analgesic and antipyretic properties. It copes well with infectious and inflammatory processes, which is why it is actively used in the treatment of dacryocystitis.
	Another antibacterial drug used in the treatment various pathologies inflammatory or infectious nature. It has bactericidal properties, due to which the drug actively fights E. coli, staphylococci and streptococci. Available in the form of eye drops.
	Antimicrobial medical drug, which has bactericidal properties. Negatively affects acid-fast, gram-positive and gram-negative bacteria. Used in the treatment of dacryocystitis and other ophthalmic pathologies.
	As active component this drug Levofloxacin is a substance with antimicrobial and anti-inflammatory properties. The drug is actively used in medicine in the treatment of inflammatory eye lesions.
	The product has bactericidal and anti-inflammatory properties. Negatively affects pathogenic microorganisms, due to which it is used for severe purulent infections. As a rule, Gentamicin is prescribed in cases where other antibacterial drugs have failed.

On a note! If the doctor has prescribed not one, but several drugs at once to treat obstruction of the lacrimal canal, then an interval must be observed between their use. Typically, a 10- or 15-minute break is sufficient.

As an addition to drug treatment, doctors prescribe to patients special affected lacrimal duct. Before carrying out it, you must wash your hands thoroughly with soap. Also make sure your fingernails are trimmed. Using a cotton swab treated with a weak solution of furatsilin, gently wipe the palpebral fissure, thereby removing accumulated pus. It is not recommended to use gauze swabs, as they may leave small lint behind.

The duration of the massage itself is 5-10 minutes. It consists of gentle jerking movements of the fingers, carried out along a small tubercle formed on the inner corner of the eye. During the procedure, purulent contents may come out of the lacrimal sac, which must be periodically removed with a cotton swab. After completing the massage, you need to drip your eyes with eye drops prescribed by your doctor. Experts recommend carrying out massotherapy at least 5 times a day for 1-2 weeks. This should be enough to eliminate the problem of a blocked tear duct.

Surgical intervention

If drug treatment for dacryocystitis is ineffective, doctors resort to surgery. Also, surgery may be prescribed if the pathology was caused by the development of a tumor or congenital obstruction. the main task surgery consists of restoring the functioning of the patient’s lacrimal canals that are underdeveloped or damaged during the course of the disease. The most common treatment methods include dacryocystorhinostomy, during which the doctor restores the outflow of tears. All procedures must be performed under general anesthesia.

After a successful operation, the patient faces a long recovery period, during which he must take prescribed medications. As a rule, doctors prescribe nasal sprays aimed at eliminating swelling of the mucous membrane. As a supplement, eye drops may be prescribed to relieve inflammation and prevent the development of infection. Correctly following all doctor's instructions will speed up the recovery process.

Prevention measures

Since there are quite a lot of factors that can cause obstruction of the lacrimal canal, there is, unfortunately, no single and universal method for preventing the disease. But there are several methods that can reduce the likelihood of developing an infection. First of all, you need observe personal hygiene rules, try not to touch your eyes with dirty hands, and also avoid contact with people suffering from certain types of eye diseases, for example, from conjunctivitis. If you wear contact lenses, you need to handle them correctly (change your lens solution regularly, wash your hands before putting them on, use only high-quality products, etc.).

Strengthening immune system can also help avoid many diseases, including dacryocystitis. To do this, it is recommended to exercise regularly, spend more time on fresh air, eat right and give up bad habits. Compliance with all these preventive measures will prevent the development of various pathologies.

Video - How to massage the tear duct