Dacryocystitis
According to various sources, the prevalence of dacryocystitis among newborns ranges from 1 to 14% of all ocular pathologies.
Dacryocystitis is inflammation of the lacrimal sac caused by congenital narrowing and/or obstruction of the lacrimal drainage pathways. This suppurative-inflammatory process is one of the most common reasons for parents to seek ophthalmological care for their children in the first years of life.
Main symptoms of dacryocystitis
- Standing tear in the lacrimal canaliculus area;
- Watering of the eye;
- Purulent or mucopurulent discharge, possibly from one eye only;
- Redness of the mucous membrane;
- Swelling in the area of the inner corner of the eye;
- Discolouration of the skin over the lacrimal sac, turning blue and/or red (in acute dacryocystitis);
- Pain on touch (in acute dacryocystitis).
As a rule, in the first days or weeks after birth, lacrimal pathway patency restores spontaneously following rupture of the lacrimal membrane or expulsion of a nasolacrimal duct plug. If this does not occur, mucus, epithelium, and residual embryonic debris accumulate in the lacrimal sac, creating a favourable environment for various bacteria. An inflammatory process develops, which may follow an indolent course or progress to abscess formation.
Diagnosis of dacryocystitis
1. Complaints and medical history.
Congenital lacrimal drainage stenosis may not involve purulent discharge; the predominant features are lacrimation and standing tear, which appear in the first 1–2 months of the child's life. In the acute dacryocystitis phase, complaints arise of persistent purulent discharge from the child's eyes, which resolves with antibiotic eye drops but returns when medication is discontinued.Acute dacryocystitis is characterised by non-pulsatile swellings in the lacrimal sac area with bluish-purple overlying skin (tissue stretching), possibly with visible yellowish content (infection in the sac area, sac abscess).
2. External examination.
Assessment of standing tear or lacrimation at rest, eyelid position, lid margin position, and lash growth. Assessment of discharge from the lacrimal sac on pressure.3. Irrigation (probing).
4. Norn test (dye test).
5. West test (dye test).
6. ENT specialist consultation.
Complications of dacryocystitis
If chronic dacryocystitis is neglected, a number of complications arise: lacrimal sac dilatation, abscess, conjunctivitis with corneal ulceration.
One common complication is phlegmon of the lacrimal sac — acute inflammation spreading to the retina and optic nerve. Pus frequently enters the paranasal sinuses.
Treatment of dacryocystitis
It is very important to begin correct treatment promptly to avoid complications.
Two approaches exist in the treatment of dacryocystitis: conservative treatment — which includes massage using the correct technique and frequency, as well as pharmacological treatment in the form of eye drops to prevent conjunctivitis — and surgical treatment: probing of the nasolacrimal duct.
We keep pace with advances in medicine and strive to apply treatment techniques that allow complete rehabilitation of our patients.
To this end, we have introduced into our practice a probing technique that takes into account the age-related characteristics of soft tissue in children.
Probing is a sufficiently uncomfortable procedure for the patient, and performing it under local anaesthesia alone cannot guarantee patient recovery.
We perform probing in our young patients under general anaesthesia, and also use endoscopic equipment, which allows full visual control throughout the procedure, avoids clinical errors arising from the child's resistance, and achieves the desired complete patient rehabilitation.
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Summary
When children come to us having undergone repeated unsuccessful probing, we perform the operation in collaboration with an ENT specialist. The condition of the lacrimal pathways is assessed endoscopically and with CT imaging, and stenting or dacryocystorhinostomy is performed where necessary, using the most modern materials available.
No marks are left on the eyelids or facial skin, as everything is performed endoscopically. When dacryocystitis is identified, it is important to seek specialist help promptly. Without treatment, the condition can become chronic, inflammatory processes intensify and spread readily, and serious complications arise.
