Tubular test. Colored nasolacrimal test

Modern scientists claim that an adult receives more than 70% of information about the world around him through vision. For newborns, this figure is approximately 90%. That is why, in case of problems with the eyes, you need to show the sick baby to a specialist - a pediatrician, pediatric ophthalmologist - as soon as possible and cure the inflammation.
Let's go along the teardrop route

To better understand all the intricacies of the disease called “dacryocystitis,” first of all, we suggest you delve into the anatomy.

The eye is washed with tears, which prevents it from drying out and prevents the proliferation of pathogenic bacteria. Normally, a person produces about 100 ml of tears every day. They are excreted from the body chemicals, formed during nervous tension, stress, foreign bodies (for example, eyelashes) are washed out.

The tear is produced by the lacrimal gland and, having washed the eyeball, ends up in the inner (near the nose) corner of the eye. In this place on the upper and lower eyelids there are tear points (you will see them if you slightly pull the eyelid). Through these points, the tear enters the lacrimal sac, and then into the nasolacrimal duct, through which it flows into the nasal cavity (this is why, when a person cries, a runny nose appears!). But all this happens if there are no obstacles in the path of the tear. And since the tear ducts have a rather tortuous structure (there are also closed spaces - a kind of “dead ends”, and very narrow places), “congestions” often form here that block the outflow of tears. The narrow nasolacrimal duct prevents tears from entering the nasal cavity, and they accumulate in the lacrimal sac (located between the nose and the inner corner of the eyelid). The lacrimal sac stretches and overflows. Bacteria multiply in it, causing an inflammatory process - dacryocystitis, which without proper treatment can lead to serious complications.
Symptoms have causes

Some signs will tell you that your child has an inflamed lacrimal sac. In no case should they be ignored, because the later treatment is started, the greater the likelihood that conservative methods it won't be possible to get by.

L Persistent viral, bacterial conjunctivitis. Moreover, they arise both against the background of acute respiratory infections, acute respiratory viral infections, and in the form of separate disease(often involves one eye and then moves to the other).

L The eye is inflamed and red (the baby constantly rubs it).

L Excessive lacrimation (because tears cease to be absorbed at the lacrimal openings and stagnate in the eye) and leakage of tears and pus through the cilia. Often because of this they stick together, especially after a night or daytime sleep.

L When pressing on the area of ​​the swollen lacrimal sac, the child experiences painful sensations, crying. Often a cloudy fluid (pus) is released.

Similar symptoms are observed in many newborns. But older children can also catch dacryocystitis, because the causes of the disease are associated not only with structural anomalies (underdevelopment tear ducts).
Congenital

In infants, quite often the nasolacrimal duct becomes clogged with fetal mucus, which leads to the fact that the tears begin to stagnate. A so-called “gelatinous plug” appears. It happens that over time it resolves itself. But sometimes this doesn't happen. Then the traffic jam turns into connective tissue, becomes more rough. And this makes treatment very difficult!
Purchased

Foreign bodies caught in the eye, injuries, infectious and inflammatory diseases eyes, nose, paranasal sinuses (conjunctivitis, sinusitis, sinusitis) - all this serves as an impetus for inflammation of the lacrimal sac in older children.

We diagnose using the Vesta test

Symptoms of dacryocystitis are similar to other diseases. Therefore, making an accurate diagnosis is very problematic. To understand whether there are any obstacles in the path of the tear, experts often prescribe an X-ray examination of the lacrimal sac (it can be used in children after two months).

There is a method that allows you to find out about the patency of the nasolacrimal duct at home. To do this, you need to conduct a Vesta test.

Insert a cotton pad into the baby's nostril (on the side of the sore eye). Drop a few drops of collargol into your sour eye (ask your doctor what its concentration should be). The test results are judged by the coloring of the cotton swab. The faster orange spots appear on it, the better the patency of the eye-nose path. Normally, this will happen within 2-3 minutes after you instill collargol (measure the time, remove the turunda from the nasal passage and evaluate the result).

A couple of minutes have passed, but the cotton swab is still white? Place it in the baby's nose again and wait some more time. If the baby has colored after 5-10 minutes, then a little later (let the baby rest!) the test should be repeated, since its result is in doubt.

Collargol did not appear for more than 10 minutes? Unfortunately, this indicates that the lacrimal ducts are obstructed or their patency is significantly impaired.
Can we do without surgery?

Of course, first they try to treat the disease conservatively. Fortunately, in 90 cases out of 100 such methods work great! True, there is a condition: therapy must be carried out comprehensively! And no amateur performances!
Massage

Using your fingers, lightly press (push) in the direction from the eye to the baby’s nose. Carry out a similar procedure at least 3 times a day for several minutes. But first, be sure to ask the doctor to show you a master class!

There is another type of massage: do it with your little finger circular movements at inner corner eyes (just try it on yourself first - this will help calculate the force of pressure). You will know that you are doing everything correctly by the amount of purulent discharge. Does cloudy liquid flow out more when you move your fingers? This is good. This means that thanks to massage, the patency of the lacrimal ducts improves.
Washing

Disinfecting plant solutions and furatsilin solution make it possible to clean the eyes. The liquid is applied to a cotton pad and distributed throughout the palpebral fissure. After such washing and cleansing, other medications are instilled into the eyes.
Burying

Usually prescribed eye drops with an antimicrobial effect (“Albucid”, “Oftadek”). They prevent the growth of harmful bacteria.
Anti-inflammatory, antibacterial agents

Pharmacy medications help relieve inflammation and avoid severe infectious complications. Don't give up on using them. And don't worry! The doctor will prescribe these medications based on the child’s age. Conservative therapy alas, turned out to be powerless? This is not entirely true! After all, you can operate on the eye only after it has subsided. acute inflammation(this often takes three to six days) and the results will be ready general analysis blood (indicating its clotting time).

It is believed that one of the most simple ways surgical intervention that helps restore the patency of the nasolacrimal duct - bougienage.

A special surgical instrument is used to pierce the plug or blockage and push apart the walls of the nasolacrimal duct, which have narrowed due to inflammatory process. The procedure lasts only a couple of minutes, so the child doesn’t even have time to come to his senses! When the bougie (somewhat reminiscent of a wire) is removed, the patency of the lacrimal ducts is restored.

25-01-2014, 01:11

Description

External examination and palpation of the lacrimal gland, tubules and lacrimal sac

As with diseases of many other departments human body, in case of pathology of the lacrimal apparatus, external examination is the main method of examining the patient. The lacrimal gland is normally accessible to inspection and palpation only to a very small extent, when it is inverted upper eyelid and dislocated. In case of its diseases, examination, if not the gland itself, covering its eyelids, and most importantly palpation, brings a lot of data. The external one provides significantly greater opportunities when examining all parts of the lacrimal apparatus, i.e. grooves, lacrimal stream, lacrimal lake, lacrimal caruncle and semilunar ligament of lacrimal openings, tear ducts, lacrimal sac. When examining, you can use a Garcher's magnifying glass or a simple magnifying glass. Palpation of the lacrimal canaliculi and lacrimal sac, gentle at first, should be followed by forced palpation, trying to squeeze out the contents of the sac and canaliculi, if any are present.

External examination is supplemented by some special tests. Special attention deserve:

1. Schirmer tests,
2. capillary test,
3. tubular and nasal tests,
4. probing the lacrimal canaliculi,
5. probing of the nasolacrimal canal,
6. washing the lacrimal ducts,
7. contrast and radiography of the lacrimal ducts.

The intended purpose of Schirmer tests, No. 1 and No. 2 comes down to trying to find out with their help the functional status of the lacrimal gland - whether there is hypofunction of the gland and what the condition is! its reactive secretion. The intended purpose of all other tests is topical diagnosis of the level of damage to the lacrimal tract, if any.

Schirmer test No. 1

is carried out as follows. The lower eyelids of both eyes are folded 0,5 cm ends of narrow strips of filter or litmus paper long 3,5 and width 0,5 cm. The other ends of the strips remain hanging freely over the eyelids. Gradually the strips are wetted from the ends placed behind the eyelids. Through 5 min, the length of the wetted part of the strips is measured. If not wetted 1,5 cm length of the paper strip, we can assume that there is no hypofunction of the lacrimal gland on the side being examined.

Schirmer test No. 2

serves to resolve the issue of the state of the reflex system of the tear-producing apparatus. After unilateral local anesthesia of the conjunct and the valvular sac, the end of a strip of filter paper is placed behind the edge of the eyelid. Then mechanical irritation of the nasal mucosa in the area of ​​the middle concha is performed. By the length of time the filter paper becomes wet, one can judge whether the state of the reflex system is satisfactory or unsatisfactory.

Stream sample or capillary sample.

A drop of dye is placed into the conjunctival sac ( 1 % solution of flirescein or 3% solution of collargol). Through 10-15 sec pay attention to the tear stream: if it looks like a hair capillary, then it is not changed (Fig. 92).

However, the expansion of the stream, indicating pathology, may be so insignificant that it is not detected even by staining. In such cases, a comparison of the colored tear ducts on both sides is very revealing. If the capillary test does not reveal expansion of the stream, then the lacrimal drainage apparatus is functioning properly and lacrimation is caused by some other reason, for example, conjunctivitis. In the normal state of the lacrimal apparatus, while the eye moves in all directions, the colored hair capillary remains unchanged. In cases of pathology, when the patient looks up, the tear stream becomes wider. This symptom occurs in people of all ages and is associated with muscle atony Riolapa - a consequence of pulling back the lower eyelid when wiping away tears.

The capillary test reveals functional disorders in the lacrimal drainage system very early (even before pathological atopic changes become clearly expressed).

Pokhisov evaluates the capillary test using a three-point system:

1. it is normal when the tear stream looks like a hair capillary;
2. the sample is indicated by a + sign when the tear duct is slightly dilated;
3. the test is designated ++ when the tear stream is sharply expanded.
4. The greatest advantage of the capillary test is that it is objective and allows one to judge how well-founded the patient’s complaints are.

Tubular and nasal tests

These tests are performed simultaneously and serve to determine the patency of the lacrimal canaliculi and nasolacrimal canal.

Into the conjunctival sac three times with an interval of 1-2 minutes let in the dye ( 1% - solution of fluorescent or 3% solution of collargol). If after one and a half to two minutes the solution disappears from the conjunctival sac, it means that fluid is being absorbed normally from the lacrimal lake - the ability of the tubules is preserved, and the reason lies somewhere further in the lacrimal ducts. In addition, in these cases, when pressing on the lacrimal canaliculi into the conjunctival sac, drops of the dye solution come out through the points.

If the dye remains in the conjunctival sac for more than two to five minutes and does not appear from the dots when pressing on the area of ​​the lacrimal sac, the tubular test should be considered negative. However, experience shows that even under normal conditions, a tubular test can sometimes be negative. Thus, the diagnostic value of this test for lacrimation is low.

At the same time, a nasal test is performed to determine the narrowing in the nasolacrimal canal. The subject is asked to blow his nose or a tampon is inserted into the nose under the lower concha, alternately on each side. The appearance of paint in the nose after five minutes indicates good patency of the tear ducts. If there is no color in the nose or it appears later, then there is no patency or it is difficult.

It should be noted that even with normal conditions Collargol does not always appear in the nasal cavity within five minutes. This is explained by the fact that, in addition to pathological conditions,9 in the lacrimal ducts, other factors also influence their patency. In particular, individual characteristics the structure of the nasolacrimal canal, excessive development of the Ashner valve, etc., may cause a delay in the appearance of paint in the nose, which, however, does not at all indicate a narrowing of the canal. Therefore, the nasal test cannot be considered reliable.

Probing of tear ducts

After anesthetizing the conjunctiva with a few drops 0,5-1 % - but a conical probe is inserted into the canaliculus through the lacrimal punctum, first vertically, then it is transferred to horizontal position and is brought to the lateral bone wall of the nose. After removing the conical probe, an ordinary zone of larger or smaller caliber is introduced. If a stricture is detected in the tubule, it is immediately dissected with a probe. Thus, this manipulation is not only diagnostic, but also an effective therapeutic measure for strictures, foreign bodies in lacrimal canaliculi and other diseases.

After probing, it is necessary to drip a solution of some antiseptic used in ophthalmic practice into the conjunctival sac. Pokhnsov recommends letting it into the conjunctival sac after such an intervention 1-2 drops 1 % - a solution of lapis and 5% xeroform ointment, and bury it at home 3% -we are a solution of collargol or 30% - solution of albucid.

Probing of the nasolacrimal duct

This manipulation is also carried out with both diagnostic and therapeutic purpose, since it allows you not only to determine! the presence of narrowings and curvatures of the nasolacrimal canal, but in some cases it makes it possible to restore its normal patency.

Probing can be done either from top to bottom, i.e., through one of the lacrimal openings (usually through the lower one), or from bottom to top, from the side of the nasal passage (endonasally, or retrograde).

Probing consists of three points:

1. insertion of the probe vertically through the lacrimal punctum into the vertical surface of the lacrimal canaliculus;
2. transferring the probe to a horizontal position and moving it along the canaliculus up to the nasal wall;
3. moving the probe back into a vertical position and advancing it into the lacrimal sac and nasolacrimal canal.

Ophthalmologists probe primarily through the lacrimal openings with conical and then Bowman probes of varying thicknesses. Previously, the lacrimal canaliculi were split during probing, as they were not given any importance in the lacrimal drainage mechanism.

Golovin et al. (1923) used it for probing to force the expansion of the nasolacrimal canal.

Odintsov, Strakhov, Tikhomirov, Kolen and many others, attaching great importance to the lacrimal canaliculi in the mechanism of lacrimal drainage, spare them in every possible way. They first dilate the lacrimal canaliculi with conical probes and then probe them with thin Bowman probes.

Before probing, local anesthesia is administered by multiple installations into the conjunctival sac 0,5% -th dicaip solution. It is recommended to lubricate the probe with oil before insertion.

When probing, it is necessary to take into account the topographic structure of the entire lacrimal canal. You can’t rush, you need to insert it carefully, especially if there is an obstacle in the canal.

If probing fails, it should be postponed. Considering that the probing operation is sometimes very painful, in addition to dikaip installations, we can recommend infiltration for particularly sensitive patients 2% solution of novocaine with 3-4 drops of adrenaline under the lacrimal sac area. It is also necessary that the probes be polished, smooth, and without bending. They should be sterilized first.

If the probing method and technique is incorrect or if probing is rough, complications may occur. Thus, rough penetration of the probe in the horizontal direction can lead to damage to the lacrimal bone and the probe entering the nasal cavity. It is also possible to rupture the wall of the lacrimal canal with the formation of a passage. There were even cases of bone wall fracture and the end of the probe getting into the maxillary cavity.

Other complications are also dangerous: nosebleed, phlegmon of the lacrimal sac, which developed as a result of the formation of a false passage, phlegmon of the orbit with inflammation of the optic nerve. The literature reports meningitis and orbital thrombophlebitis. Improper insertion of the probe can cause swelling and tissue swelling; after two or three days they usually disappear without a trace. It is dangerous to rinse the lacrimal ducts after probing if you are not sure of the correct placement of the probe. If there is a suspicion of a false passage (a feeling of bare bone and the appearance of two or three drops of blood from the lacrimal punctum after removing the probe), it is necessary to immediately perform an active massage of the lacrimal sac area from the bottom up towards the lacrimal punctum, thus freeing the canal from blood (so that prevent the formation of a hematoma) and apply a tight, damp bandage for one or two days. Sulfonamides are given internally. For a week after this, you should not probe through the lacrimal openings, you should be content with only endonasal probing.

Retrograde probing does not replace probing through the lacrimal tubules, but only complements it. It is an auxiliary intervention used in cases where probing from above is not effective enough,

The widespread opinion among ophthalmologists about the difficulty of mastering the retrograde sounding technique is unfounded. Thus, Arlt wrote in 1856 that it is easy to acquire the skill of retrograde insertion of a probe into the nasolacrimal canal. Pokhisov recommends the widespread use of retrograde probing as an independent intervention and as an auxiliary measure when probing through the lacrimal openings. He conducts it in both adults and children, even newborns.

Washing the tear ducts

Washing of the lacrimal ducts is done through the lower lacrimal punctum, and if the lower lacrimal canaliculus is narrowed, through the upper punctum. Anesthesia is required in advance - two or three times instillation into the conjunctival sac 0,5 - 1 % -n solution of dicaine, which is used to simultaneously extinguish the lacrimal opening. For rinsing, use a two-gram syringe, an Anel syringe or an injection needle with a blunt and rounded end. Washing for diagnostic purposes is performed 0,1 % rivanol solution or saline solution. Lacrimal punctum and the tubule is first expanded with a conical probe. The needle is advanced along the lacrimal canaliculus, drawn outward and downward, while the head of the patient is tilted. Then the needle is slightly pulled back and the syringe is emptied by pressing on the plunger.

If the patency is normal, the flushing fluid flows out in copious streams. Slow fluid flow indicates a narrowing of the canal. With complete obstruction, fluid does not flow out of the nose, but flows out in a thin stream from the upper or lower lacrimal duct. When probing, it is necessary to take into account the topographic diatom of the lacrimal canal.

Probing is difficult in case of abnormal development of the lacrimal canal, atresin of the lacrimal punctum, cicatricial changes in the nasolacrimal canal, narrowing of the lacrimal punctum and canaliculus of a spastic nature.

The following complications of probing are possible: nosebleeds, swelling in the lower eyelid, phlegmon of the lacrimal sac, which developed as a result of the formation of a false passage, phlegmon of the orbit with inflammation of the optic nerve.

X-ray examination of the lacrimal ducts

If you inject the lacrimal ducts with a control mass that blocks X-rays, then it will fill all the smallest bends of the lacrimal sac, nasolacrimal canal and lacrimal canaliculi, forming an exact cast of them. Photographs taken in two mutually perpendicular planes will give a completely accurate and clear image of the cast, and with it an image of the lacrimal ducts themselves. Such images not only allow you to see the exact location and nature of the stenosis, but also indicate the topography of the pathological area, but also the size and degree of disorders,

In this regard, radiography of the lacrimal ducts is the most accurate method for determining the location of obstacles that cause their complete or partial obstruction.

The method of radiography of the lacrimal ducts was first used by Ewing in 1909. He injected the lacrimal ducts with a mast emulsion of bismuth nitrate and took photographs in the lateral position. Regardless of Ewing, the contrast method has been used since 1911 by Aubert, who developed a detailed methodology and detailed instructions on the diagnostic use of this method. However, in those years the contrasting method did not become widespread, and the works of these authors were forgotten. In 1914, he independently rediscovered this method, re-developing its technical and clinical aspects and, through persistent polarization, achieved its introduction into clinical practice.

Oxide on liquid paraffin, barium sulfate, podulyatrin, torotrost, podipin, sublipol can be used as a contrast mass.

The technique for injecting a contrast mass is as follows: after local linthesis (Sol. dicaini 0,5-1,0% ) with a conical probe, the lacrimal canaliculus is expanded and the lacrimal ducts are washed with some solution. Then, using a syringe, a contrast mass is very slowly injected through the lower lacrimal canaliculus into the lacrimal ducts until the patient feels its presence in the nose. In total, at least 0,3-0.4 ml. After this, the patient is quickly placed on the table and two x-ray- lateral and anteroposterior. If the nasolacrimal duct is passable, then the injected mass comes out on its own through 1-2 hours. Sometimes the release of the mass must be facilitated by a light massage or rinsing. In case of complete obstruction, the contrast mass is delayed for several days.

Typically, the contrast mass is administered through the lower canaliculus. In cases of atresia of the inferior lacrimal punctum, the contrast mass can be injected through the superior lacrimal punctum.

Radiography of the lacrimal ducts has great scientific, theoretical and clinical and practical significance. This method makes it possible to study in situ the normal shape of the lacrimal duct with all the variations in its direction, bends, calibers, changes in the lumen at different levels, as well as its relationship to the surrounding sinuses, to the nasal cavity itself, etc.

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 queue 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 (upper and lower), lacrimal canaliculi (upper and lower), 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 nasolacrimal test indicates a conduction disorder in the lacrimal drainage system, but does not determine the level and nature of the lesion, therefore 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

I followed the steps (which are highlighted in bold and underlined) and the next day Nastya began to have a strong tear with pus - and our eye almost stopped festering. And a day later the eye returned to a normal “human” state. But I still massaged Nastya week. I did the massage when I was breastfeeding, the baby is calmer at this time and does not fidget. It’s so good that we got rid of this disease, thanks to such an instructive article. Now our eyes are completely fine.

An idea of ​​the state of the tear-producing and tear-ducting apparatuses is obtained through inspection, palpation and special techniques(canalicular and nasolacrimal tests, lavage of the lacrimal ducts, x-ray examination).

When looking at the orbital area, pay focused attention to the color and nature of the skin surface in the area of ​​projection of the lacrimal gland and lacrimal sac. When assessing the palpebral fissure, pay attention to the presence of tears between eyeball and the edge of the eyelids (tear stream), as well as the position of the lacrimal openings. Normally, the lacrimal openings are adjacent to the bottom of the lacrimal lake. They are not visible. There is no tearing. In order to see the lower lacrimal opening, the edge of the lower eyelid at the inner corner of the palpebral fissure is pulled back with a finger, and the patient looks up. To examine the superior lacrimal punctum upper eyelid pulled upward, and the patient should look down. Identification of lacrimal openings is facilitated by preliminary instillation of a collargol solution into the conjunctival cavity.

Palpation. It is most often carried out using the ends of the index or middle finger, moving along the edge of the orbit. When palpating the area of ​​the lacrimal gland, pay attention to the temperature of the skin, the nature of its surface, the contour and density of the gland. Normally, in most cases it is not palpable, but its palpebral part can be examined. To do this, the upper eyelid should be raised at the outer corner of the palpebral fissure. The patient at this time should look strongly down and inward. In this case, normally the lobules of the lacrimal gland are visible through the conjunctiva with a yellowish color. In this way, it is possible to determine the prolapse of the lacrimal gland and its enlargement. When palpating the area of ​​the lacrimal sac, attention is paid to the presence of protrusion and skin temperature. At the same time, pressure is applied to the lacrimal sac. It is located in the fossa of the same name immediately behind the edge of the orbit. This pressure is accompanied by an anterior displacement of the edge of the lower eyelid. The inferior lacrimal punctum becomes visible. In case of chronic dacryocystitis, serous or purulent contents are squeezed out of it.

(question 14) The state of tear production is determined using Schirmer tests. Strips of filter paper measuring 5x35mm are used for this purpose. One end of the strip is bent at a distance of 5 mm from the edge. This part of it is placed behind the lower eyelid. They notice the time. Normally, after 5 minutes the strip is wetted by at least 15 mm. With hypofunction of the glands, wetting slows down.

The patency of the lacrimal ducts is judged by the amount of tears in the area of ​​the lacrimal duct and lacrimal lake, the state of the canalicular and nasolacrimal samples and the results of their washing.

Tubular test is the initial part of the nasolacrimal test. Its result allows us to judge the patency of the lacrimal canaliculi connecting the conjunctival cavity with the cavity of the lacrimal sac and the absorption capacity of the lacrimal openings. To perform this test, a drop of a 3% collargol solution or a 1% fluorescein solution is instilled into the conjunctival cavity. Time is noted and the gradual disappearance of this coloring matter is observed. Normally, within the first 2-5 minutes after several blinks of the eyelids, the dye disappears from the conjunctival cavity.

If the patency or absorption of tears by the tubules is impaired, the dye remains in the conjunctival cavity. The colored tear is visible in the tear stream and tear lake.

Vesta nasolacrimal test carried out with normal patency of the tubules. Based on its results, the passage of tears from the lacrimal sac into the nasal cavity is judged. For this purpose, it is examined whether the dye has entered the nasal passage. To do this, in the corresponding lower nasal passage using glass rod or anatomical tweezers, a moist sterile turunda is inserted to a depth of 3-5 cm. It is better to do this before instilling the dye. 5 minutes after instillation, the turunda is removed. If the tear passes into the nose, a stain of dye is visible on it. The same result can be obtained if you ask the patient to blow his nose into a gauze napkin.

Lacrimal duct rinsing performed in the case of a negative nasolacrimal test. It is carried out using a special cannula placed on a syringe with a capacity of 2-3 ml. A cannula is the thinnest injection needle with a blunt tip. For washing, use a sterile saline solution or antiseptic solution. Before washing, a 0.25% solution of dicaine is instilled into the conjunctival cavity three times. The subject is in a sitting position. The face should be well lit. A kidney-shaped basin is placed under the corresponding part of the face. The lacrimal punctum and canaliculus should first be expanded by introducing a sterile conical probe. The probe is inserted, like a cannula, repeating the natural direction of the lacrimal canaliculus. At first, for up to 1.5 mm, it is vertical, and then horizontal.

When inserting the probe and cannula into the lower canaliculus, the patient is asked to look up. At this time, the eyelid is slightly retracted thumb left hand downwards and outwards. The cannula inserted into the canaliculus is advanced until it touches the back of the nose, then slightly pushed back. Resting your little finger on upper jaw, the syringe is held in such a way that the cannula does not come out of the tubule. At this time, the head of the person being examined is tilted forward. Press the plunger of the syringe. When the lacrimal ducts are blocked, rinsing fluid flows out in drops or streams from the corresponding nostril. If the patency of the nasolacrimal canal is disrupted, this fluid, without entering the nose, flows out through the upper canaliculus. If the canaliculus is obstructed, it returns through the same lacrimal punctum.

General information

To start working in the Vesta.Acceptance subsystem after authentication, in the window that appears, click on the link "Acceptance"(Fig. 1):

Rice. 1. List of available subsystems in the Vesta system

Colored icons located at the top above the button "Add sample"(Fig. 2) mean:

• Green- link to | official website of Rosselkhoznadzor;
• Blue- link to a website dedicated to the state information system in the field of veterinary medicine | "Vetis" ;
• Yellow- link to the help system dedicated to automated system "Vesta" .

Rice. 8. Form for searching for a counterparty in the Vesta.Acceptance subsystem (05/12/2015)

If the counterparty is not found, you can add it yourself by going to the tab "Add new".

The form of filling may vary depending on the type of counterparty; for an individual, the following fields are filled in (Fig. 8):

• Counterparty type- selection of counterparty type: Legal entity, Individual, Individual entrepreneur;
• Full name- indicate the full name of the counterparty;
• Passport- indicate the passport details of the counterparty;
• TIN- indicate the TIN of the counterparty, if any;
• Country- selection of the counterparty country;
• Region- region selection;
• Locality, Street, House, Structure, Office/Apartment.

After filling out the fields, click on the button "Add".

Rice. 8. Filling out the form for adding a new counterparty in the Vesta.Acceptance subsystem (05/12/2015)

Block "Sampling"

Contains the following fields (Fig. 9):

Rice. 9. Filling out the “Sampling” block in the “Vesta.Acceptance” subsystem (05/12/2015)

• Owner- the counterparty is indicated - the owner of the product or material from which the sample is taken. You must press the button with three white stripes;
• Selection act number- the number of the sampling report is indicated;
• Date of the selection report- the date of the sampling act is indicated;
• Package safe number- indicate the number of the safe package;
• Date and time of selection- the date and time of sampling is indicated;
• Place of selection- the location of sampling is indicated;
• Selection made- the official who collected the sample is indicated.
• In the presence- the persons in whose presence the samples were taken are indicated, if any.
• ND for sampling- indicated normative document regulating sampling;
• Number of samples- the number of samples taken is indicated, and the type of packaging of the product is also indicated;
• Sample weight/volume- the mass and units of measurement of the sample are indicated;
• Accompanying document- the accompanying document for the product is indicated, if any. This could be an invoice, inventory, label.

Block "Origin"

Contains the following fields to fill in (Fig. 10):

Rice. 10. Filling out the “Origin” block in the “Vesta.Acceptance” subsystem (05/12/2015)

• Manufacturer- the manufacturer of the product is indicated. You need to press the button with three white stripes.

The manufacturer is selected from the general Rosselkhoznadzor Register of supervised objects “Cerberus”. If the required manufacturer is not available, then it is possible to add it yourself; the form of addition is similar to the form of adding a counterparty (Fig. 11). The form of filling may vary depending on the type of counterparty. After filling out the fields, click on the button "Add";

Rice. 11. Adding a manufacturer in the “Vesta.Acceptance” subsystem (05/12/2015)

• Country of origin- country of origin is indicated;
• Region of origin- the region of the country of origin is indicated;
• Origin- a text field where you can enter information about the origin of the product;
• ND for product production- regulatory document for production;
• Fishing area.

Block “Information about the party”

Contains the following fields to fill in (Fig. 12):

Rice. 12. Filling out the “Batch Information” block in the “Vesta.Acceptance” subsystem

• Vet number document- number of the veterinary document accompanying the batch;
• Vet date document- date of the veterinary document accompanying the batch;
• Departure country- country of origin of the product (selected from the drop-down list);
• Departure region- region of the sending country (selected from the drop-down list);
• Departure point- point of departure of products;
• Sender- name of the sender;
• Destination country- country of destination of the product (selected from the drop-down list);
• Destination region- region of the country receiving the product (selected from the drop-down list);
• Destination- the final destination where the product goes;
• Recipient- name of the recipient of the products;
• Marking- cargo marking;
• Batch weight/volume- mass/volume of the batch indicating the unit of measurement;
• Quantity per batch- quantity of products (material) indicating the unit of measurement;
• Production date;
• Best before date;
• Transport- you need to indicate the type of transport (select from the list) and indicate the number vehicle or name, then add to the batch information by clicking on the “plus” icon.