Colored nasolacrimal test. Avoided eye probing Complications of tear duct obstruction in newborns

Maybe my story will help someone who currently has problems with their eyes.
When Nastya was born in the maternity hospital, they told me that she had conjunctivitis and sent me to another hospital, we spent 10 days there and smeared her eye with tetracycline ointment, but as soon as we stopped applying it, the eye began to fester again. But when we arrived home, I called my relative, she I have a nurse and she told me: “Natasha, it doesn’t look like you have conjunctivitis, because after tetracycline it goes away on the third day, and you most likely have an obstruction of the lacrimal canal, it’s better to go to the ophthalmologist.” But we don’t go to the ophthalmologist We got there, there was a huge line there. At 1.5 months we met our nurse and she said that we would have to wash out the eye, the word “wash” for such a baby felt like a knife to my heart, I immediately began looking for information on how to avoid this procedure and found the following article:

In the first days after birth, children often develop purulent discharge from the eyes. One of the reasons for purulent discharge may be dacryocystitis of newborns- inflammation of the lacrimal sac.

Why does this disease develop?

Usually, in all people, tears from the eye go through the lacrimal ducts into the nasal passage. The lacrimal ducts include: lacrimal puncta(superior and inferior), lacrimal canaliculi (superior and inferior), lacrimal sac and nasolacrimal canal, which opens
under the inferior nasal concha (here the tear fluid evaporates due to the movement of air during breathing), this is 1.5 - 2.0 cm from the external nasal opening. Posteriorly, the nasal cavity communicates with upper section pharynx (nasopharynx). During intrauterine life, the child has a gelatinous plug or film in the nasolacrimal duct that protects him from amniotic fluid. At the moment of birth, with the first breath and cry of the newborn, the film breaks through, and the patency of the canal is created. If this does not happen, then the tear stagnates in the lacrimal sac, an infection develops, and acute or chronic dacryocystitis develops.
The first signs of dacryocystitis, which are detected already in the first weeks of life, are the presence of mucopurulent discharge from the conjunctival sac of one or both eyes, lacrimation, lacrimation (rarely) in combination with mild redness of the conjunctiva. This process is often mistaken for conjunctivitis.
The main symptom of dacryocystitis is the release of mucopurulent contents through the lacrimal openings when pressing on the area of ​​the lacrimal sac. Sometimes this symptom is not detected, which may be due to previous drug therapy. To clarify the diagnosis, a collarhead test (Vest test) is performed. 1 drop of a 3% solution of collargol (dye) is instilled into the eyes. First, a cotton wick is inserted into the nasal cavity. The appearance of a dye on the wick 5 minutes after instillation is assessed as a positive test. The sample is considered delayed if paint is detected in the nose after 6-20 minutes and negative after 20 minutes. The test can also be considered positive if, after instilling Collargol, the conjunctiva of the eyeball clears within 3 minutes. Negative result The nasolacrimal test indicates a conduction disorder in the lacrimal drainage system, but does not determine the level and nature of the lesion, so consultation with an ENT doctor is necessary, because the canal is the nasolacrimal canal, so if a child has a runny nose, the mucous membrane of the lacrimal ducts swells, the lumen narrows and the outflow of tears becomes difficult. Severe complication Unrecognized and untreated dacryocystitis of newborns may be phlegmon of the lacrimal sac, accompanied by a significant increase in body temperature and anxiety of the child. As an outcome of the disease, fistulas of the lacrimal sac are often formed.
In case of chronic course main process clinical sign is a profuse purulent discharge from the lacrimal sac, which fills the entire palpebral fissure, usually after sleep or crying.
Once the diagnosis is made, treatment must begin immediately. First, study the anatomy of the lacrimal ducts, the projection of the lacrimal sac (see above). Before starting the massage, wash your hands thoroughly, cut your nails short, and you can use sterile gloves.
1. Squeeze out the contents of the lacrimal sac.
2. Instill a warm solution of furatsilin 1:5000 and use a sterile cotton swab to remove the purulent discharge.
3. Massage the lacrimal sac area by gently pressing 5 times index finger from top to bottom using jerky movements, trying to break through the gelatinous film.
4. Apply disinfectant drops (chloramphenicol 0.25% or Vitabact)
5. Carry out these manipulations 4 – 5 times a day. The massage is carried out for at least 2 weeks. According to the literature and our data, the gelatinous plug resolves or breaks through by 3-4 months, if parents correctly and carefully follow the above recommendations.
If these manipulations do not give the desired result, then it is necessary to carry out probing of the nasolacrimal canal in an eye office. Probing the nasolacrimal canal is a complex, painful and far from safe procedure. Under local anesthesia(anesthesia), using conical Sichel probes, the lacrimal openings and lacrimal canaliculi are expanded, then a longer Bowman probe No. 6; No. 7; No. 8 is inserted into the nasolacrimal canal and breaks through the plug there, then the canal is washed with a disinfectant solution. After probing, it is necessary to carry out massage for 1 week (see above) to prevent relapse associated with the formation of adhesions.
Probing is ineffective only in cases where dacryocystitis is due to other reasons: an anomaly in the development of the nasolacrimal duct, a deviated nasal septum, etc. These children need complex surgery– dacryocystorhinostomy, which is performed no earlier than 5–6 years.

Dacryocystitis is an inflammation of the lacrimal sac and occurs in 1-5% of newborns. Dacryocystitis is diagnosed in the first days and weeks of life, so it happens that the baby is diagnosed already in the maternity hospital.

The causes of the disease may be:
– Pathology of the nose and surrounding tissues due to inflammation or injury.
– Obstruction of the nasolacrimal duct at the time of birth of the child, due to the presence of the so-called gelatinous plug, which did not resolve by the time of birth.

Normally, free communication between the nasolacrimal duct and the nasal cavity is formed in the 8th month of intrauterine development. Until this time, the outlet of the lacrimal canal is closed by a thin membrane. By the time of birth, in most cases, the membrane dissolves or breaks through at the first cry of the child. If the film does not dissolve or does not break through, then problems with tear drainage arise. As in most cases, the outcome of the disease depends on timely diagnosis and timely treatment.

The first signs of the disease are mucous or mucopurulent discharge from the eye, swelling in the inner corner of the eye.
Quite often, pediatricians regard this as conjunctitis and prescribe anti-inflammatory drops, but this treatment does not help.
The distinctive signs of dacryocystitis are mucopurulent discharge when pressing on the area of ​​the lacrimal openings.

Treatment begins with massage of the nasolacrimal duct. The purpose of the massage is to break through the gelatinous film. Massage of the nasolacrimal canal is performed with several jerking or vibrating movements of the finger with some pressure directed from top to bottom, from the top of the inner corner of the eye down. Due to the created high blood pressure in the nasal duct, the embryonic membrane breaks through. (Does this remind you of the plunger principle?)
Massage should be done 8-10 times a day. If there is no effect in the coming days, then it should be continued for a month. Purulent discharge, which is squeezed out of the lacrimal sac, must be removed with a cotton ball soaked in a decoction of chamomile, tea leaves, or calendula.

If massage does not help, then hard probing of the nasolacrimal canal is necessary. It is better to do it in 2, 3 one month old.

To carry out this procedure, it is necessary to undergo a blood test for coagulation and an examination by an ENT doctor to exclude pathology of the nasal cavity. After the probing procedure, treatment in the form of drops continues for another week as prescribed by the doctor, and massage is preferably carried out for a month

The lacrimal apparatus includes the lacrimal gland and lacrimal ducts. The lacrimal gland is located in the upper outer part of the orbit. The tear fluid from the gland enters the upper fornix of the conjunctiva (under the upper eyelid at the outer corner of the eye) and washes the entire anterior surface of the eyeball, covering the cornea from drying out.

1. Vesta color nasolacrimal test - allows you to determine functional state lacrimal ducts, starting from the lacrimal openings. A 2% fluorescein solution is instilled into the eye and the patient's head is tilted down. If the paint has been applied within 5 minutes, the test is positive (+); slow - 6-15 minutes; absence of paint in the nasal passage - test (-).
2. Determination of indicators of total tear production - Schirmer test - carried out using a strip of graduated filter paper bent at an angle of 45°, which is placed behind the lower eyelid to the bottom of the lower fornix of the conjunctiva. Eyes closed. After 5 minutes, the length of wetting is measured. Normally it is 15 mm.
3. Norn's Test - allows you to determine the stability of the precorneal film. After clearing the conjunctival sac of mucus and pus, the patient is instilled with 1-2 drops of a 2% collargol solution twice with an interval of 0.5 minutes. The test is considered positive if collargol is completely absorbed within 2 minutes, and when pressing on the area of ​​the lacrimal sac, a drop appears from the lacrimal punctum. If collargol is not released from the lacrimal openings, the test is considered negative.
4. At the same time, a nasal collarhead test is checked.. To do this, a cotton swab is inserted under the inferior nasal concha to a depth of 4 cm. If it is stained after 2-3 minutes, the test is considered positive, after 10 minutes - delayed, and if there is no coloring - negative.
5. Lacrimal duct rinsing - performed after anesthesia of the conjunctiva with a three-fold installation of 0.25% dicaine solution. A conical Sichel probe is inserted into the inferior lacrimal punctum, first vertically and then horizontally, along the lacrimal canaliculus to the nasal bone. Then, using a syringe with a blunt needle or with a special cannula, a physiological or disinfectant solution is injected in the same way. The patient's head is tilted downwards, and when in good condition the lacrimal ducts, fluid flows out of the nose in a stream. In cases of narrowing of the nasolacrimal duct, the liquid flows out in drops, and in case of obstruction of the lacrimal ducts, it pours out through the upper lacrimal punctum.
6. Probing the lacrimal ducts - performed after expansion of the inferior lacrimal punctum and canaliculus with a Sichel probe. Along this path, a Bauman probe No. 3 is passed to the nasal bone, after which the probe is turned vertically and, adhering to the bone, passes through the lacrimal sac into the nasolacrimal canal. Probing is used to localize strictures and widen the nasolacrimal ducts.
7. To diagnose changes in the lacrimal ducts It is better to use radiography. After anesthesia of the conjunctival sac with dicain and dilation of the lacrimal punctum and canaliculi with a conical probe, 0.4 ml of an emulsion of bismuth nitrate in vaseline oil is injected into the lacrimal ducts with a syringe. Then, placing the patient in the chin-nasal position, a picture is taken. In this case, violations are easily detected normal structure lacrimal ducts. After radiography, the lacrimal ducts are washed with saline to remove the emulsion.

Keratometry. Keratometry is already used when examining the organ of vision in a child in maternity hospital. This is necessary for early detection congenital glaucoma. Keratometry, which can be performed by almost everyone, is based on measuring the horizontal size of the cornea using a ruler with millimeter divisions or a strip of sheet from a squared notebook. By placing the ruler as close as possible, for example, to the child’s right eye, the doctor determines the division on the ruler that corresponds to the temporal edge of the cornea, closing his right eye, and corresponding to the nasal edge, closing the left eye. The same should be done when a “cell strip” is brought to the eye (the width of each cell is 5 mm). When performing keratometry, it is necessary to remember the age norms for the horizontal size of the cornea: in a newborn 9 mm, in a 5-year-old child 10 mm, in an adult about 11 mm. So, if in a newborn it fits into two cells of a strip of paper and a small gap remains, then this is normal, but if it goes beyond two cells, then pathology is possible. To more accurately measure the diameter of the cornea, devices have been proposed - a keratometer and a photokeratometer (Fig. 37).

It should be noted that when examining the cornea, it is important to determine not only its transparency, sensitivity, integrity and size, but also its sphericity. This research has become especially important in recent years due to the increasing prevalence of contact correction vision. Keratoscopes are used to determine the sphericity of the cornea.

Algesimetry. An important criterion in diagnosis, assessment of severity and dynamics pathological process is the state of corneal sensitivity. The simplest known method, although crude and allowing only an approximate idea of ​​the sensitivity of the cornea, is algesimetry using a lint of cotton wool or a hair. In order not to frighten children, you should bring a lint or hair to the eye not directly, but from the temporal side, doing it slowly, as if imperceptibly, with your right or left hand, slightly parting the eyelids (opening the palpebral fissure) with the other hand from the side of the nose . Such a study allows us to judge the presence of pronounced sensitivity or its significant impairment.

More complex, but quite accessible and sufficient informative research- determination of the sensitivity of the cornea using a set of hairs (according to Samoilov) of varying elasticity (0.5; 1.0; 3.0; 5.0; 10.0, etc.), which can be fixed in the cleft of the end of the match. First, the elasticity of the hairs is determined on an analytical balance (mass, the force of movement at which the hair bends). As a rule, 4-6 different hairs are prepared and each of them is numbered. Store the hairs in a box (small sterilizer for a syringe). First, the study is carried out in different points along the periphery and in the center of the cornea (6-8 points or more), using the least elastic hair. If sensitivity is not determined using this hair, then hairs with greater elasticity are successively used. The sensitivity of the cornea is determined by the hair that caused the reaction. Sensitivity at different points may be different; in these cases, sensitivity is recorded at each point. In order to assess the dynamics of corneal sensitivity during the disease process and under the influence of treatment, it is necessary to compare the results of repeated studies with the initial data, but the study must again begin, as in the first study, with the hairs of the least elasticity.

The most advanced devices for studying and recording the state of corneal sensitivity are algesimeters of various designs, which were proposed by A. N. Dobromyslov and B. L. Radzikhovsky. However, they are used, as a rule, in the course of research and clinical experimental work. In practice, it is enough to conduct a study of the hair sensitivity of the cornea, but always in dynamics and in each eye.

Methods for studying the lacrimal ducts. The study of the lacrimal ducts in children must be carried out in the maternity hospital, and then throughout the first six months of life. In almost 5% of newborns, the nasolacrimal duct is closed by a gelatinous plug, which dissolves in the first days of life as a result of exposure to mucolacrimal fluid containing the enzyme lysozyme, and the path for lacrimal drainage is open. However, in approximately 1% of newborns, this plug does not dissolve, but is organized into a connective tissue septum, as a result of which tear drainage becomes impossible. In addition, the cause of obstruction of the lacrimal ducts may be changes in each of their sections, as well as in the nose. The first sign of pathology of the lacrimal ducts is constant lacrimation, and often lacrimation. In order to establish the cause or causes of lacrimation and lacrimation, it is necessary to consistently carry out a series of studies, starting with a simple visual determination of the position of the eyelids in relation to the eyeball. Normally, the upper and lower eyelids are in contact with the eyeball, and thus the tear duct can be considered to be fully functioning. The presence of eversion, entropion, coloboma of the eyelids, lagophthalmos and other changes predominantly in the edges of the eyelids can cause lacrimation and lacrimation.

It is also very important to establish whether the newborn has lacrimal openings, how they are expressed and where they are located. To do this, it is necessary to slightly pull each eyelid at the inner corner of the palpebral fissure and determine the condition of each lacrimal punctum. If, in the normal position of the eyelids, the lacrimal openings are not visible and appear only when the eyelid is gently pulled back, then it means that they are positioned correctly. Normally, lacrimal puncta are clearly defined as a miniature funnel-shaped depression in the lacrimal tubercle.

By pressing with your finger or glass rod in the area of ​​the lacrimal canaliculus with a retracted eyelid, check whether there is mucous or other discharge from the lacrimal openings. As a rule, there is no discharge from the lacrimal openings during this manipulation.

The next stage of the study is to determine the presence and functioning of the lacrimal sac. For this purpose, press the skin near the lower inner corner of the orbit with a finger or a glass rod, i.e., in the area of ​​​​the projection of the lacrimal sac. In this case, the eyelid should be pulled away from the eyeball so that the lacrimal punctum is visible. If, when pressing on this area, there is no discharge from the lacrimal punctum or it is very scanty, transparent and liquid (tear), then it means there is a lacrimal sac. However, it is safe to say that it functions well and has correct location and sizes are not allowed. If during this manipulation there is abundant mucous or mucopurulent discharge from the lacrimal openings, then this indicates obstruction of the nasolacrimal duct. In those rare cases when, when you press on the area of ​​the lacrimal sac, its contents come out not through the lacrimal openings, but through the nose (under the inferior nasal concha), one can think about the irregular structure and shape of the lacrimal sac and the patency of the bony part of the nasolacrimal duct.

Finally, the area of ​​the inferior turbinate is examined and the condition of the nasal septum is determined. In addition, pay attention to the presence or absence (difficulty) of nasal breathing.

After visual-manual examinations, functional lacrimal and nasolacrimal tests should be performed.

Functional tests are carried out in two stages. The first stage is the assessment of the functioning of the lacrimal ducts from the lacrimal opening to the lacrimal sac (Vest's canalicular test), the second - from the lacrimal sac to the release of fluid from under the inferior nasal turbinate (Vest's lacrimal-nasal test). The Vesta nasolacrimal test is performed as follows. A loose swab of cotton wool or gauze is inserted under the inferior turbinate; 2-3 drops of a 1-3% solution of collargol or fluorescein are instilled into the conjunctival cavity; note the time of instillation and the time of disappearance of the dye from the conjunctival sac (normally it should not exceed 3-5 minutes). 5 minutes after instillation of the dye, every minute the swab is removed from the nose with tweezers and the time for the appearance of its staining is determined.

The West nasolacrimal test is considered positive if staining of the tampon occurred in the first 7 minutes after installation of the dye, and weakly positive or negative if staining was noted later than 10 minutes or did not occur at all.

In cases where the canalicular or nasolacrimal West test, or both together, are slow or negative, diagnostic probing should be performed with a Bowman probe (No. 1). In the process of careful probing, either free patency of each section of the lacrimal duct is revealed, starting from the lacrimal punctum and ending with the bony part of the nasolacrimal duct, or an obstacle in any of the sections. Before or after probing, the lacrimal ducts are washed. To do this, using a syringe and a blunt-ended straight or curved needle under pressure, a weak solution of an antiseptic, antibiotic, sulfonamide drug, isotonic sodium chloride solution, and lidase is injected through the upper (if necessary, through the lower) lacrimal opening. If the solution is excreted only through the nose, then this test is positive, if through both the nose and through the second lacrimal punctum, then it is weakly positive, and if only through the second lacrimal punctum, then negative. In cases where fluid is released from the same lacrimal opening, that is, does not pass through the tubules, the sample is considered sharply negative. In order to exclude the presence of an obstruction in the nasolacrimal duct in such cases, retrograde sounding is performed together with an otolaryngologist.

Finally, in order to finally establish the location and extent of the pathology of the lacrimal ducts, an X-ray examination should be performed. As contrast agent use iodolipol, which is administered through the lacrimal openings, after which they do x-ray. X-ray contrast images reveal strictures and diverticula, obstruction of various sections tear ducts, lacrimal sac, bony part of the nasolacrimal duct.

Only after sequentially carrying out all diagnostic studies can be supplied correct diagnosis and choose an adequate treatment method (bougienage, probing, reconstructive surgery on tear ducts, in the nose).

Due to the fact that pathology lacrimal organs consists not only of impaired lacrimal drainage, but also of changes in the tear-producing apparatus (lacrimal gland), you need to know that dysfunction of the lacrimal gland can be judged by the indicators of the Shprimer test. The essence of this test is that a strip of filter paper 0.5 cm wide and 3.5 cm long is placed behind the lower eyelid for 3-5 minutes. If all the paper becomes homogeneously moist during this time, this indicates normal functioning of the gland. if it is faster or slower, then it means that its hyper- or hypofunction is noted, respectively.

Fluorescein test. A fluorescein test is performed if there is a suspicion of a violation of the integrity of the cornea (keratitis, damage, dystrophy). 1-2 drops of fluorescein solution are installed into the conjunctival cavity (on the cornea) (in cases where there is no fluorescein solution, the test can be performed using a collargol solution), and then the cavity is quickly washed with an isotonic sodium chloride solution or any ophthalmic solutions of antiseptics, antibiotics, sulfa drugs. After this, the cornea and conjunctiva are examined using a combined method using a binocular loupe, a manual or stationary slit lamp. If there is a defect in the cornea (the integrity of the epithelium and its deeper layers is damaged), then a yellowish-greenish color will be visible in this place. In the process of treating a disease (damage) of the cornea, the sample is used many times, which makes it possible to monitor the dynamics of the process, the effectiveness of treatment and the restoration of its integrity.

TARGET: diagnostic.

INDICATIONS:

CONTRAINDICATIONS: No.

EQUIPMENT: stool, cotton balls or gauze balls, drops of collargol 3% or fluorescein 1%, pipettes.

PREREQUISITE: No.

Technique:

The patient is seated on a chair.

If after 1-2 minutes the tear fluid begins to discolor, therefore, the suction function of the tubules is preserved, and tears freely pass through them into the lacrimal sac - a positive tubular test.

If the dye is retained in the conjunctival sac for a longer period, the tubular test is considered negative.

1. Nasal test

TARGET: diagnostic.

INDICATIONS: carried out in case of pathology of the lacrimal drainage apparatus.

CONTRAINDICATIONS: No.

EQUIPMENT: chair, cotton balls or gauze, gauze pads, drops of collargol 3% or fluorescein 1%, nasal tweezers, pipettes.

PREREQUISITE: No.

Technique:

The patient is seated on a chair.

A cotton or gauze swab is inserted into the lower nasal passage using nasal tweezers from the side being examined.

A 3% solution of collargol or a 1% solution of fluorescein is instilled into the conjunctival sac.

After 5 minutes, the tampon is removed.

The appearance of a dye after 3-5 minutes on a tampon (or on a napkin when blowing your nose) indicates a positive nasal test with normal patency of the lacrimal ducts.

If there is no paint on the swab at all or it appears later, then the nasal test is considered negative or sharply delayed.

1. Examination of intraocular pressure by palpation

TARGET: diagnostic.

INDICATIONS: carried out for indicative research intraocular pressure.

CONTRAINDICATIONS: No.

EQUIPMENT: No.

PREREQUISITE: No.

Technique:

The patient is asked to look down.

The index fingers of both hands are placed on eyeball and alternately press on it through the eyelid.

At the same time, tension is felt.

About the level of intraocular pressure (tensio) judged by the compliance of the sclera. There are four degrees of eye density: T n – normal pressure; T +1 – moderately dense eye; T +2 – the eye is very dense; T +3 – the eye is hard as a stone.

When intraocular pressure decreases, three degrees of hypotension are distinguished: T -1 - the eye is softer than normal; T -2 – soft eye; T-3 – the eye is very soft, the finger encounters almost no resistance.

1. Determination of corneal integrity

TARGET: diagnostic.

INDICATIONS: performed in case of disease or damage to the cornea.

CONTRAINDICATIONS: No.

EQUIPMENT: chair, table, table lamp, lenses of 13 and 20 diopters, binocular magnifier, slit lamp, cotton or gauze balls, 1% fluorescein solution, pipettes.

PREREQUISITE: dark room.

TECHNIQUE:

The patient is seated on a chair.

A 1% fluorescein solution is instilled into the conjunctival sac.

Wash the conjunctival sac.

The cornea is examined using focal illumination or biomicroscopy.

The defect in the cornea turns green.

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Ophthalmology course SOGMA

Practical skills.

Study of visual acuity using the Sivtsev table. (3)

Rinsing the conjunctival sac. (3)

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Ophthalmology course SOGMA

Practical skills.

Visual acuity examination is below 0.1. (3)

Instillation of drops. (3)

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Ophthalmology course SOGMA

Practical skills.

Perimetry. (2)

Laying ointment. (3)

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Ophthalmology course SOGMA

Practical skills.

Determination of the boundaries of the field of view using a control method. (3)

Removing superficial foreign bodies from the cornea and conjunctiva. (2)

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Ophthalmology course SOGMA

Practical skills.

External examination of the eye and surrounding tissues. (3)

Applying a monocular bandage. (3)

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Ophthalmology course SOGMA

Practical skills.

Eversion of the lower eyelid. (3)

Application of a binocular bandage. (3)

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Ophthalmology course SOGMA

Practical skills.

Eversion of the upper eyelid. (3)

Diaphanoscopy. (2)

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Ophthalmology course SOGMA

Practical skills.

Determination of the presence of pathological contents in the lacrimal sac. (3)

Securing young children for eye examination. (3)

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Ophthalmology course SOGMA

Practical skills.

Examination of the eye with focal illumination. (3)

Tubular test. (2)

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Ophthalmology course SOGMA

Practical skills.

Ticket No. 10

Examination of the eye in transmitted light. (3)

Nasal test. (2)

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Ophthalmology course SOGMA

Practical skills.

Ticket No. 11

Ophthalmotonometry. (3)

Examination of intraocular pressure by palpation. (3)

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Ophthalmology course SOGMA

Practical skills.

Ticket No. 12

Exophthalmometry. (2)

Determination of corneal integrity. (3)

Alternative names: color test Vesta, fluoroscein test, nasal test.

Colored nasolacrimal test is one of the research methods in ophthalmology, which consists in assessing the active patency of the paths along which tears flow from the eye into nasal cavity. During the test, the doctor measures the time it takes for dye instilled into the conjunctival cavity to travel from the conjunctival cavity into the nasal passage.

The purpose of this technique is to provide an integrative assessment of the active conductivity of tear fluid along the entire lacrimal duct.

This research method is the most popular method for diagnosing diseases of the lacrimal duct due to the ease of its implementation and complete absence side effects and complications.

Preparing for the test. No special preparation is required. The test can be carried out at any time of the day.

How is the color nasolacrimal test performed?

The patient sits and one drop of dye (1% sodium fluoroscein solution or 3% collargol solution) is instilled into the conjunctival cavity using a pipette. After this, the doctor asks the patient to tilt his head forward and blink a little. After 3 and 5 minutes, the patient is asked to blow his nose wet wipe each nostril separately. If necessary, the doctor inserts a button-shaped probe, tightly wrapped with damp cotton wool or a bandage, under the inferior nasal concha. Based on the presence of dye on a napkin or bandage, the results are interpreted.

Interpretation of results

With normal patency of the lacrimal ducts, the dye enters the nasal cavity no later than 5 minutes. In this case, the sample is considered positive.

Staining a napkin or turunda from 6 to 20 minutes after the introduction of the dye is regarded as a delayed test. This fact can talk about stenosis of one of the sections of the lacrimal ducts.

If the dye appears later than 20 minutes or does not appear at all, the sample is considered negative. This may occur when the tear ducts or nasolacrimal duct are completely obstructed.

Indications

The main indications for performing a color nasolacrimal test are lacrimation and lacrimation. Also, this test can be carried out as part of a comprehensive examination of the organ of vision during preventive examinations.

Contraindications for the test

The only contraindication for the test is individual intolerance to the dye (collargol or fluorescein). Considering that these substances do not have cross-allergy, when allergic reaction One drug can be tested through another.

Complications

No complications were noted.

More information

This test is highly specific, but in some cases it is possible to obtain false results. This happens in following cases: with severe inflammation of the nasal mucosa (rhinitis) or when squeezing dye onto the skin during blepharospasm (involuntary contraction of the orbicularis oculi muscle). In these cases, it is advisable to postpone the procedure.

The colored nasolacrimal test is the most accessible method studies of active patency of the lacrimal ducts. The only more accurate alternative method is scintigraphy of the lacrimal ducts, which is based on monitoring the passage of a radiopharmaceutical containing the technetium-99 isotope through the tracts using a gamma camera. This study allows us to assess the degree of stenosis of the tubules and canal. However, due to the difficulty of conducting this study it is not widely used in clinical practice.

Based on the results of a color nasolacrimal test, the question of the need for other examination methods is most often decided: diagnostic lavage and probing of the lacrimal ducts, radiography of the lacrimal ducts. Comprehensive examination allows you to make the correct diagnosis and decide on treatment tactics.

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