Dacryocystitis

Acute purulent dacryocystitis, or phlegmon of the lacrimal sac, is a purulent inflammation of the lacrimal sac and fatty tissue that surrounds it. Purulent dacryocystitis can develop without previous chronic inflammation of the tear ducts when infection is infiltrated from the focus of inflammation on the nasal mucosa or in the paranasal sinuses.

[1], [2], [3], [4], [5], [6]

Causes of dacryocystitis

In the etiopathogenesis of dacryocystitis, many factors play a role: occupational hazards, sudden fluctuations in ambient temperature, diseases of the nose and paranasal sinuses, trauma, decreased immunity, virulence of the microflora, diabetes mellitus, etc. The blockage of the nasolacrimal duct most often occurs as a result of inflammation of its mucosa with rhinitis. Sometimes the cause of violation of patency of the nasolacrimal duct is its damage in trauma, often surgical (with puncture of the maxillary sinuses, maxillary sinus). However, most authors consider the presence of pathological processes in the nasal cavity and its accessory sinuses as the main cause of development of dacryocystitis.

[7], [8], [9], [10]

Symptoms of acute dacryocystitis

With the phlegmon of the lacrimal sac in the region of the inner corner of the eye gap and on the corresponding side of the nose or cheek, redness of the skin and dense, sharply painful swelling appear. The eyelids become swollen, the eye gap narrows or the eye closes completely. The spread of the inflammatory process to the surrounding bag of cellulose is accompanied by a rapid general reaction of the body (temperature increase, disruption of general state, weakness, etc.).

Symptoms of chronic purulent dacryocystitis

Chronic inflammation of the lacrimal sac (chronic dacryocystitis) develops more often as a result of impaired passableness of the nasolacrimal duct. Delayed tears in the bag lead to the appearance in it of microorganisms, more often staphylococci and pneumococci. There is a purulent exudate. Patients complain of lacrimation and a purulent discharge. The conjunctiva of the eyelids, the semilunar fold and the teardrop are reddened. Swelling of the lacrimal sac is noted, with pressure on which lacrimal purulent or purulent contents are released from lacrimal points. Constant lacrimation and purulent discharge from the lacrimal sac in the conjunctival cavity are not only a disease of "discomfort", but also a factor that reduces the ability to work. They limit the performance of a number of professions (turners, jewelers, surgical professions, transport drivers, people who work with computers, artists, athletes, etc.).

Chronic dacryocysts are more likely to be middle-aged people. In women, dacryocystitis is more common than in men. Lachrymation often increases in the open air, most often in the cold and wind, bright light

Complications

Dacryocystitis often leads to severe complications and disability. Even the slightest defect of the epithelium in the cornea in the case of the ingress of mote can become the entrance gate to the coccal flora from the stagnant contents of the lacrimal sac. There is a creeping ulcer of the cornea, leading to persistent impairment of vision. Severe complications can occur even if the purulent dacryocystitis remains unrecognized before the abdominal operation on the eyeball.

[11], [12], [13]

Treatment of acute dacryocystitis

In the midst of inflammation, antibiotics, sulfonamides, analgesics and antipyretic drugs are prescribed. Gradually, the infiltration becomes softer, an abscess is formed. Fluctuating abscess is opened and the purulent cavity is drained. The abscess can open itself, after which the inflammation gradually subsides. Sometimes, at the site of the abscess, there is an unhealed fistula, from which pus and tears stand out. After suffering acute dacryocystitis, there is a tendency to repeated outbreaks of phlegmonous inflammatory process. To prevent this, in a quiet period perform a radical surgery - dacryocystorhinostomy.

Treatment of chronic dacryocystitis

At present, chronic dacryocystitis is treated mainly by surgical methods: a radical operation is performed - dacryocystorhinostomy, with the help of which shedding in the nasal cavity is restored. The essence of dacrycistorinostomy is to create an anus between the tear sack and the nostrils. The operation is performed with external or intranasal access.

The principle of external surgery was proposed in 1904 by the rathologist of Toti, later it was improved.

Dupuy-Dutan and other authors produce dacryocystorhinostomy under local infiltration anesthesia. Perform an incision of soft tissues to a bone length of 2.5 cm, retreating from the place of attachment of the inner ligament in the direction of the nose 2-3 mm. The dissector is moved apart by soft tissues, cuts the periosteum, peels it along with a teardrop from the bone of the side wall of the nose and tear fossa to the nasolacrimal canal and is moved outward. A bone window measuring 1.5 x 2 cm is formed using a mechanical, electric or ultrasonic cutter. Cut longitudinally the nasal mucosa in the bone "window" and the wall of the lacrimal sac, put the catgut sutures first on the back flaps of the nasal mucosa and bag, then on the front flaps. Before applying the front seams in the area of the anastomosis, drainage is introduced towards the nasal cavity. The edges of the skin are sewn with silk threads. Apply an aseptic pressure bandage. The nose is injected with a gauze swab. The first dressing is performed after 2 days. Sutures are removed after 6-7 days.

Endonasal dacryocystorino-stoma of West with modifications is also performed under local anesthesia.

For proper orientation in the position of the lacrimal sac, the medial wall of the lacrimal sac and the lacrimal bone are punctured with a probe inserted through the lower lacrimal canaliculus. The tip of the probe, which will be visible in the nose, corresponds to the posterior-lower corner of the lacrimal fossa. On the side wall of the nose, in front of the middle nasal concha, a projection of the lacrimal fossa is cut out, a flap of the nasal mucosa 1 x 1.5 cm in size and is removed. At the site of the projection of the lacrimal sac, remove the bone fragment, the area of which is 1 x 1.5 cm. Droplet with a probe inserted through the lacrimal canaliculus, the wall of the lacrimal sac is dissected as a "c" within the bone window and used for plasty of the anastomosis. This opens the outlet for the contents of the lacrimal sac in the nasal cavity.

Both methods (external and intranasal) provide a high percentage of recovery (95-98%). They have both testimony and limitations.

Intra-nasal operations on the lacrimal sac are marked by a slight traumatism, ideal cosmeticity, less disruption of the physiology of the tearing system. Simultaneously with the main operation, anatomical and pathological rhinogenic factors can be eliminated. Such operations are successfully performed in any phase of phlegmonous dacryocystitis.

In recent years, endoscopic treatment methods have been developed: endocanalicular laser and intranasal surgery using operating microscopes and monitors.

With combined nalmusheniya patency of the lacrimal canaliculus and nasolacrimal duct, operations with an external and intranasal approach - canaliculorhinostomy with the introduction for a long period of time in the tear ducts of intubation materials - tubes, filaments, etc., have been developed.

With complete destruction or obliteration of the lacrimal pathways, lacorynostomy is done-creating a new lacrimal route from the lacrimal lake to the nasal cavity using a lacoprosthesis made of silicone or plastic that is injected for a long time. After epithelialization of the walls of the lacostomy, the prosthesis is removed