Dacryocystitis is an inflammatory process of the lacrimal sac that develops when the lacrimal fluid stagnates. This happens for various reasons, which can be found in our previous article. It is not difficult to suspect the presence of dacryocystitis. But the differential diagnosis and treatment of dacryocystitis require a qualified approach from the doctor. Diagnosis of dacryocystitis is carried out on the basis of characteristic complaints, a typical picture and external examination data. Palpation examination of the lacrimal sac and specific tests are also carried out. What is the diagnosis and treatment of dacryocystitis?
Specific diagnostic procedures performed before treatment of dacryocystitis
Palpation is accompanied by painful sensations and the release of a purulent secret from the lacrimal openings. The patency of the lacrimal ducts is examined using the West color test. The test is carried out as follows – Collargol solution is instilled into the eye, and a swab is inserted into the nasal passage. In the presence of patency of the lacrimal ducts, traces of a dye appear on the swab for 2 minutes. A doubtful sample is considered when a substance is released for 5-10 minutes. If the substance has not been released within 10 minutes, the West test is considered negative, indicating obstruction of the nasolacrimal canal.
The following diagnostic procedures are also used before treatment of dacryocystitis:
- Diagnostic probing of the nasolacrimal canal to clarify the extent of the lesion.
- Instillation test.
- Biomicroscopy of the eye.
- To obtain a clear architectonics of the lacrimal ducts, an x-ray with a solution of iodolipol is performed, which reveals the presence of obliteration zones and strictures, which must be known before treating dacryocystitis.
- Microbial pathogens are identified by bacteriological culture. The diagnosis of dacryocystitis is differentiated from erysipelas, canaliculitis and conjunctivitis.
What is the treatment for dacryocystitis in newborns?
Treatment of dacryocystitis in newborns is carried out in stages, starting with a massage of the lacrimal sac, which must be performed for 2-3 weeks. Then the lacrimal canal is washed for 1-2 weeks, later retrograde probing of the nasolacrimal ducts through the lacrimal puncta is performed. This procedure is also carried out for 2-3 weeks. Usually, against the background of the above procedures, in combination with eye treatment with antiseptics, it is possible to obtain a positive result. If these methods still do not bring effect, after the child is 3 years old, an endonasal dacryocystorhinostomy is indicated.
Treatment of dacryocystitis in the acute course of the process
Acute course of dacryocystitis is an indication for hospitalization. In order to soften the infiltrate, UHF – therapy, systemic vitamin therapy and application of dry heat to the area of the lacrimal sac. In the presence of fluctuation, the abscess is subject to opening, after which the wound is washed and drained with antiseptics. It is recommended to instill antibacterial drops into the conjunctival sac and apply antibacterial ointments. In the treatment of dacryocystitis, systemic antibiotic therapy with broad-spectrum drugs is carried out. After eliminating the acute symptoms of dacryocystitis, a dacryocystorhinostomy is performed.
Treatment of dacryocystitis in the chronic course of the process
The main method of treating chronic dacryocystitis is dacryocystorhinostomy, the essence of which is the formation of an anastomosis between the nasal cavity and the lacrimal sac in order to effectively drain the lacrimal fluid. Surgical ophthalmology now uses minimally invasive methods of surgical treatment of dacryocystitis – This is a laser and endoscopic dacryocystorhinostomy. Sometimes the patency of the canal can be restored using balloon dacryocystoplasty or bougienage. Balloon dacryoplasty is performed when a probe with a balloon is inserted into the cavity of the duct. When the balloon is inflated, the internal lumen of the canal expands.
In the presence of chronic dacryocystitis, in order to prevent the formation of a purulent corneal ulcer, it is forbidden to use contact lenses and carry out any manipulations related to touch to the cornea. The course of uncomplicated dacryocystitis is favorable. Dacryocystitis can be complicated by the development of phlegmon of the orbit, thrombosis of the cavernous sinus, inflammation of the meninges, thrombophlebitis of the orbital veins and sepsis.
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