Dakriotsistit – the inflammatory process in a plaintive bag developing against the background of an obliteration or a stenosis of the nososlezny channel. Dakriotsistit it is shown by constant dacryagogue, mucopurulent separated from eyes, hyperaemia and hypostasis of plaintive meat, a conjunctiva and semi-lunar fold, a swelling of a plaintive bag, local morbidity, narrowing of an eye crack. Diagnostics of a dakriotsistit includes consultation of the ophthalmologist with survey and a palpation of area of a plaintive bag, conducting plaintive and nasal test of Vest, a X-ray analysis of slezootvodyashchy ways, instillyatsionny flyuorestseinovy test. Treatment of a dakriotsistit can consist in sounding and washing of the plaintive and nasal channel antiseptic solutions, application of antibacterial drops and ointments, physiotherapy; at inefficiency carrying out a dakriotsistoplastika or dakriotsistorinostomiya is shown.
Dakriotsistit makes 5-7% of all pathology of plaintive bodies diagnosed in ophthalmology. At women the plaintive bag inflames by 6-8 times more often than at men that is connected with narrower anatomic structure of channels. With Dakriotsistit persons at the age of 30-60 years mainly get sick; in a separate clinical form it is allocated dakriotsistit newborns. Danger of a dakriotsistit, especially at children, consists in high probability of development is purulent - septic complications from hypodermic cellulose a century, cheeks, a nose, soft tissues of an eye-socket, brain (purulent encephalitis, meningitis, brain abscess).
Normal the secret (plaintive liquid) produced by plaintive glands washes an eyeball and flows the so-called, plaintive points conducting in plaintive tubules to an internal corner of an eye where are available. Through them the tear comes at first to a plaintive bag, and then via the nososlezny channel flows in a nose cavity. At a dakriotsistita in view of impassability of the nososlezny channel process of a slezootvedeniye is broken that leads to a tear congestion in a plaintive bag – the cylindrical cavity located in the top part of the nososlezny canal. Stagnation of a tear and infection of a plaintive bag leads to development of an inflammation in it – a dakriotsistita.
In clinical forms distinguish chronic, sharp dakriotsistit (abscess or phlegmon of a plaintive bag) and dakriotsistit newborns. Depending on an etiology dakriotsistit can be virus, bacterial, chlamydial, parasitic, post-traumatic.
Reasons of a dakriotsistit
Impassability of the nososlezny channel is the cornerstone of pathogenesis of a dakriotsistit of any form. In case of a dakriotsistit of newborns it can be connected with congenital anomaly of slezootvodyashchy ways (a true atresia of the nososlezny channel) which did not resolve at the time of the birth a zhelatinozny stopper or existence of a dense epitelialny membrane in disteel department of the nososlezny channel.
At adults the stenosis leading to a dakriotsistit or an obliteration of the nososlezny channel can result from hypostasis of surrounding fabrics at a SARS, chronic rhinitis, sinusitis, nose cavity polyps, adenoides, fractures of bones of a nose and an orbit, damages of plaintive points and tubules as a result of wound a century, etc. reasons.
Stagnation of plaintive liquid leads to loss of its antibacterial activity that is followed by reproduction in a plaintive bag of pathogenic microorganisms (more often than stafilokokk, pneumococci, streptococci, viruses, is more rare – a tubercular stick, hlamidiya and other specific flora). Walls of a plaintive bag gradually stretch, sharp or slow inflammatory process develops in them - dakriotsistit. The secret of a plaintive bag loses the abakterialnost and transparency and turns into mucopurulent.
As the contributing factors to development of a dakriotsistit serve diabetes, decrease in immunity, professional harm, sharp differences of temperatures.
Symptoms of a dakriotsistit
Clinical manifestations of a dakriotsistit are quite specific. At a chronic form of a dakriotsistit persistent dacryagogue and a swelling in a projection of a plaintive bag is observed. Pressing on area of a swelling leads to allocation from plaintive points of a mucopurulent or purulent secret. Hyperaemia of plaintive meat, a conjunctiva and a semi-lunar fold is noted a century. The long current of a chronic dakriotsistit leads to an ektaziya (stretching) of a plaintive bag – in this case skin over an ektazirovanny cavity of a bag becomes thinner and gets a bluish shade. At a chronic dakriotsistit the probability of infection of other covers of an eye with development of a blefarit, conjunctivitis, a keratit or a purulent ulcer of a cornea with the subsequent formation of a cataract is high.
Sharp dakriotsistit proceeds with brighter clinical symptomatology: sharp reddening of skin and a painful swelling in the field of the inflamed plaintive bag, hypostasis a century, narrowing or a full smykaniye of an eye crack. Hyperaemia and hypostasis can extend to a nose back, eyelids, a cheek. On appearance skin changes remind an erysipelatous inflammation of the person, however at a dakriotsistita there is no sharp otgranicheniye of the center of an inflammation. At a sharp dakriotsistit the pulling pains in the field of an orbit, a fever, fever, a headache and other symptoms of intoxication are noted.
In several days dense infiltrate over a plaintive bag is softened, appears fluctuation, skin over it becomes yellow that demonstrates formation of abscess which can spontaneously be opened. Further on this place the fistula from which the tear or pus is periodically allocated can be formed external (in face skin) or internal (in a nose cavity). At distribution of pus on surrounding cellulose eye-socket phlegmon develops. Sharp dakriotsistit quite often accepts recidivous character of a current.
At newborns dakriotsistit is followed by a swelling over a plaintive bag; pressing on this area causes release of slime or pus from plaintive points. Dakriotsistit newborns can be complicated by development of phlegmon.
Diagnostics of a dakriotsistit
Recognition of a dakriotsistit is made on the basis of a typical picture of a disease, characteristic complaints, data of external examination and palpatorny inspection of area of a plaintive bag. At survey of the patient with dakriotsistity dacryagogue and a swelling in the field of gas comes to light; at a palpation of the inflamed site morbidity and allocation from plaintive points of a purulent secret is defined.
The research of passability of plaintive ways at a dakriotsistita is conducted by means of color test of Vest (kanaltsevy). For this purpose the tampon is entered into the corresponding nasal course, and in an eye dig in solution of a kollargol. At passable plaintive ways within 2 minutes on a tampon dye traces have to appear. In case of longer time of a prokrashivaniye of a tampon (5-10 min.) it is possible to doubt passability of plaintive ways; if it was not allocated within 10 min. Vest's test is regarded as negative that testifies to impassability of plaintive ways.
For specification of level and extent of defeat diagnostic sounding of plaintive channels is carried out. Conducting passive plaintive and nasal test at a dakriotsistita confirms impassability of plaintive ways: in this case in attempt of washing of the plaintive and nasal channel liquid in a nose does not pass, and a stream follows through plaintive points.
In a complex of ophthalmologic diagnostics of a dakriotsistit use flyuorestseinovy instillyatsionny test, eye biomicroscopy. The contrast X-ray analysis of slezootvodyashchy ways (dakriotsistografiya) with solution of a yodolipol is necessary for a clear idea of very tectonics of slezootvodyashchy ways, localization of a zone of a striktura or an obliteration. For identification of microbic activators of a dakriotsistit investigate separated from plaintive points by bacteriological crops.
For the purpose of the specifying diagnostics the patient with dakriotsistity has to be examined by the otolaryngologist with carrying out a rinoskopiya; according to indications consultations of the stomatologist or the maxillofacial surgeon, the traumatologist, the neurologist, the neurosurgeon are appointed. Differential diagnostics of a dakriotsistit is carried out with kanalikulity, conjunctivitis, an ugly face.
Treatment of a dakriotsistit
Sharp dakriotsistit is treated permanently. To a softening of infiltrate carry out system vitamin therapy, appoint UVCh-therapy and dry heat to area of a plaintive bag. At emergence of fluctuation abscess is opened. Further carry out drainage and washing of a wound by antiseptics (solution of Furacilin, a dioksidin, hydrogen peroxide). In a conjunctival bag dig in antibacterial drops (, gentamycin, , , etc.), put antimicrobic ointments (eritromitsinovy, tetracycline, etc.). At the same time at a dakriotsistita system antibacterial therapy is carried out by medicines of a broad spectrum of activity (tsefalosporina, aminoglycosides, penicillin). After knocking over of sharp process in the "cold" period the dakriotsistorinostomiya is carried out.
Treatment of a dakriotsistit at newborns is carried out step by step and includes performance of the descending massage of a plaintive bag (during 2-3 weeks), washing of the plaintive and nasal channel (during 1-2 weeks), carrying out retrograde sounding of the plaintive channel (2-3 weeks), sounding of nososlezny ways through plaintive points (2-3 weeks). At inefficiency of the carried-out treatment on reaching the child of age of 2-3 years the endonasal dakriotsistorinostomiya is carried out.
As the main method of treatment of a chronic dakriotsistit serves operation – the dakriotsistorinostomiya assuming formation of an anastomoz between a cavity of a nose and a plaintive bag for an effective drainage of plaintive liquid. In surgical ophthalmology low-invasive methods of treatment of a dakriotsistit - an endoscopic and laser dakriotsistorinostomiya were widely adopted. In certain cases passability of the nososlezny channel at a dakriotsistita can try to be restored by means of a buzhirovaniye or a balloon dakriotsistoplastika – introduction to a cavity of a channel of the probe with a cylinder when which inflating the internal gleam of the channel extends.
In order to avoid formation of a purulent ulcer of a cornea, patients with dakriotsistity are forbidden to use contact lenses, to apply bandages eyes, to carry out any ophthalmologic manipulations connected with a touch to a cornea (a tonometriya, ultrasonography of an eye, a gonioskopiya, etc.).
Forecast and prevention of a dakriotsistit
Usually the forecast at an uncomplicated dakriotsistit favorable. The cataract which results not only in cosmetic defect, but also permanent decrease in sight can be an outcome of an ulcer of a cornea; at perforation of an ulcer there is a development of an endoftalmit and subatrophy of an eye.
The current of a dakriotsistit can be complicated by orbit phlegmon, thrombophlebitis of orbital veins, thrombosis of a kavernozny sine, an inflammation of brain covers and tissues of a brain, sepsis. In this case the probability of an invalidization and death of the patient is high.
Prevention of a dakriotsistit demands adequate and timely treatment of diseases of ENT organs, avoiding of injuries of eyes and a facial skeleton.