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The importance of tears for the organs of vision is difficult to overestimate. Scientists jokingly claim that it was crying that helped humanity survive under conditions of natural selection. It has long been known that tears improve visual acuity. The lacrimal mechanism ensures constant renewal of the film on the cornea. Lubricating the eyeball, tears protect it from drying out, inflammation and saturate it with nutrients and oxygen. They have antibacterial properties and help to get rid of foreign bodies in the eye.
To perform all the functions laid down by nature, the lacrimal mechanism works like a clock and requires special attention and support. A number of reasons can cause blockage of the tear ducts, which are designed to drain tear fluid. As a result of a violation of the outflow, involuntary tearfulness of the eyes appears, which creates fertile ground for the development of various kinds of infections of the visual organs.
Every fifth baby is born with a similar pathology, but adult patients can also suffer from it. Obstruction or narrowing of the lacrimal canals can cause serious diseases of the organs of vision. To eliminate them, ophthalmologists practice the manipulation of washing the lacrimal canals, which will be discussed in this article.
A little anatomy
Nature has endowed man with a unique lacrimal apparatus, which consists of the lacrimal gland and lacrimal ducts. The lacrimal gland is almond-shaped and is located just behind the eye under the frontal bones of the skull. A dozen lacrimal canals run from it to the eye and eyelid. When blinking, tears are released from the lacrimal gland, with which the eye is washed. Sterile tears keep the eye clean, moisturize it, and the enzymes they contain destroy bacteria, preventing the spread of infection.
The lacrimal points in the inner corner of the eye (on the lower and upper eyelids) are connected to the lacrimal sac, from which tears enter the nose through the nasolacrimal canal. Uninterrupted outflow of eye fluid is carried out due to negative pressure in the lacrimal sac.
In case of obstruction of the channels, the fluid formed in the eye stagnates in the lacrimal sac and can lead to its swelling and inflammation. In such cases, rinsing is required.
Symptoms of blocked tear ducts
The simplest example of the well-coordinated work of the lacrimal canal is the manifestation of a runny nose in case of crying or an allergic reaction to the organs of vision.
In turn, malfunctions in its work or infection of the tear ducts can be judged by the manifestation of the following symptoms:
- Watery eyes, excessive tearing.
- Persistent inflammation and infection.
- Pain in the corners of the eyes and their swelling.
- Secretion or accumulation of mucus.
- Blurred vision.
- Blood in tears.
Indications for manipulation
Blockage of the tear ducts can be congenital or caused by a number of factors, including age.
The most common indications for lavage of the lacrimal canal are listed below:
- Obstruction of the channels in infants, caused by an anomaly in the structure of the nasal bone or underdevelopment of the drainage system of the eye. It is characterized by the appearance of a mucous film, which can lead to inflammation with purulent discharge. In this case, the film is removed, followed by washing with disinfectants and anti-inflammatory substances.
- Blockage of the channels in newborns with a gelatinous plug that did not resolve in the first two weeks after the birth of the child. In such cases, it is recommended to massage the lacrimal ducts after each feeding and only if there are no positive results.
- Narrowing of the entrance to the tear ducts in adults, caused by trauma, inflammatory diseases in the nasal cavity, a tumor of the intraocular or surrounding tissue.
- Obstruction of the lacrimal canal in the elderly, caused by atherosclerosis, colds and swelling of adjacent tissues, injuries and other severe pathologies.
In addition to diagnosing pathologies of the lacrimal canals, manipulations to wash them are also carried out for medicinal purposes, for example, when inflammation (canaliculitis) is detected. In this case, the procedure is preceded by the cleansing of the tubules from mucopurulent secretions.
During the manipulation of washing the lacrimal canals with diagnosed dacryocanaliculitis – inflammation of the lacrimal canals and dacryocystitis – inflammation of the lacrimal sac, medications are introduced into the cavity of the lacrimal canal or sac.
In addition, washings are used in the case of such a diagnosis as stenosis of the lacrimal canaliculus, as well as in mild degrees of stenosis of the nasolacrimal duct and corneal ulcer (for sanitation of the primary focus of infection).
Противопоказания
Only an ophthalmologist can evaluate the function of drainage of the lacrimal canal with the subsequent choice of treatment methods.
In this case, the procedure for washing the lacrimal canal is not recommended in two cases:
- When stretching the lacrimal sac with filling it with mucus, since such a procedure can give impetus to the spread of pus throughout the organs of vision.
- With purulent acute inflammation – dropsy of the lacrimal sac – washing can cause its overstretching, and lead to rupture of the sac structure.
Procedure
In cases of blockage of the nasolacrimal canal, ophthalmologists recommend trying a less invasive treatment first. The washing procedure can be carried out both for diagnostic and therapeutic purposes. In the first case, this procedure allows ophthalmologists to verify the patency of the lacrimal ducts, for which fluid is injected into them under moderate pressure. If there is a need for treatment, antibiotics, antiseptics or substances that improve patency are injected into the lacrimal ducts, depending on the indications.
Elimination of obstruction of the lacrimal ducts is performed under local anesthesia. In cases where there is no need for probing the lacrimal ducts, punctures are not performed. An anesthetic is instilled into the conjunctival cavity, after which a special cannula with a syringe is inserted into one of the tear outlet points. If the fluid gradually introduced into the cavity freely exits the nasal sinuses, the lacrimal canals are not clogged, and the flow of fluid back from the eyes indicates the presence of pathology. In such cases, the lacrimal-nasal tract is washed with a solution of furacilin or an isotonic sodium chloride solution.
The procedure is absolutely safe, does not injure tissues and is recommended for patients regardless of age, including newborns after they reach two months. Ophthalmologists do not recommend postponing the diagnosis of the pathology of the lacrimal canals in adults, because with age the course of such manipulation becomes more complicated.
The procedure and features of the procedure for newborns and adults are given below.
Washing the tear ducts in infants
At the birth of a baby, the nasolacrimal canals in children are blocked by a gelatinous film, which, under the influence of tears, should dissolve in the first two weeks of a child’s life. However, in 6% of newborns this does not happen due to the increased strength of the film or the abnormal structure of the canals and bones of the skull, which makes it difficult for the outflow of tears.
In such cases, not earlier than after the child reaches two months, ophthalmologists practice a number of manipulations related to the removal of the film with further probing and washing the lacrimal canal. Having previously anesthetized the site of the procedure, a special conical instrument called the Sichel probe is inserted. This manipulation is necessary for the initial expansion of the channel, into which the Bowman probe is then inserted. With this tool, which has pointed ends, the gelatin film is pierced.
At the next stage, the lacrimal canals are washed with a disinfectant solution. In order to avoid infection of the lacrimal system, the procedure ends with disinfection of the lacrimal ducts with antibiotic eye drops. The washing process is absolutely painless and lasts no more than a quarter of an hour. Over the next few days, the child should be instilled with eye drops, carefully selected by the doctor, taking into account the age of the patient, according to the scheme and dosage prescribed by the ophthalmologist.
To prevent recurrence of the disease and prevent the formation of adhesions, ophthalmologists recommend massaging the child’s tear ducts for two weeks after removing the film. To do this, with the help of the index finger, lightly press on the inner corner of the eye for one to two minutes.
Often, on the eighth or ninth day of life, a child develops dacryocystitis – purulent inflammation of the eyes, accompanied by reddening of the inner corner of the eyes, lacrimation and discharge of pus from the lacrimal punctum when pressing on the lacrimal sac. This disease develops due to the stagnation of tears caused by the remnants of embryonic tissue in the nasolacrimal canal, which prevents the outflow of tears from the lacrimal sac.
With dacryocystitis of newborns, ophthalmologists practice a special massage, which is aimed at improving the patency of the lacrimal ducts, and only if it is ineffective, treatment is prescribed in the form of probing and washing the clogged lacrimal canals.
At the first stage of treatment, the mother of the newborn is recommended to massage the baby’s lacrimal sac (6-10 movements up and down with effort) after each feeding. With proper massage, the amount of outgoing pus increases.
After the massage, it is necessary to rinse the eyeball with a solution of furacilin (1 tablet is dissolved in a glass of boiling water). Purulent particles should be removed by wiping the palpebral fissure with cotton swabs moistened with the solution, moving from the temple to the nose. The procedure ends with the instillation of an antibiotic solution – 1 drop of 0,25% chloramphenicol at least 5 times a day.
The effectiveness of the procedure directly depends on the age of the child, the younger he is, the more effective this massage. Such treatment is recommended for two weeks, and only if it is ineffective, proceed to the second stage, namely the probing and washing described earlier.
The course of therapeutic lavages for dacryocystitis in newborns in some cases can be delayed for a week or two, while the procedures are carried out once every one or two days.
Irrigation of lacrimal ducts in adults
The pathology of the lacrimal canals in adults occurs at any age and is determined by diagnostic means. Unlike infants, it is not possible to solve the problem of canal patency in adults with one massage, as well as with probing. Having established the passive patency of the tear ducts, the ophthalmologist, in case of pathology, prescribes forced washing with disinfectants.
To achieve the best results, ophthalmologists practice a combination of flushing with lacrimal probing. Such a procedure is considered the most effective for obstruction of the tear ducts, since with a simultaneous increase in the lumen of the channel, it helps to relieve inflammation.
At the same time, it is less traumatic compared to hard probing.
The solution for washing is injected into the region of the lacrimal opening at the nose using a syringe with a blunt needle or cannula through a conical probe that expands the entrance to the canal. The cannula is inserted as deep as possible without touching the walls. Pulling the patient’s eyelid, the doctor slowly presses the syringe plunger, observing the dynamics and ease of passage of the solution during the procedure.
For pain relief, drops are instilled into the eye before the procedure. In the event that it is not possible to solve the problem with washings and pus continues to be released from the channels, ophthalmologists connect drug treatment with antibiotics and anti-inflammatory drugs, or surgery.
Analysis of results
Ophthalmologists interpret the results when washing the lacrimal canals according to the following scheme.
In the absence of channel pathology, fluid easily flows out through the nose. When introducing the solution, no special efforts are required, the liquid is introduced by light pressure on the piston. Stenosis of the nasolacrimal duct or fusion of the orifices of the canals is evidenced by the outflow of fluid from the opposite lacrimal punctum.
With stenosis of the nasolacrimal duct, fluid may begin to flow from the opposite lacrimal punctum not immediately, but after a few seconds or after increasing pressure on the piston. At the same time, traces of blood are noted in it. With stenosis of the internal part of the canal, the fluid flows out of the same place where it was injected.
When the nasolacrimal duct is blocked, fluid flows out of the nose when pressure on the syringe plunger increases.
Complications during the procedure
In the case when all contraindications are taken into account and the technique of the procedure is observed, no special complications are noted.
The only negative consequence may be the distortion of the results of the diagnostic test in case of incorrect insertion of the cannula with liquid, in particular, if the cannula touches the canal walls.