Neonatal dacryocystitis, also known as congenital dacryocystitis, is caused by the embryonic remnant membrane at the lower opening of the nasolacrimal duct not regressing during development, or because the opening is blocked by epithelial debris, resulting in the nasolacrimal duct not being open, and tears and bacteria being retained in the dacryocyst, causing secondary infection. The clinical manifestations are tearing, a little mucopurulent discharge from the conjunctival sac, a slight local elevation of the lacrimal sac, skin congestion or eczema in the inner r part sometimes, and mucus or mucopurulent discharge from the lacrimal sac area by pressure. The disease needs to be differentiated from neonatal ophthalmia.
Etiology
The exact cause is still inconclusive, but lacrimal sac inflammation is often secondary to inflammation of adjacent tissues, such as the conjunctival nasal cavity and paranasal sinuses, or some specific infection such as tuberculosis or syphilis. The cause is unclear in those with a primary origin in the lacrimal system.
Clinical manifestations
1. Acute dacryocystitis
The skin of the lacrimal sac area at the root of the nose is usually red, swollen, hot and painful, and even swollen on the same side, sometimes accompanied by enlarged and painful lymph nodes in front of the ear and under the jaw, tearing of the eyes, and the tear dots can be accompanied by the overflow of purulent secretions, which can break down from the skin surface when the abscess is limited. Most patients usually have a history of chronic dacryocystitis.
2. Chronic dacryocystitis
Mostly manifested as lacrimation, more secretions from the eye, squeezing the lacrimal sac area of the affected eye can be seen from the tear dots gushing out a large amount of purulent or plasma secretions, the affected eye tear duct flushing is not open.
Examination
1.Blood test
In acute dacryocystitis, routine blood tests can clarify the extent and nature of the infection.
2.Bacterial culture and drug sensitivity test of the lacrimal sac secretion
To clarify the nature of the infection and the type of pathogenic bacteria, and to provide important reference for drug treatment.
3.Pathological examination
4.CT examination
When chronic dacryocystitis forms a cyst, it shows a round or round-like cystic watery density shadow, and the density of abscess is slightly higher than the density of water. Intensive scans have different degrees of circular enhancement.
5.Lacrimal sac angiography
After flushing the lacrimal duct and compressing the lacrimal sac, 20% iodine oil or 60% pantothenic glucosamine is injected into the lacrimal punctum in 1~2ml, and the residual contrast agent in the conjunctival sac is swabbed away, and the orbital frontal and lateral images are taken to observe the filling of the contrast agent.
Diagnosis
1.Tear overflow, conjunctival congestion in the inner canthus, and skin often with eczema.
2, squeeze the tear sac with fingers, there is mucus or mucopurulent secretion from the tear dots.
3.The tear sac may gradually dilate due to a large accumulation of secretions, and there is a sac-like bulge below the medial canthal ligament.
4.CT examination, pathological examination, lacrimal sac imaging, etc. are helpful for diagnosis.
Treatment
The basic principle of treatment is to remove the foci of lacrimal sac infection and establish intranasal drainage channels.
1.Drug treatment
Local drops of various antibiotic eye solution, 3 to 4 times/day, squeeze and empty the secretion in the tear sac before dropping, the medicine can only be inhaled into the tear sac; systemic use of sulfonamide or antibiotics, purulent secretions can disappear, but can not lift the obstruction and retention, as a preparation before surgery.
2.Rinsing the tear duct
In order to completely remove purulent or mucus secretions, the tear sac can be flushed with saline pus flushed clean, and then injected with 0.3 to 0.5 ml of antibiotics. Using a mixture of antibiotic adrenocorticotropic hormone and lyso-fibrin to flush can have a better effect on early obstruction that does not yet have a fixed-shaped scar.
3.Lacrimal duct intubation
For patients with obstruction at the nasolacrimal duct, lacrimal intubation can be considered. The lacrimal duct is first explored, and then the lacrimal duct is dilated and a lacrimal duct is placed.
4.Lacrimal sac nasal anastomosis
The local nasal mucosa and the tear sac are surgically anastomosed together to establish a channel for drainage of tears.
5.Lacrimal sac removal surgery
The indications should be selected according to the situation: patients with atrophic rhinitis, lupus, tuberculosis, syphilis, inflammation of the tissue around the tear sac or purulent inflammation of the septal sinus, malignant tumors, inflammation of the cornea, endophthalmitis, ocular trauma, etc. should be considered first for tear sac removal.