Newborn dacryocystitis
Dacryocystitis is an inflammation of the lacrimal sac, which is located in the upper part of the orbit. The cause of dacryocystitis in newborns is a variety of anomalies in the development of the nasolacrimal canal, through which normally the outflow of tear fluid from the eye into the nasal cavity occurs. In the case of an anomaly of development, this channel ends with a blind bag. In connection with the violation of tearing, mucopurulent or purulent( in most cases) inflammation of the lacrimal sac develops. The microflora of the lacrimal fluid finds a favorable nutrient medium in the lacrimal sac, which is represented by a jelly-like mass consisting of mucus and necrotic embryonic cells. This mass fills a blind bag and a nasolacrimal canal. Usually in the first days and weeks after birth, the jelly-like plug is eliminated on its own, and the lumen of the nasolacrimal canal is released. Removal of the plug is difficult in the case of a narrowing of the lumen of the nasolacrimal canal, as well as in the formation on the mucosa of the channel lining it from the inside, annular folds. Self-removal of the plug and restoration of the lumen of the canal is difficult when forming the blind end of the canal that drains the lacrimal fluid. This lower end of the nasolacrimal canal remains closed until 8 months of the baby's uterine life, and at the 9th month its discovery takes place. In the event that there are adverse conditions or the film covering the mouth is very thick, the lumen of the nasolacrimal canal does not open, which leads to the development of dacryocystitis.
Manifestations of dacryocystitis of newborns are monotonous. A few days after birth, the child has a slight mucous or mucopurulent discharge in one or both eyes, drowsiness, lachrymation( rarely), combined with a slight reddening of the eyes, is often associated with conjunctivitis. In addition, a swelling appears in the area of the lacrimal sac, which usually remains unnoticed. The main sign of dacryocystitis is the secretion of mucopurulent contents through tear points when pressing on the area of the lacrimal sac. Sometimes this feature is not observed. Usually, this situation occurs against the background of previous treatment.
Treatment of newborn dacryocystitis should be started immediately after its detection. To do this, immediately after birth, a lachrymus massage is performed daily for 2-3 weeks. Beginning with the age of one month, lachrymation of the tear ducts is carried out. Such treatment is carried out every other day for 1-2 weeks. Then, starting from the age of 2 months, sounding of the tear ducts is carried out with the purpose of their expansion and preservation of the lumen.
The phased, sequential treatment of newborn dacryocystitis with sounding leads to recovery in 98% of cases.
Later detection and untimely started treatment of newborn dacryocystitis leads to a transition to chronic course, the appearance of complications in the form of multiple tight fusion in the nasolacrimal canal, excessive expansion, and often suppuration of the lacrimal sac. Such complications significantly reduce the effectiveness of conservative treatment and require an operation.