Dacryostenosis is a pathological narrowing of the tear ducts. There are congenital and acquired forms of dacryostenosis. Clinically, both forms manifest themselves in approximately the same way: lacrimation, lacrimation, purulent discharge from the affected eye. Diagnosis is carried out using basic methods (biomicroscopy, visometry, tonometry) and special (tubular samples, diagnostic washing and radiography of the lacrimal tract with contrast). Treatment of congenital or acquired dacryostenosis is initially conservative, with inefficiency, surgical expansion of the tear ducts is required.
Dacryostenosis is a pathological narrowing of the vertical part of the lacrimal tract, leading to disruption of the movement of lacrimal fluid into the nasal cavity. The congenital form occurs in 6% of newborns (more often in premature infants) and children under one year old and is the main cause of the development of inflammation of the lacrimal sac (dacryocystitis). It occurs with the same frequency in boys and girls. The acquired form is one of the most frequent pathologies in ophthalmology in patients over 50 years of age. It manifests itself in the form of copious lacrimation, which can significantly reduce the quality of human life. Women are more likely to develop dacryostenosis than men. Pathology is found in all developed countries.
The causes of congenital dacryostenosis include anatomical features in the structure of various parts of the nasolacrimal tract. According to the results of special studies, ophthalmologists have found out that the formation of stenosis is most often found at the level of the nasal anastomosis of the nasolacrimal duct. There are the following factors contributing to the development of congenital dacryostenosis: the transition of the epithelial membrane of the nasal mucosa into the mucosa of the nasolacrimal canal; the emergence of a common vascular network of the nose with the nasolacrimal canal; the presence of joint venous vessels passing into the plexus of the nasolacrimal canal; the presence of mucosal folds, constrictions, bends, and diverticula in the lumen of the canal.
The causes of acquired dacryostenosis may be long-term inflammation of the lacrimal system, severe facial injuries, tumors, radiation therapy of the head area, operations on the organ of vision, nasal cavity and sinuses in the anamnesis. Prolonged use of eye drops (for example, with glaucoma) is also a risk factor for the development of dacryostenosis.
With a congenital form of dacryostenosis, parents may notice lacrimation and lacrimation in the affected eye in infants. A clinic of acute or recurrent conjunctivitis may appear – redness of the conjunctiva of the eye, mucous or purulent discharge, a feeling of pain and burning. The acquired form occurs in adults, more often after 40-50 years. The main complaints that patients turn to an ophthalmologist are copious lacrimation, which causes discomfort and reduces visual acuity. Periodically, there is a slight mucopurulent discharge from the eye. The lesion can be one- or two-sided.
Of the complications of dacryostenosis, the most common is dacryocystitis (inflammation of the lacrimal sac), less often peridacryocystitis (inflammation of the tissues surrounding the lacrimal sac) and periorbital phlegmon may occur. The development of purulent complications is indicated by the appearance of swelling, redness and soreness in the projection of the lacrimal sac, signs of systemic inflammation (fever, malaise, etc.).
Methods of diagnosis of dacryostenosis include anamnesis collection, biomicroscopy, in adults – visometry and tonometry. From special methods, tubular or nasal samples are used (the time of passage of the dye through the tear duct (TD) is determined). Diagnostic flushing is performed to determine the patency of the lacrimal apparatus, the degree of narrowing of the canal is judged by the nature of evacuation from the TD of the flushing fluid (drops or jet).
The main diagnostic method is dacryocystorentgenography with contrast (it is possible to accurately determine the location of blockage or narrowing of the lacrimal duct by contrast agent delay). Of the additional methods, computed tomography can be prescribed, which allows you to determine pathological foci or processes in the nasal sinuses, possible deformations of intra-nasal structures that affect the patency of the lacrimal apparatus of the eye.
Conservative methods are used to treat congenital and acquired forms. In congenital dacryostenosis, lacrimal tract massage is primarily recommended; a pediatric ophthalmologist teaches massage techniques to parents at the reception. The ineffectiveness of massage for six months is an indication for referral for diagnostic probing and flushing of the tear-nasal duct in a child. Treatment of the acquired form immediately begins with the washing of the tear ducts. With purulent discharge, antibacterial drops are prescribed. Eye washing with antiseptic may be required. Copious lacrimation in adults is an indication for the appointment of moisturizing drops or gels.
Surgical intervention is resorted to if there is no effect from conservative methods during the year, both in adults and in children. Surgical treatment includes balloon dacryoplasty, stenting or drainage of the lacrimal tract. The essence of the techniques is to expand the tear duct in various ways.
With timely and competent treatment, the prognosis is favorable. Measures for the prevention of dacryostenosis are aimed at preventing the acquired form. They include regular visits to an ophthalmologist, the use of the correct technique of instilling eye drops (observe an interval of 10 minutes when instilling more than 3 types of drops at the same time), if necessary, the patient should be trained in the techniques of proper wiping of tears. The congenital form is not preventable. If symptoms of dacryostenosis are detected in a child, the main task of parents is to contact a specialist in time and perform the prescribed treatment.