What happens with dacryocystitis
Tears constantly wash the surface of the eye and collect at the inner corner into lacrimal puncta on the upper and lower eyelids. Further along the lacrimal canaliculi they enter the lacrimal sac and flow down the nasolacrimal duct into the lower nasal passage. When the canal is narrowed or blocked, tears accumulate in the bag, the wall of the bag stretches, and stagnation creates conditions for infection. Chronic dacryocystitis is manifested by constant lacrimation and purulent discharge. Acute dacryocystitis is accompanied by severe inflammation of the tissue around the sac and can form an abscess.
- Dacryocystitis of newborns
- Acute dacryocystitis in adults
- Chronic dacryocystitis
- Cellulitis of the lacrimal sac - a complication
- Dacryocystocele in infants
Causes and risk factors
In newborns, the main cause is the preserved embryonic membrane at the point where the canal enters the nose. It usually opens with the first breaths and crying, but in some babies it remains, and then stagnation develops. Less commonly, the cause is anomalies in the structure of the canal and facial skeleton. In adults, narrowing of the canal develops gradually due to chronic inflammation of the mucous membrane, more often in middle-aged and older women. Chronic rhinitis and sinusitis, deviated septum and nasal injuries, sinus surgery, some eye drops, and stones in the lacrimal ducts contribute to this.
- Congenital membrane of the nasolacrimal duct
- Anomalies of facial development
- Age-related narrowing of the canal in adults
- Chronic rhinitis and sinusitis
- Injuries and fractures of the nose
- Operations on the paranasal sinuses
- Stones and tumors of the lacrimal ducts - rare
Symptoms
From the first weeks of life, a baby’s eyes become watery, even when the child is not crying, yellow discharge accumulates on the eyelashes, and the eyelids stick together after sleep. When lightly pressing on the area at the inner corner of the eye, mucus or pus comes out of the lacrimal punctum. The eyeball is usually not red, unlike conjunctivitis. In adults, chronic dacryocystitis is manifested by constant lacrimation in the street and cold, slight swelling at the corner of the eye and pus when pressed. The acute form causes sharply painful red swelling, fever and weakness.
- Constant watery eyes
- Purulent discharge from the eye
- Sticking of eyelids in the morning
- Pus when pressing on the lacrimal sac
- Swelling at the inner corner of the eye
- In the acute form - pain, redness, temperature
Diagnostics
The ophthalmologist examines the area of the lacrimal sac, gently presses on it and evaluates the discharge. The patency of the lacrimal ducts is checked using a color test: a safe dye is dropped into the eye and seen if it appears in the nose. Rinsing the lacrimal ducts through the lacrimal punctum shows whether fluid is passing into the nose. To select a drug, a culture of the discharge is taken. Before surgery, adults are prescribed a CT scan or X-ray with contrast of the lacrimal ducts and referred to an otolaryngologist to examine the nasal cavity. Acute dacryocystitis is distinguished from phlegmon of the orbit and barley.
- Inspection and pressure on the lacrimal sac
- Colored nasolacrimal test
- Lacrimal duct rinsing
- Culture of the discharge
- CT or dacryocystography in adults
- Endoscopy of the nasal cavity
Treatment
For newborns, the ophthalmologist shows parents a massage of the lacrimal sac: jerky movements with a finger from top to bottom along the nose, which create pressure and help open the membrane. In case of purulent discharge, eye rinsing and drops are prescribed. If patency has not been restored by the age determined by the doctor, probing of the nasolacrimal duct is performed. Acute dacryocystitis in children and adults is treated with antibiotics orally or intravenously; if an abscess is opened, it is opened; Probing in the acute stage is not performed in adults. Chronic dacryocystitis in adults is treated with surgery - dacryocystorhinostomy, which creates a new path for the outflow of tears into the nose.
- Massage of the lacrimal sac in infants
- Eye rinsing and drops as prescribed
- Probing of the nasolacrimal duct
- Lacrimal duct rinsing
- Antibiotics for acute dacryocystitis
- Endoscopic or external dacryocystorhinostomy
- Treatment of chronic rhinitis and sinusitis
