Tear duct obstruction or dacryostenosisis the most common disorder of the lacrimal system, and approximately of newborns show signs of this condition. Typically, tear duct obstructionIt presents with symptoms of excessive tearing and ocular discharge, beginning in the first weeks or months of life, when normal tear production begins.
Erythema of the periorbital skin and upper and lower eyelids may result from irritation from tears and discharge due to inadequate drainage. Consequently, the condition may mimic a chronic unilateral eye infection.
Erythema of the skin around the eyes, upper and lower eyelids, due to insufficient drainage tear flow It may be caused by irritation and friction. Consequently, the condition may present as long-term unilateral conjunctivitis.
Most cases resolve spontaneously or with interventions in the first year of life, but there are cases that cannot be resolved. probing For children younger than 6 months, a referral to an ophthalmologist is necessary and may require surgery. Massage and medical treatment are typical methods. Lacrimal sac massage, eye drops, and topical antibiotics are commonly used.
The incidence of this condition is approximately %6 to in infants. Congenital tear duct obstruction The spontaneous resolution rate is high; approximately of affected children are symptom-free by 3 months of age, and more than recover by the first year. In of generally healthy infants, defective lacrimal drainage has been demonstrated within the first year of life.
Approximately % of infants with congenital nasolacrimal duct obstruction will resolve spontaneously by 6 months of age. Approximately two-thirds of infants with persistent symptoms between 6 and 10 months of age will resolve within 6 months. In cases persisting beyond 12 months, probing the tear duct This condition occurs equally in boys and girls.
In babies with congenital tear duct obstructionThere may be a history of chronic or intermittent eyelash rash. Eye redness is not characteristic, but irritation from tearing and chronic eye rubbing may cause mild redness of the upper and lower eyelids. Compression of the lacrimal sac may cause tear reflux and/or mucus discharge into the eye.
In congenital canal obstruction Stagnation of fluid within the lacrimal sac creates a moist, warm environment suitable for bacterial growth.
In some infants, it presents with a more severe infection within the first few weeks of life: acute dacryocystitis. Clinical findings include edema and erythema, and enlargement of the lacrimal sac beneath the medial canthal tendon, and patients may have systemic signs of infection such as fever and irritability.
This is a rare isolated congenital complication. Acute dacryocystitis may be complicated by preseptal or orbital cellulitis, sepsis, or meningitis and should be treated promptly with systemic antibiotics. Although antibiotic therapy is often prescribed for dacryocystitis, definitive treatment is usually surgery.
Diagnosis is typically made by history and physical examination alone. If symptoms are intermittent and signs of abnormal tearing or "curdling" are not present on examination, a dye loss test may be performed to help confirm the diagnosis. A drop of fluorescein is placed on the lower inner lid area of the patient's eyes. Wait 5 minutes and examine the eyes. If there is no obstruction in the lacrimal drainage system, the fluorescein should drain completely into the nose within 5 minutes.
Uncomplicated tear duct obstruction The primary treatment is a regimen of nasolacrimal massage, usually performed 2 to 3 times daily, accompanied by cleansing the eyelids with warm water and topical antibiotics; this will resolve the infection in most cases.
Topical antibiotics are used to control mucopurulent drainage, and a gentle ophthalmic ointment may be applied to the eyelids if the skin is softened. In cases that do not improve within 6-10 months, the child's age will require an ophthalmologist in the operating room. lacrimal duct probing is done.
During the procedure, the doctor inserts a catheter or irrigation cannula and advances it through the lacrimal drainage system until it contacts the obstruction; the probe is then pushed through the obstruction into the nose. Fluorescein-stained saline irrigation is often used to ensure patency. If there is a concomitant infection or cellulitis, systemic antibiotics should be used first, then probing should be done.
