Many babies are seen in the clinic with teary eyes and discharge. Parents describe their babies as having this symptom soon after birth, sometimes lighter, sometimes heavier, and using eye drops only makes it lighter but not better. What exactly is this disease? This is congenital tear duct obstruction. How does it develop? How will we treat it? What is the effect of the treatment? Will there be any sequelae? This is the most important question for parents. I will give you a brief introduction to the following.
I. Etiology
The obstruction of this disease can occur in any part between the lacrimal duct, the common lacrimal duct, the junction of the lacrimal sac and the nasolacrimal duct to the lower nasolacrimal duct (Hasner flap), can be an obstruction, but also multiple obstruction, which is the formation of the nasolacrimal duct in the process of the lacrimal duct epithelial column segmental canalization failed to open completely. Most of the occlusion is in the lower orifice. There are reports of congenital unilateral or bilateral bony unopened nasolacrimal ducts, which are relatively rare.
Second, clinical manifestations and diagnosis
1, overflowing tears: that is, the eyes are always tearful. It occurs mostly within 10 days or later after birth, and in some cases even 1-2 months after birth. After the lacrimal function is fully developed, there is obvious tearing.
2.It may be accompanied by different degrees of conjunctivitis or keratitis.
3.There are mucous or purulent secretions.
4.Some children can squeeze out clear mucous secretion from the tear sac, if the mucous is cloudy like pus when squeezed out, it indicates that there is an infection in the tear sac.
Treatment
Conservative treatment first, then do the following treatment according to different situations.
1.Rinsing: regular lacrimal duct rinsing treatment, a small part of it can be opened by itself.
2.Massage: Massage is performed along with the above treatment.
3.Intubation: suitable for the following cases.
1.Children for whom conservative treatment is not effective.
2.For older children with initial lacrimal duct obstruction (>5 months).
3.Children with a history of failed lacrimal tract exploration, children who have had one or more lacrimal tract explorations in other hospitals.
4.Children who are far away from the hospital, children who need to travel to and from the hospital several times for inconvenient treatment.
5.Parents who are willing to receive intubation treatment at one time and are not willing to perform lacrimal duct probing repeatedly.
6.Children with a family history of lacrimal stenosis.
7.Children who are less than 5 months old but suffer from neonatal dacryocystitis, or even acute dacryocystitis.
5.Introduction of intubation surgery.
Surgical modality.
At present, the Ritleng tear duct intubation surgery is mostly used. In the lacrimal duct unblocking, from the upper and lower tear dots into the needle, in the lacrimal duct implant a U-shaped medical slim transparent silicone tube, so that the inaccessible lacrimal duct, the ends of the silicone tube in the nasal cavity, and will be fixed in the nasal wing of a sewing ring.
Advantages of lacrimal intubation surgery.
1, Ritleng intubation probe is thinner than the traditional probe (the diameter of the opening is only 1mm), which causes minimal damage to the infant’s tear duct during surgery.
2.The combination of the soft lacrimal guide system (only 0.4mm in diameter) and the transparent lacrimal silicone tube (only 0.6mm in diameter) allows smooth access to the lacrimal tract without any wound on the skin surface, leaving no scar after surgery.
3.After surgery, unless you look closely, you can see a small section of the transparent silicone tube ambulating on the surface of the eye in the inner corner of the eye, and there is a thin line ring at the lower end of the nose, and the appearance and normal life are not affected in any way.
4.The uniquely designed lacrimal probe system with hollow track makes the operation more concise and shortens the operation time greatly.
5.Post-operative extubation can be performed when the child is awake and under surface anesthesia, so the procedure is easy and quick, and the child does not have any pain.
Because the anatomical structure of the nasal cavity is more complicated in older children, there are often multiple obstructions and adhesions in the lacrimal duct, common lacrimal duct and nasolacrimal duct, some of which are atresia of the lacrimal dots and even bony narrowing of the nasolacrimal duct. These cannot be solved by conventional lacrimal duct exploration surgery. There are also some children with a history of failed access, many of whom have tearing of the lacrimal duct and “pseudo-tracts”, so repeated access to the “pseudo-tracts” is very likely to cause serious tissue edema and secondary infection. Therefore, lacrimal duct reconstruction cannulation becomes the first choice for these children.
Based on many years of clinical experience, my experience is that in small children with little secretion, simple lacrimal obstruction, no adhesions and lacrimal malformation, the effect of exploration treatment is better. If older (more than 5 months), with more secretions, adhesions, history of probing, or lacrimal duct malformation, intubation should be preferred. This procedure is less invasive, safe, reliable, highly effective and painless, and is internationally recognized as a new type of surgery.