Dacryocystitis in adults: treatment

When the lacrimal nasal canal is blocked or narrowed, a dangerous eye disease - dacryocystitis - can develop in adults. Without proper diagnosis and quality treatment, this disease is fraught with irreversible consequences, which in neglected cases can lead even to the death of the patient. Therefore, in this article we will consider all aspects of the disease, symptomatology and modern methods of treatment.

What it is?

Dacryocystitis is an infectious and inflammatory disease characterized by the destruction of a tear sack of the eye. As a rule, this disease is most often observed in people aged 30-60 years. In women, this disease manifests itself more often due to the narrower anatomical structure of nasolacrimal canals.

As a rule, in adults, lesions with dacryocystitis are always one-sided.

The disease occurs due to blockage of the lacrimal nasal canal. As a result, the tear fluid accumulates in the tear bag and can not penetrate outside.

Because of the violation of outflow of tear fluid, active reproduction of microorganisms takes place, which leads to inflammation and formation of mucopurulent discharge.

Manifestation of dacryocystitis in adults

Causes

In adults, dacryocystitis occurs due to narrowing and closing of the nasolacrimal canal. Due to the narrowing of the channels, the circulation of the liquid is disturbed.As a result, the stasis of a secret secretion occurs, in which microorganisms begin to develop actively.

Edema of tissues surrounding the nasolacrimal canal occurs as a result of inflammatory diseases of viral or bacterial origin (respiratory infections, chronic rhinitis, sinusitis).

The disease, also, can cause:

• fractures of the bones of the nose and orbit;
• damage and violation of the integrity of lacrimal ducts;
• polyps of the nasal cavity;
• penetration into the eye of debris, dust and other foreign bodies.

Also, the following factors can contribute to the onset of the disease:

• metabolic disease;
• diabetes;
• weakening of the immune system;
• allergic reactions;
• interaction with visually hazardous chemicals;
• sharp temperature fluctuations.

Symptoms

With dacryocystitis, the following clinical manifestations occur:

• constant lacrimation;
• mucopurulent discharge from the eyes;
• hyperemia and edema of lacrimal flesh, conjunctiva and semilunar fold;
• swelling of the lacrimal sac;
• soreness of the eyes;
• narrowing of the eye gap;
• increased body temperature;
• general intoxication of the body.

Dacryocystitis can have an acute or chronic form of the disease. Clinical manifestations of the forms of the disease are different.

In acute forms of the disease, clinical symptoms are most pronounced.In the field of inflammation of tear ducts, there is a sharp redness of the skin and a painful swelling.Eye cracks due to edema of the eyelid strongly narrow or completely close. The patient may experience pain in the eye area, chills, fever, headache.

The started stage of dacryocystitis

The chronic form of the disease is characterized by constant lacrimation and swelling in the area of ​​the lacrimal sac. When pressure is applied to this area, mucopurulent exudate is released from the lacrimal ducts.In the area of ​​the lacrimal sac, a swollen neoplasm is formed that visually resembles beans.As it develops, it becomes tightly elastic.

Inside the cavity of this tumor, pus accumulates, which, when pressed, is released outward. With further development of infection, the appearance of phlegmon of the orbit or fistula may occur.

Diagnostics

In order to identify the disease the patient must undergo an examination with an ophthalmologist. As a rule, dacryocystitis is easily diagnosed because of its characteristic clinical symptoms.During the examination, the doctor conducts an external examination and palpation of the lacrimal sac area, conducts a tear-nose test of Vesta, an instillation fluorescein test, an x-ray of the lacrimal passages.

First of all, the ophthalmologist listens to the patient's complaints and performs an external examination of the lacrimal sac area. When palpation of this area, a purulent secret from the lacrimal ducts should be released.

The most common is a tear-nasal Vesta.It is one of the most common diagnostic techniques. During this procedure, a solution of collargol or protargolum is instilled into the conjunctival sac. These colorants are used to determine the patency of the lacrimal canal. A swab of cotton wool or turunda is inserted into the sinus of the nose. Traces of the coloring material should appear on the tampon no later than 5 minutes later.Delay in the receipt of the substance in the nasal cavity or its absence indicates a violation of the patency of the lacrimal nasal duct.

The degree of patency of the entire lacrimal system, as well as the level and localization of the sites of obliteration is determined with the help of contrast radiography. During this diagnostic method, a solution of iodolipol is used.

If it is required to identify microbial pathogens of dacryocystitis, bacteriological culture is carried out.

To clarify the diagnosis, the patient must additionally undergo an examination with an otolaryngologist. As a rule, the otolaryngologist in dacryocystitis performs a rhinoscopy.Perhaps the patient will also need to consult a dentist, traumatologist, neurologist or neurosurgeon.

Treatment

As a rule, if dacryocystitis without complications, the prognosis of recovery is favorable.Treatment of dacryocystitis, in the first place, depends on the form of the disease and the causes of its occurrence.

The process of treatment of dacryocystitis as a whole is divided into two parts:

• restoration of patency of the lacrimal nasal canal;
• anti-inflammatory therapy.

In the treatment of dacryocystitis in adults, bougie and wash the tear-nasal canal with disinfectant solutions, the use of antibacterial drops and ointments.

Buzhirovanie - this is the most common, sparing method for restoring the patency of the lacrimal nasal canal. During this procedure, the physical elimination of lacrimal nasal obstruction by means of a special hard probe (bougie) is carried out.

Initially, patients suffering from dacryocystitis are prescribed increased antibacterial treatment to avoid infectious complications.This is necessary because with dacryocystitis there is a possibility of a purulent form of encephalitis or an abscess of the brain.

Dacryocystitis in old age

The acute form of the disease is treated under hospital conditions. As a rule, intramuscular injections are prescribed in this casebenzylpenicillin sodium salt(3-4 times a day) or oral intaketetracycline(4 times a day),sulphadimezine(4 times a day).

If an abscess of the lacrimal sac has formed, it is opened through the skin. Before opening the abscess, systemic vitamin therapy and UHF therapy are performed. After opening, the wound is drained and washed with antiseptic solutionsfuracilin, dioxidine, hydrogen peroxide. To prevent further development of infection in the cavity of the conjunctiva, antibacterial drops are instilled (levomitsetin, miramistin, sulfacil-sodium, gentamicin) and antibacterial ointments (erythromycin, tetracycline, floxal).

In addition to local treatment, systemic antibiotic therapy is carried out with preparations of a wide spectrum of action. To do this, use cephalosporins, aminoglycosides, penicillins.

With advanced forms of dacryocystitis, when standard medical treatment is already ineffective,dacryocystoplastyorendoscopic dacryocystorhinostomy.

Endoscopic dacryocystorhinostomy

Endoscopic dacryocystorhinostomyIs a surgical intervention that is used to treat dacryocystitis in adults. For the operation, special modern minimally invasive equipment is used.Dacryocystorhinostomy can be performed only in patients who do not have an allergic reaction to anesthesia.During the operation, a special flexible tube is inserted into the lacrimal duct - an endoscope with a microscopic chamber. With the help of an endoscope an incision is made in a blocked tear duct. The rehabilitation period after the operation is 6-8 days. To prevent inflammation of the cornea, appoint a course of antibiotics. The advantage of this surgery is that it does not leave visible cutaneous scars on the face and damage to the lacrimal ducts.

Balloon dacryocytoplasty

In most cases, balloon dacryocystoplasty is used.This is a safe operation, which can be carried out even for children from 1 year old. During the operation, a special thin conductor is inserted through the angle of the eye into the tear-nasal canal, which is equipped with a microscopic dilating balloon filled with liquid. In the blocked place of the tear-nasal canal, the balloon expands and opens the duct with the help of pressure and then is removed from the canal. The procedure is carried out under local anesthesia. After the operation, a course of antibiotics and the use of eye drops are prescribed to avoid the development of infection.

Complications

Dacryocystitis is a rather dangerous disease, since in the absence of treatment, it can provoke the appearance of various complications.

Particularly dangerous is the chronic form of the disease.In this case, infection of other eye membranes is possible. There is a possibility of developing concomitant diseases -blepharitis, conjunctivitis, keratitis. With further development of chronic dacryocystitis, the cornea is affected and a purulent ulcer is formed. As a result of the appearance of corneal ulcers, a thorn can subsequently develop, which can become not only a cosmetic defect, but also reduce the quality of vision.

Further development of the ulcer can also lead to the appearance of endophthalmitis, which is characterized by inflammation of the internal structures of the eye.

An important complication may be the development of life-threatening diseases that can lead a patient to disability or to death:

• sepsis;
• phlegmon orbit;
• thrombophlebitis of orbital veins;
• thrombosis of the cavernous sinus;
• inflammation of the meninges and brain tissue.

Prevention

For the prevention of dacryocystitis, it is necessary to timely treat inflammatory diseases of the eyes and ENT organs, and also to avoid damage to the eyes, foreign bodies.With timely diagnosis and treatment of dacryocystitis, complete recovery without serious consequences is possible.

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conclusions

Dacryocystitis is a dangerous eye disease in adults, which can lead to serious complications. A disease similar to it is a temporal arteritis, which is fraught with great consequences for improper diagnosis and untimely treatment in a polyclinic. Therefore, it is necessary to conduct correct, timely treatment and, of course, preventive measures to avoid the occurrence of this disease. There are various methods of preventing the disease, such as massage, eye exercises, yoga.