Dacryocystitis in newborns - what is it, causes, diagnosis and treatment

Dacryocystitis in newborns (from the Greek dakryon - tear and kystis - bag) is obstruction of the nasolacrimal duct.

The lacrimal ducts begin with lacrimal puncta located in the medial canthus. Lacrimal canaliculi, connected to the lacrimal sac, depart from them; the cavity of the lacrimal sac passes into the nasolacrimal duct. When the mechanism of tear fluid outflow is disrupted, 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 outlet of the nasolacrimal duct.

Source: o-glazah.ru

Normal lacrimation in children usually forms in the second or third month of life; the lumen of the lacrimal ducts is released independently when the germinal film covering the lower section of the nasolacrimal canal ruptures. If the patency of the lacrimal ducts is not restored, dacryocystitis develops.

In order to prevent dacryocystitis, the newborn's eyes should be washed daily after waking up, especially if mucous discharge has already been noticed.

Dacryocystitis is a common disease, occurring in 2–7% of all newborns.

Causes and risk factors

The main cause of dacryocystitis in newborns is obstruction of the nasolacrimal duct. The reasons for such obstruction may 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 injuries (fracture of the upper jaw, etc.);
the presence of rudimentary or gelatinous plugs closing the lumen of the nasolacrimal duct;
chronic inflammatory processes in the maxillary cavity and in the tissues surrounding the lacrimal sac.

Forms of dacryocystitis in newborns

Depending on the duration and intensity of the disease, the disease can be acute or chronic.

There are several clinical forms of chronic dacryocystitis of newborns:

simple;
catarrhal;
purulent;
phlegmonous.

Types of dacryocystitis in newborns, depending on the cause, type of infectious pathogenic agents and their sensitivity to antibacterial drugs:

bacterial;
viral;
chlamydial;
parasitic;
post-traumatic.

Treatment methods

Therapy is carried out in several stages. If, after an examination, the ophthalmologist diagnosed “dacryocystitis,” do not be alarmed and look for ways to treat it yourself.

A successful outcome will depend on a quick response and compliance with medical orders.

Probing the tear ducts

Probing is considered one of the most successful methods for eliminating this problem.

In this case, in a hospital setting, the child is given a special probe that widens the lacrimal canal.

The procedure is relatively safe and painless. Depending on the practice of the medical institution, general anesthesia or local anesthetics may be used. After the manipulation, antibacterial therapy and eye rinsing are used, which can also be carried out in a hospital or clinic.

Massage technique

Special massage techniques usually work well to remove pus from the lacrimal sacs.

The first session is necessarily performed by a specialist who will show the mother the direction of manipulation.

Such procedures, coupled with the use of medications and folk remedies, give good results when it comes to partial blockage of the tear ducts. If we are talking about serious disorders and complete obstruction, special probing may be required.

Massage should be performed regularly for one to two weeks. The complex also uses lavage of the tear ducts and drug therapy. Also find out about moderate hypermetropia in children here.

On video: dacryocystitis in newborns, treatment, Dr. Komarovsky

Medicines: ointments and drops

The optimal treatment using pharmaceutical drugs should be prescribed by a doctor, especially since they are effective only when the main causative agent of the infection is identified.

The most commonly used is eye rinsing (at home or in the hospital), instillation with antibacterial drops (Levomycetin, Oftaquix, Tsipromed, Oftalmoferon, Tobrex, Albucid and others).

For young children, it is also possible to use special ointments and gels , for example, Oftagel, Floxal, and the classic Tetracycline and Hydrocortisone.

In the picture: how to properly apply ointment to a baby’s eyes

Traditional methods

, washing the eyes with herbal decoctions has worked very well

You can use tea leaves, chamomile decoctions and strings. At the same time, responsible parents should know for sure that the main cause of the disease will not be eliminated in this way.

A doctor may recommend such methods in combination with other measures to prevent the spread of infection.

What could be the consequences if the obstruction of the tear ducts is not treated?

Early diagnosis and adequate treatment are an important stage of therapy. If the tear ducts are obstructed, fluid stagnation occurs, and if infection gets inside, purulent inflammation occurs.

All this can lead to general infection of the body and clogging of the tear ducts. This condition is very difficult to treat, and if in the early stages everything can be solved with probing and drug treatment, then later surgical intervention will be necessary.

If an infection of any nature gets inside, unpleasant consequences can begin - a purulent process, fraught with deterioration and even complete loss of vision.

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 mucous, purulent or mucopurulent exudate in the conjunctival cavity;
“sourness” of the eyes (usually one-sided) after sleep.

General symptoms of dacryocystitis in newborns are manifested by an increase in signs of intoxication: weakness, increased body temperature, general depression.

What is dacryocystitis

Watery eyes, purulent discharge from the eyes, the appearance of a red, swollen bulge in the corner of the eye - all these are symptoms indicating a malfunction of the lacrimal apparatus. What is dacryocystitis in a child or adult? This is an inflammation of the lacrimal sac due to the penetration of a bacterial or viral infection.

The lacrimal apparatus performs an extremely important function for maintaining eye health, because tears:

washes the eye, creates a special film on it that protects the eye from drying out;
acts as a natural lens that affects visual acuity;
destroys microbes caught on the eye shell;
washes away particles of dust, pollen and other foreign bodies.

Tear fluid is produced by the lacrimal gland and small glands located in the conjunctival sac. Having completed its work, the tear is drained into the nasal cavity through a complex structure. Tear fluid enters the lacrimal openings - the openings of the lacrimal canaliculi, which pass into the lacrimal sac. From the lacrimal sac, the spent tear is discharged through the nasolacrimal duct into the nasal cavity, where it flows down the nasopharynx - we regularly swallow it without even noticing it.

It is with disruption of the lacrimal apparatus that most of the problems that arise in babies are associated. One of the most common diseases is dacryocystitis - inflammation of the lacrimal sac.

Dacryocystitis occurs due to a violation of the patency of the nasolacrimal duct, through which fluid is discharged into the nasal cavity.

Think about how you recently cut an onion. Not only does it make your eyes water, but your nose also starts to run. When we cry, we sniffle. This condition occurs precisely because tears, being actively produced, are discharged into the nasal cavity. Now imagine what will happen if this path is closed to her. A tear that has washed away all the filth from the eye cannot be evacuated. It stagnates in the lacrimal sac, creating an excellent environment for the proliferation of microbes. An inflammatory process occurs, which quickly turns purulent.

Diagnostics

Diagnosis of the disease begins with an objective examination of the condition of the lacrimal ducts: 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 ducts, a canalicular test (Vest color test) is performed. The procedure consists of inserting a tampon into the nasal passage, and instilling several drops of a 3% collargol solution into the conjunctival cavity. It is necessary to evaluate the rate of disappearance of the dye from the conjunctival cavity. If the patency of the lacrimal ducts is not impaired, the tampon will stain quickly, within a few minutes. If more than 5-10 minutes pass between the installation of the dye and the dyeing of the tampon, the patency is impaired. If the tampon remains clean, there is no patency in the lacrimal ducts.

With timely detection of the disease and proper treatment, the prognosis for dacryocystitis in newborns is favorable.

Obstruction of the lacrimal ducts with dacryocystitis in children can be detected using a passive nasolacrimal test. Its principle is that the liquid does not pass into the nose when washing the nasolacrimal canal, but flows out in a stream through the lacrimal openings.

If it is necessary to clarify the level and degree of obstruction of the lacrimal ducts, dacryocystography is performed - an X-ray examination of the lacrimal ducts with contrasting with iodolipol solution. To identify microbial pathogens, a scraping from the conjunctiva of the eyelids is examined (PCR analysis) and a bacteriological examination of a smear from the conjunctiva is carried out.

Passive patency of the lacrimal ducts is determined by diagnostic probing and lavage. To minimize the risk of complications, rhinoscopy is first performed before probing the lacrimal canals. If necessary, a maxillofacial surgeon, neurosurgeon, traumatologist, otolaryngologist, or neurologist can be involved in the diagnosis.

Therapy of dacryocystitis in infants

Dr. Komarovsky notes that the best solution to the problem of dacryocystitis in infants is a special massage. But it is effective only up to three months of age, since after this period the existing plug turns into connective tissue. According to statistics, approximately 60% of babies under the age of three months are completely cured with the help of massage. And at the age of three to six months, the number of recovered fluctuates around 10%. There is no need to delay, because the sooner all necessary measures are taken, the higher their effectiveness.

The massage is performed as follows:

Before manipulation, one of the parents should thoroughly wash their hands with soap, preferably antibacterial. Nails must be cut short and nail polish is not advisable.
Next, the baby’s eyes are cleaned of tears and purulent accumulations. To do this, they need to be washed with clean boiled water or chamomile infusion, tea, or furatsilin solution. For this purpose, cotton pads are used, with which you need to wipe your eyes with gentle movements in the direction from the outer edge to the inner.
After removing all the secretions, you need to wash your hands again!
During the massage, the index finger is placed on the tubercle located in the inner part of the eye. Next, you should lift your finger up a little and make several sharp but gentle downward movements. There is no need to pause between manipulations, and the movements themselves should be vibrating. If a mucous mass is released during this, it must be removed by rinsing and then the massage continues.
After completing the procedure, the eyes should be rinsed again or drops prescribed by the ophthalmologist should be placed in them.

It is recommended to carry out massage at least five times a day, because only in this case will it give a positive result. The duration of conservative treatment can be several days or a couple of weeks.

Treatment of dacryocystitis in newborns

Treatment of dacryocystitis in newborns requires an individual approach, taking into account the duration and nature of the disease, the risk of complications, the clinical form of dacryocystitis, the effectiveness of previous therapy, the rhinogenic factor, the presence of congenital anomalies of the nasal cavity and maxillofacial region.

At the first stage of treatment, gentle methods are used to remove the embryonic film at the mouth of the nasolacrimal canal.

When the mechanism of tear fluid outflow is disrupted, pathogenic (usually streptococcal or staphylococcal) microflora develops in the lacrimal sac, which leads to inflammation.

First of all, this is a finger massage of the lacrimal sac projection area, 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 its pad towards the bridge of the nose and applying light pressure. The degree of pressure must still be sufficient to break through the film covering the nasolacrimal duct or remove the gelatinous plug, thus freeing the nasolacrimal duct. Continuing to press on the selected point, make jerking movements along the bridge of the nose downwards. With the help of such downward movements, 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, they begin the reverse movement, returning it to the corner of the eye. The younger the child, the more effective the massage. After the massage, you need to rinse your eyes with a disinfectant solution and apply eye drops.

Source: about-vision.ru

Drug therapy is used to combat pathogenic microorganisms and stop the spread of infection. It is recommended to begin treatment with the use of non-allergenic antiseptics (solutions of Miramistin, Chlorhexidine, Picloxidin, Furacilin). Rinse the eyes with a sterile cotton swab using movements from the temple to the nose. Solutions prepared for washing should not be stored for more than a day.

In case of acute manifestations, after obtaining the results of identification of the flora and its sensitivity to antibiotics, local antibiotic therapy (penicillins, aminoglycosides, cephalosporins) is prescribed. Ciprofloxacin is contraindicated for newborns, and the use of Albucid (sulfacyl sodium) is also undesirable. The maximum effect is achieved by a combination of sulfonamide and bactericidal drugs.

The main cause of dacryocystitis in newborns is obstruction of the nasolacrimal duct.

If conservative therapy in the first 2-3 months of the baby’s life does not bring the desired effect, probing the tear ducts may be advisable.

For probing using the classical method, a rigid probe is used to remove the remaining film and expand the nasolacrimal canal, ensuring normal outflow of tears.

Bougienage is a type of sounding in which a special probe is inserted into the nasolacrimal canal through the lacrimal opening, expanding its narrowed walls.

Probing is performed within a few minutes and is considered more gentle than surgery; in some cases it is performed under local anesthesia. Due to the possible entry of rinsing fluid into the respiratory tract, resuscitation and anesthesia support is provided. Several treatments may be required.

Treatment of dacryocystitis by probing is effective in 90% of infants, especially when carried out in the early stages, before the age of 9 months. In the vast majority of cases, after probing, lacrimation stops and the discharged substance disappears.

In case of insufficient effectiveness of minimally invasive manipulations, surgical intervention is performed, but it is indicated for children from 5 years of age. For primary dacryocystitis in newborns, a less traumatic operation is used - laser dacryocystorhinostomy.

Is the treatment of dacryocystitis effective with folk remedies?

Those who do not trust pharmaceutical drugs, considering them harmful chemicals, try to cure any disease with folk remedies. In some cases, this method of treatment is justified, but in others it does more harm than good.

If we talk about whether it is possible to treat dacryocystitis with folk remedies, then the answer is yes. However, only in the case when the disease can be eliminated in a conservative way, without surgical intervention.

Treatment of dacryocystitis with traditional methods:

The most important point in the treatment of dacryocystitis is massage.

It doesn’t matter whether you treat the disease using a conservative or traditional method, you cannot do without this procedure. Porous Kalanchoe juice is often used as a medicine to replace an antibiotic. Although it irritates the eye, it removes inflammation and infection

To prepare medicine from Kalanchoe, you need to wash and wrap the leaves of the plant in gauze and let them lie in the refrigerator for three to four days. Then the leaves are ground and the juice is squeezed out of them, which is diluted with saline in a 1:1 ratio. This composition is instilled into the nose, 3 drops in each nostril. At the same time, the child sneezes heavily, due to which the tear duct is cleared. After you have cleaned the channels with massage and Kalanchoe, you need to rinse your eyes with eyebright solution. This medicinal plant can be found in the pharmacy in tablet form. The tablet is dissolved in warm water, and this composition is used to wash the eyes.

This type of treatment usually helps within two weeks. If this does not happen, then you need to resort to more serious methods.

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 spread of the infectious-inflammatory process beyond the lacrimal sac:

abscess and phlegmon of the lacrimal sac (or phlegmonous dacryocystitis);
acute purulent peridacryocystitis;
meningitis, thrombosis of the cavernous sinus, sepsis with hematogenous foci of purulent infection, caused by the spread of purulent infection from the lacrimal sac into the cranial cavity.

With proper treatment, dacryocystitis has no long-term consequences.

Phlegmonous dacryocystitis is characterized by hyperemia, swelling, 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, even life-threatening: a sharp increase in body temperature, leukocytosis, increased ESR.

When the infiltrate is opened to the outside, an external fistula (fistula) is formed. If the opening of the abscess occurs in the nasal cavity, an intranasal fistula of the lacrimal sac is formed.

Etiology of the disease

The appearance of dacryocystitis in childhood causes stenosis of the lacrimal canal, against the background of which fluid stagnates in the cavity of the lacrimal sac. Part of the lacrimal apparatus is located in the area of the lacrimal fossa, which is located near the medial corner of the orbit. This sac contains the tear ducts.

Most often, the disease occurs due to underdevelopment of the nasolacrimal ducts

This disease is most often caused by atresia of the terminal opening of the nasolacrimal duct. The pathology develops against the background of blockage of the outlet and accumulation of fluid in the bag, while a flora favorable for bacteria is formed in its cavity. In addition to microbes, other microorganisms can develop there, which cause disorders and impairments in functionality.

Often, the flow of tears from the bag can be difficult due to inflammatory processes in the mucous membrane.

Obstruction of the lacrimal duct in newborns causes the following symptoms:

excessive, causeless lacrimation;
red cover;
swelling in the area of the inner corner of the orbit;
sharp painful sensations in the inner corner.

Upon examination, the doctor notes swelling and a local increase in temperature at the location of the lacrimal sac.

These signs in infants may spread to nearby areas of the nasal cavity and cheeks. When palpation is carried out, the density of the tissue around the bag is noted and painful sensations occur. The palpebral fissure may narrow if swelling is severe. When you press on the problem area, pus may leak out.

Prognosis of dacryocystitis in newborns

With timely detection of the disease and proper treatment, the prognosis for dacryocystitis in newborns is favorable. The use of early probing of the nasolacrimal canal and therapeutic massage makes it possible to stop the inflammatory process in the vast majority of cases. Sanitation of the lacrimal sac using therapeutic lavages avoids the need for radical surgery and scar deformities. With proper treatment, dacryocystitis has no long-term consequences.

Surgical intervention

If dacryocystitis was diagnosed after six months, then it is almost impossible to eliminate it with massage. In this case it is prescribed:

Probing is a simple and painless procedure for the child, performed on an outpatient basis under local anesthesia. It takes no more than 15 minutes, during which the ophthalmologist inserts a special probe into the nasolacrimal canal, removing the resulting plug. After this, rinsing with antiseptic solutions is carried out. In 70% of cases, a single probing is enough to completely eliminate the problem, and in 30% a second procedure is required.
Surgical intervention prescribed in the absence of a therapeutic effect from conservative treatment and probing. As a rule, it is necessary for serious physiological pathologies and the chronic stage of dacryocystitis. Low-traumatic laser dacryocystorhinostomy is indicated for infants. Most often, the operation is performed through the nose, which avoids an unaesthetic scar on the face.

Dr. Komarovsky claims that any surgical interventions should be performed only if massage does not bring relief even after a two-week course. You should not avoid probing, as it will subsequently eliminate the risk of developing serious inflammatory processes. In addition, the sooner this is done, the less discomfort the child will feel during the manipulations performed.