Sounding the lacrimal canal of a newborn -what for? Indications for sensing the tear channel innewborn

ATс, 16 окт 2016 Автор: врач-терапевт Елена
Kornilov

Одной из проблем у newborn ребёнка, с которой приходится
collide with parents – an inflammation of the lacrimal sac leading to
obstruction of the tear duct (dacryocitene).

5% of newborns suffer from this disease.

A tear forms in the lacrimal gland (located outside the upper
part of the orbit), falls into the cavity of the conjunctiva, from there on tears
duct passes into the tear bag and then through the tear channel
goes into the nasal cavity. Tear bag located between
the inner corner of the eye and nose, its continuation is tearful
pleated canal to prevent penetration
pathological microorganisms from the nasal cavity.

Lacrimal canal in newborns approximately 8 mm long, its valves
underdeveloped, it contributes to the smooth penetration
pathogenic bacteria (for comparison: in adults – 14 – 25 mm). Have
the baby is in the womb, the tear channel is closed
gelatinous membrane that protects the channel from amniotic
fluid.

Normally, during childbirth, the membrane breaks immediately after the first cry
newborn. If for some reason this did not happen,
the excreted fluid does not flow down the tear duct but accumulates in
tear bag

If infection occurs, inflammation may occur.
process.

Over time, dacryocystitis develops – inflammation of the tears
bag, one of the methods of treatment which is probing
слёзного канала у newborn.

Causes of obstruction of the tear duct and the development of inflammation
tear bag

The causes of dacryocystitis, except those preserved intact
gelatinous film, there may be anatomical narrowing of the lacrimal
canal, congenital anomalies of the structure of the nasal cavity. This leads
to blockage of the lacrimal canal with mucus and dead epithelium cells. AT
further – to dacryocyan. If in the first weeks after birth
patency of the tear channel is not restored independently,
need expert intervention and sensing
(bougienage) tear channel.

With the development of dacryocystitis, if no action is taken and no
провести зондирования слёзного канала у newborn, процесс
will develop further. ATозникнет боль, гиперемия, отёк с
просвечивающимся гнойным содержимым в проекции tear bag. AT
in case of failure to provide assistance, symptoms increase, increase
температура, развивается флегмона tear bag, которая может
uncover yourself if the newborn is not held
sounding of the tear channel.

Симптомы воспаления tear bag у newborn

When viewed from a child, tearing or
tearing in his calm state. These symptoms
observed only from the second month of life, when the lacrimal gland
begins to produce enough tears. Before
двухмесячного возраста у newborn выделяемой слезы хватает
only on the hydration of the eye membranes. In addition to these manifestations,
visible severe swelling (bulging), redness in the corner of the eye, which
may reach large sizes, purulent discharge from the eye.
Поражение при воспалении tear bag, как правило, носит
односторонний process.

Sounding слёзного канала у newborn как один из
ways to diagnose dacryocystitis

For the diagnosis carried out several tests.

1. Estimated patency tear channels holding
special canalicular test. To this end, the affected eye
bury 3% collargol. AT норме в течение 5 минут краска исчезает.
If the absorption of paint takes about 10 minutes – patency
lacrimal ducts slowed down, although there is swelling. When paint
delayed in the conjunctiva for more than 10 minutes – the sample is negative,
patency tear channel significantly impaired.

2. The permeability of the entire tear system is checked by conducting
nasal test. It is similar to the tubular sample, but in the nasal passage with
the corresponding side is laid cotton turunda, and in time
her staining when instilled eyes kollargolom judge
patency tear-waste system: staining after 5 minutes –
permeability is normal, up to 10 minutes – slowed down, 10 minutes or more
– there is no outflow, the sample is negative.

3. Обязательно исследуется отделяемого из tear bag.
The causative agent and its sensitivity to antibiotics are determined.

4. With the diagnostic and therapeutic purpose probing is carried out and
промывание слёзного канала у newborn.

Sounding слёзного канала у newborn как один из
ways to treat dacryocystitis

The goal of dacryocystitis treatment is:

– restoration of the full patency of the tear duct;

– prevention of complications and sanitation of all conductive lacrimal
systems (anti-inflammatory and antibacterial therapy).

Предварительно назначается массаж tear bag. Procedure
very effective if carried out correctly. But the massage is shown
in the initial stages of the disease. If there is puffiness,
compaction, redness – massage can not be performed.

If a the effect of the treatment and properly performed massage
for two weeks is missing, this is an indication for
зондированию слёзного канала у newborn. Most suitable
The age for this procedure is 1 – 3 months.

To conduct sensing tear channel
newborn существуют и другие показания:

– the presence of tearing and tearing;

– suspicions of anomalies of the tear channel;

– Chronization process.

Перед зондированием слёзного канала newborn необходим
examination by a pediatrician to make sure that the child is healthy and
the process of suppuration is not associated with the presence of viral or bacterial
infections.

Procedure со стороны выглядит устрашающе, сопряжена с некоторыми
inconvenience on the part of the patient, but generally painless.
Therapeutic manipulation is performed under local anesthesia. ATыполняет
her experienced doctor. By the time it takes a few minutes. The essence
the sensing of the lacrimal canal consists in breaking the film or
образовавшейся пробки у newborn при помощи специального
probe to restore the patency of the channel. ATрач вводит в слёзный
channel hard probe (like a piece of wire – Bowman’s probe),
�”Breaks” them blockage and expands the opening of the channel.

ATо многих случаях достаточно однократного зондирования слёзного
канала у newborn для достижения нужного результата. But at 40%
cases have to repeat it, sometimes – several times with
a gap of several days. With a later performance
manipulation its effectiveness is reduced.

После зондирования слёзный канал у newborn сразу
washed. Then within 3 months treatment is prescribed and at
need to re-wash.

If there is no effect, a rather complicated operation is performed –
dacryocystorhinostomy. The operation is performed to prevent
serious complications at the age of 5 – 7 years.

Complications of dacryocystitis with late treatment

Dacryocystitis is dangerous because the purulent process is located in
close proximity to the brain. If a медицинская
help rendered out of time, it can lead to the formation of an abscess
или флегмоны с флюктуацией в области tear bag. This state
requires immediate intervention: the phlegmon is opened and
prescribed a course of systemic antibacterial drugs for
prevent further complications.

With inadequate treatment or late treatment
develop:

– corneal ulcer;

– Severe conditions threatening the life of the child, associated with
the spread of purulent pathological process beyond
tear bag вплоть до развития тромбоза кавернозного синуса,
meningitis, sepsis, etc .;

– transition to a chronic course with the development of atony, fusion,
dilatation (expansion) of the lacrimal ducts.

Prevention of Dacryocystitis Complications

Timely examination by a neonatologist or pediatrician and prompt
consultation of the child by a pediatric ophthalmologist for the diagnosis and
detection of dacryocystitis is one of the conditions for successful treatment.
The use of sensing and flushing the tear channel in
newborn приводит к быстрому купированию воспаления.

Ни в коем случае нельзя лечить newborn самостоятельно,
without doctor’s prescriptions. Often parents confuse manifestations
dacryocystitis with conjunctivitis and treat conjunctivitis. Cause
disease while not eliminated. You can aggravate the situation and
wrong actions cause the development of complications. Sounding
lacrimal canal in infants extremely rarely causes complications.
The older the child, the more painful the procedure and more complications
causes, often requires re-holding.

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