Dacryocystitis: causes of development and methods of treatment

Anatomically, the nasal cavity and the visual apparatus are connected by a small bridge - the tear-nasal canal, which is necessary for the natural circulation of tear fluid. If pathogenic microorganisms get into any of the components of this mechanism, serious infectious disease - dacryocystitis, which, with insufficient treatment, leads to the most tragic consequences.

Description of the disease

Dacryocystitis is an acute inflammation, localized in a lacrimal sac.Usually, the pathology develops against the background of infectious diseases of the nasal cavity or the area of ​​the paranasal sinuses, which causes narrowing or blockage of the nasolacrimal canal. This leads to a disruption in circulation and stagnation of the lacrimal fluid, where pathogenic microorganisms accumulate over time.

In most cases, the ailment affects adults from 30 to 60 years old, but separately isolates dacryocystitis in newborns, caused by a violation of the anatomical structure of the nasolacrimal canal.

Depending on the clinical manifestations, acute or chronic dacryocystitis is isolated. And by its nature, the disease can be parasitic, viral, bacterial or develop as a result of a mechanical trauma to the nasal sinuses.

Dacryocystitis is diagnosed only in 5% of all cases of pathology of the nasolacrimal canal, with the disease more common in women because of the peculiarities of the anatomy of this area.

Causes

Regardless of the form and type, dacryocystitis is always formed against the background of the obstruction of the nasolacrimal canal.In adults, the ailment is more often caused by acquired causes, and in newborns the disease can manifest due to some congenital anomalies:

• Violation or pathology of patency of lacrimal passages;
• Insufficient elasticity of the fetal membrane;
• Embryonic pathology of the folds of the lacrimal mucosa of the lacrimal sac.

Acquired dacryocystitis is often diagnosed on the background of diabetes mellitus of any type, general decrease in immunity, as well as in people working in production, associated with abrupt changes temperatures.In addition, there are a number of traditional causes that cause the disease:

• Mechanical damage to the sinuses of the nose or nasolacrimal canal;
• Consequences of infectious or parasitic diseases;
• Prolonged or chronic purulent conjunctivitis;
• Acute inflammation in the maxillary sinus of the nose;
• The ingress of foreign bodies into the tear duct.

  Topography of lacrimal organs: 1 - lacrimal gland; 2 - a lacrimal flesh; 3, 4 - tear ducts; 5 - lacrimal sac; 6 - nasolacrimal duct; 7 - lower nasal concha.

A special risk group is people with chronic respiratory diseases. For example, dacryocystitis often develops in the genyantritis or polyps in the nasal cavity.

Main symptoms

Diagnosis of the disease is usually not difficult due to specific clinical manifestations.Regardless of the form and nature of the disease, involuntary and abundant lacrimation is observed, purulent discharge from the infected eye, as well as swelling of the lacrimal sac and the release of exudate upon palpation of this region.The clinical picture differs somewhat in acute and chronic dacryocystitis:

• If the disease persists for a long time, it leads to hyperemia of the lacrimal sac tissue and other nearby departments.At the same time the skin is much thinner and has a characteristic blue hue. As the disease develops, a swelling develops in the affected area, which becomes dense to the touch.
• Acute dacryocystitis is characterized by a strong reddening of the skin of the lacrimal sac, there are strong painful sensations during palpation of this area, the eye gap can not completely close.Plus, the acute form of the disease is often accompanied by subfebrile hyperthermia and headache. If an abscess develops, the tissues of the lacrimal sac turn yellow and soften. Such a pathology is dangerous by the subsequent formation of an internal or external fistula.

  Acute dacryocystitis

Dacryocystitis in newborns is always accompanied by a strong swelling and secretion of pus of a characteristic color when pressing on tear points.

Possible complications

If the treatment is not started on time, the disease can lead to serious complications, especially if dacryocystitis becomes chronic.The most common ophthalmic effects of the disease:

• Blepharitis. Inflammation of the ciliary ridge from the top and from the bottom develops. This leads to a strong swelling and redness of the eyelids, photosensitivity and loss of eyelashes;

  Blepharitis

• Conjunctivitis. Inflammatory process passes to the mucous membrane of the eye. It often increases tearing, there is a strong itching and burning;

  Conjunctivitis

• Phlegmon. It may occur if the inflammatory process has gone beyond the limits of the lacrimal sac. There is a strong and rapidly developing edema, there is a painful sensation when palpation of the inner corner of the eye.

  Phlegmon

The most dangerous complication of dacryocystitis is meningitis, which, if untimely, can lead to the most serious consequences, up to a lethal outcome, especially in children.

Treatment

The choice of treatment strategy always depends on the clinical manifestations of the disease.Dacryocystitis in the initial stage without acute manifestations is well suited for drug therapy, which is enhanced by physiological procedures. To soften the edema and active discharge of purulent exudate, UHF therapy is prescribed, as well as application of dry heat to the affected area. When the purulent neoplasm is opened, drainage is carried out followed by washing with antiseptic means. As a conservative treatment, antibacterial drops are prescribed in the conjunctival sac - Levomycetin, Miramistin or Sulfacetamide, as well as antimicrobial ointments based on Tetracycline or Erythromycin. During this period, an additional intake of vitamins and strengthening procedures are especially important for strengthening the body's natural defenses.

Tetracycline ointment is a bacteriostatic antibacterial drug

Surgical methods

Dacryocystitis in neglected and acute forms is almost always treated surgically.The choice of the method of treatment depends on the degree of inflammation and the presence of any complications on the part of the visual apparatus and sinuses of the nose.

• Buzhirovanie. The simplest, but effective method used in the event that the inflammatory processes did not spread to a large area.It is most often used to treat the acute form of dacryocystitis.The procedure consists in physically eliminating tear fluid stasis by inserting the probe into the nasolacrimal canal. To prevent complications, the subsequent intake of complex and local antibacterial agents is mandatory;

  Buzhirovanie with the subsequent intubation of the tear-nasal canal

• Endoscopic dacryocystorhinostomy. The operation is a kind of endoscopy. A flexible tube is inserted into the lacrimal duct, on which the chamber with the light source is located. With the help of an endoscope, a thin incision is made in the plugging of the lacrimal canal, and then a purulent exudate is removed.The procedure is always performed under local or general anesthesia and rarely causes complications.Endoscopy is the most preferred procedure for treating complex forms of dacryocystitis in adults, since the patient does not need training, and the postoperative period lasts only 6-10 days.
• Balloon dacryocytoplasty. A modern method of treating the disease, which is prescribed even for young children. The procedure is carried out under local anesthesia and consists in introducing a thin probe into the nasolacrimal canal, on which a balloon with space-expanding liquid or gas is located. Under pressure, the blocked duct expands, which allows the normalization of the circulation of tear fluid. As a follow-up treatment, administration of antibacterial drops and a course of local antibiotics are prescribed to prevent complications.

During the entire treatment period, it is strictly forbidden to wear corrective contact lenses and eye bandages, as this can lead to a purulent ulcer of the cornea (keratitis) against a background of copious discharge exudate.

Prevention

Acquired dacryocystitis can be completely avoided if in time to treat infectious ophthalmic and systemic diseases, as well as avoid injuries to the skull and nasal sinuses.In addition, you need to use personal protective equipment when working in harmful production conditions, which helps prevent a lot of diseases of the visual apparatus.

In the event that the child is diagnosed with congenital dacryocystitis, it is necessary to begin treatment as early as possible in order to avoid the development of complications.Surgical manipulations are allowed not earlier than one year, and before this time the disease can be successfully controlled medically.

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conclusions

Dacryocystitis is a serious ophthalmic disease that can form in both an adult and a child. Methods of modern medicine can eliminate the disease at almost any stage, however, in avoid complications, you need to contact a specialist in a timely manner and follow simple measures prevention.