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Obstruction of the nasolacrimal canal: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Obstruction of the nasolacrimal canal is better called delayed recovery of patency of the nasolacrimal canal, as it is often resolved spontaneously. The lower part of the nasolacrimal canal (Hasner valve) is the last part of the teardrain system, in which the patency is restored. Complete recovery of patency occurs usually immediately after birth. However, almost 20% of children in the first year of life show signs of Nazelacrimal obstruction.
[Symptoms of obstruction of the nasolacrimal canal
- Lachrymation and gluing of eyelashes in children can be permanent or transient in hypothermia and respiratory infections.
- With a weak pressure on the tear sack from the tear point, purulent contents are released.
- Acute dacryocystitis is rare.
Differential diagnosis of other congenital causes accompanied by lacrimation includes atresia of lacrimal points and a fistula between the lacrimal sac and the skin.
NB: It is important to exclude congenital glaucoma in infants with lacrimation.
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Treatment of obstruction of the nasolacrimal canal
Massage of the lacrimal sac increases hydrostatic pressure, which can break the membrane obstruction. When performing this manipulation, the index finger is placed on a common canaliculus to block reflux through the lacrimal point, then forces are directed downward. It is recommended to carry out 10 massage movements 4 times a day, necessarily combining them with the hygiene of the eyelids. Local antibiotics should be used in case of attachment of bacterial conjunctivitis, which is rare enough;
The sounding of the lacrimal system in the child should be delayed until it reaches the age of 12 months, as approximately 95% of the cases occur spontaneously restoring patency. Probing performed during the first 2 years of life, first has very high efficiency, but then it decreases. The procedure is performed under anesthesia and preferably through the upper lacrimal point, It is necessary to manually overcome the obstructive membrane on the Hasner valve. After probing, the shedding system is washed with a saline solution labeled with fluorescein. If fluorescein enters the nasopharynx, the sample is considered positive. In the future, antibacterial drops are prescribed 4 times for laziness for 1 week. If after 6 weeks there is no improvement, the probing should be repeated. Nasal endoscopic control is especially recommended before re-manipulation to detect anatomical abnormalities and correct probing.
Results. At the first sounding 90% of sick children are cured, at the second - 6%. Causes of ineffective treatment are, as a rule, anatomical features that make it difficult to carry out probing and subsequent manipulations. If the symptoms of obstruction persist despite two technically satisfactory probes, temporary tubal intubation or balloon dilatation of the nasolacrimal canal can be used. In case of impossibility of carrying out the above manipulation, the use of dacryocystorhinostomy for patients aged 3-4 years is permissible if the obstruction is distal to the lacrimal sac.