Is it possible to bathe a child after probing the eye? Probing the lacrimal duct in newborns

About 5% of newborns are diagnosed with inflammation of the lacrimal sac, which is called dacryocystitis. This is the main ophthalmological pathology for which probing of the lacrimal canal is indicated.

The disease develops as a result of obstruction of the nasolacrimal duct, due to which mucus and dead embryonic and epithelial cells accumulate in the lacrimal sac. This content creates a favorable environment for the development of the inflammatory process.

The nasolacrimal ducts can be blocked by germinal gelatinous films and embryonic membranes, which are a mechanical protective factor in the fetus until the 8th month of development. In the first days after birth, these membranes spontaneously break through and the lacrimal ducts are released.

Probing is necessary for obstruction of the lacrimal ducts

On the other hand, obstruction of the lacrimal ducts can occur due to trauma during childbirth or due to congenital structural features of the bones of the facial skull (folding and diverticula of the lacrimal sac, congenital narrow lumen of the ducts, small nasal concha, curvature of the nasal septum).

Normal lacrimal drainage is maintained by a combination of the following mechanisms:

• capillarity of lacrimal openings (absorption of tear fluid);
• maintaining negative pressure in the tear ducts by contracting the orbicularis oculi muscle;
• contractility of the lacrimal sac;
• the presence of special folds in the mucous membrane of the nasolacrimal ducts, working as hydraulic valves;
• patency of the nasal cavity and normal nasal breathing, which is very difficult with a runny nose.

When is probing needed?

Dacryocystitis in infants is manifested mainly by purulent or mucopurulent discharge from the eyes, which can intensify in response to compression of the lacrimal sac. The conjunctiva is hyperemic, constant tearing is observed in the eye, it waters even in the absence of crying. With active inflammation, general symptoms of malaise are also present - headache, weakness, and fever may rise.

Signs of inflammation of the lacrimal sac

Probing of the lacrimal canal in newborns is indicated for persistent disease that cannot be cured conservatively (with medications and pushing massage). In addition, the procedure is also carried out for diagnostic purposes. Conical or soft cylindrical probes (bougies) are used to check the possibility of patency of the nasolacrimal canals, and the lacrimal sac is also washed with antiseptics.

Many parents are concerned about the question of whether probing is dangerous. Indeed, it may be accompanied by some complications:

• the possibility of rupture of the canal wall if the diameter of the probe or the angle of its insertion is incorrectly selected;
• the possibility of rupture of the lacrimal sac with a breakthrough of purulent contents into the maxillary cavity;
• perforation of the thin bone wall of the canaliculus or lacrimal bone with the probe entering the maxillary sinus or nasal cavity;
• fracture of the probe and the need for its surgical removal;
• if after the procedure there is a little bleeding, then this is not considered a complication, but an indicator of successful removal of the blocking membranes.

Complication of dacryocystitis – phlegmon of the lacrimal sac

However, if probing of the eye in newborns is not carried out in time, then inflammatory stenosis of the mouth of the lacrimal sac develops and pus collects in its cavity. The accumulation of such contents leads to serious consequences - phlegmon of the lacrimal sac and paraorbital cellulitis, subsequent sinusitis, entmoiditis, thrombophlebitis of the ophthalmic arteries and meningeal sepsis. Visual impairment may develop due to constant lacrimation and increased intraocular pressure.

They try to do sounding in children under one year old, and it is best tolerated and has the highest recovery rate (98%) in the first 3 months of life. Today, you can have surgery in a private clinic, where treatment will be paid, or go to the ophthalmology department of the state one. For example, at the Morozov hospital they specialize in eye microsurgery for infants.

Features of the procedure

Before an appointment for surgery, the child must be examined by an ophthalmologist and pediatrician. Experts pay attention to the general condition of the baby - absence of cough, runny nose, fever, and other diseases, including ophthalmological ones. It is necessary to take blood tests and determine if you are allergic to medications that will be used during the procedure.

The fact that the treatment was performed for a fee does not guarantee its quality. A correctly performed first probing procedure allows you to maintain the normal elasticity of the lacrimal canaliculi and avoid their atony from traumatic damage by the probe. Poorly performed manipulation causes re-development of dacryocystitis. It should also be taken into account that even when the patency of the lacrimal canals is restored, the following are possible:

• development of chronic dacryocystitis with periodic exacerbation and suppuration;
• formation of fistulas or adhesions in the nasolacrimal duct;
• dilatation and atony of the lacrimal sac.

According to statistics, one procedure is enough for half of the children, and only every tenth requires multiple repetitions.

Probing of lacrimal canals with access through the nasal passage

How is probing done? In infants up to two months old, due to the structural features of the nasal passages, endonasal retrograde sounding can be performed. The manipulation is carried out without anesthesia. A button-shaped probe is inserted into the nasal passage and selected through it to the mouth of the nasolacrimal canal. A blunt end is used to break through the obliterating films. The tear ducts are washed with antibiotics. The lack of effect from retrograde probing forces one to resort to introducing a probe from the side of the eyeball through the lacrimal punctum.

For children after one year of age, the operation is performed under short-term mask or intravenous anesthesia. Anesthesia is not used in newborns. In such cases, it is important to sufficiently immobilize the child with reliable support of the head so that there is no accidental injury to the canals with the probe or subluxation of the cervical spine. Since the baby can swallow the washing liquid, resuscitation equipment must be present during the procedure.

Probing technique in a newborn

The thickness of the probe must be selected taking into account the size of the nasolacrimal duct. The doctor uses special lubricants to facilitate its passage. The movement of the probe is smooth and without pressure. The instrument should gently push apart the folds of the mucous membrane and follow the convoluted channel. The pressure of the washing liquid is also small, not forced. In most cases, the probe is inserted into the lower lacrimal punctum, but when probing again - through the upper one, so as not to expose the canaliculus to unnecessary trauma.

Immediately after probing the lacrimal canal, it is antiseptically treated with local antibacterial agents: Vitabact, Tobrex, chloramphenicol solution, gentamicin.

Treatment of dacryocystitis by simple washing without probing is not very effective in children older than one year. In older age (after two years), dacryocystitis is treated surgically by dacryocystorhinostomy. In this case, trephination of the nasal bones is performed to restore communication between the lacrimal sac and the nasal cavity. It is also possible to introduce thin elastic tubes into the tubules, which can maintain their lumen for a long time from six months to two years.

Timely and adequate probing of the lacrimal canal in children serves as protection against possible severe infectious complications, as well as preventing the risk of vision loss.

Blockage of the optic ducts is a common pathology in newborns. Its appearance may be associated with prolonged labor or intrauterine infection. 30% of children encounter the problem of obstruction of the lacrimal duct within 1 month of life.

In 70% of cases, the problem can be resolved only with the help of probing.

There are not many reasons for the development of obstruction and inflammation of the nasolacrimal duct.

In most cases, pathology is detected immediately after birth and occurs due to:

• abnormal structure of the nasal septum;
• underdevelopment of the lacrimal canal;
• preserving the film that should have broken through during the first breath and cry of the child once after birth;
• genetic pathologies of the structure of the bones of the skull or face;
• eye infections;
• entry of a foreign body into the lumen of the canal;
• tumor formations.

The most common cause of blocked eye ducts is the baby's lack of prolonged and strong crying immediately after birth.

Symptoms of inflammation of the lacrimal duct in newborns

Inflammation of the tear duct develops gradually, the symptoms may not be noticeable, but you should pay attention to:

• the appearance of tear drops when the child does not cry;
• moisture in the lower eyelashes after sleep;
• frequent blinking;
• constant scratching of the eyes.

After the initial stage, the pathology develops into dacryocystitis, which has more pronounced symptoms:

The pathology can affect not only both eyes, but also be one-sided.

Indications for probing the lacrimal canal

Surgical breakthrough of the protective film is prescribed only after conservative treatment. If there are no positive results or the condition worsens, the ophthalmologist gives permission to perform the procedure.

Indications for surgical intervention are also:

• profuse lacrimation;
• increase in the inflammatory process;
• change in color of purulent contents from yellow to green;
• ineffective treatment with massage;
• disturbances in the formation of the lacrimal canal;

Contraindications

Probing the lacrimal canal in newborns has a number of contraindications, including:

• abnormal structure of the optic ducts;
• acute sinusitis;
• chronic sinusitis;
• allergic manifestations in the form of cough or runny nose;
• curvature of the nasal septum;
• hemophilia;
• altered blood composition;
• diabetes;
• infectious diseases;
• leukemia;
• conjunctivitis;
• facial injuries;
• increased sensitivity to painkillers;
• pneumonia;
• asthma;
• tumors;
• heart failure.

If there are contraindications or congenital anomalies, the ophthalmologist may reschedule the operation at a later date or prescribe maintenance therapy.

Preparing a child for sounding

Probing is one of the types of surgical interventions, so it requires special preparation.

Before it is carried out, it is necessary to undergo a number of examinations:

When receiving all the results before probing, it is recommended:

• follow a strict diet 3 days before surgery;
• do not feed the baby 4 hours before;
• stop taking all medications.

To avoid injury or serious complications, the baby's arms and legs must be firmly secured with diapers.

It is worth noting that many clinics swaddle children themselves before surgery, so this point will be clarified during consultation.

Carrying out the operation All manipulations take no more than 10 minutes. The operation can be performed under local anesthesia. Most often, the painkiller Alcaine is instilled into the eye. The use of general anesthesia is advisable only for the treatment of bilateral dacryocystitis or when the child reaches the age of 4 months.

Probing procedure:

1. The eyes are washed with a special solution and the surrounding skin is treated with an antiseptic.
2. A Sichel tube, which has a cone shape, is inserted into the lumen of the duct near the upper eyelid. It is necessary to expand the tear ducts. The tube is first inserted horizontally and then raised vertically.
3. Then a Bowman probe, which is a thin hollow wire, is also inserted. It is used to tear the film.
4. After restoring the patency of the ducts, the tear-purulent contents are washed out with saline and the eyes are treated with a disinfectant.

After 20-40 minutes. the child is sent for outpatient treatment and a date for re-examination is set.

Many clinics are practicing a new method of treating obstruction of the optic ducts. The operation differs only in the introduction of special soft rubber tubes instead of probes.. They contain a small ball that is inflated with air or saline.

After the film breaks, the ball is removed, and the tubes remain in the ducts for about 6 months, preventing the formation of adhesions, after which they are removed.

Risks and possible complications in newborns

Removing blocked tear ducts is considered a safe procedure.

There are practically no risks of aggravating the problem or causing harm to health, since:

• all instruments are sterilized;
• modern painkillers are used;
• After the operation, the open ducts and eyes are disinfected.

The course of the operation directly depends on the qualifications of the microsurgeon, since if the procedure technique is violated, pus can get into the second eye or ear. Probing is recommended before the child reaches 6 months of age., since the film in the ducts hardens, complicating the operation.

There is also a risk of re-development of dacryocystitis after the procedure if the rules of care for the operated visual organs are not followed or if they become infected with infectious and colds after probing.

During the first few days after surgery, it is considered normal to experience:

• bloody discharge from the nasal cavity;
• shortness of breath;
• headache;
• nausea;
• profuse flow of tears;
• restlessness and irritability;
• temperature.

If these symptoms intensify or do not go away within a few days, you should consult an ophthalmologist or pediatrician.

Serious complications that require immediate medical attention include:

• conjunctivitis;
• lack of tear fluid;
• severe eye irritation or redness;
• temperature above 38°C;
• bleeding from the eyes;
• formation of scars and adhesions;
• vomiting;
• severe flow of tears 14 days after surgery;
• mechanical damage to the channel.

If left untreated, blockages of the eye ducts may develop:

• meningitis;
• sepsis;
• deformation of the nasal septum;
• ulcerative lesions of the cornea;
• partial blindness;
• fusion of tear ducts;
• otitis;
• chronic dacryocystitis.

How is recovery going?

Probing the lacrimal duct has a long recovery period. It is 2 weeks. In newborns and children up to 3 months, this period extends to 1 month. Rehabilitation is carried out at home in the absence of serious complications.

Recovery is faster if you follow all the ophthalmologist’s recommendations. It must be remembered that during rehabilitation you should not overcool and have contact with sick people, since any disease of the ENT organs can provoke recurrent dacryocystitis.

Also, during recovery, it is necessary to do a special massage, which prevents the growth of scar tissue or adhesions.

What is prohibited during the rehabilitation period

There are practically no strict restrictions during rehabilitation. Immediately after the procedure, you can walk, but this must be done away from dusty roads. and children's playgrounds with sandboxes. For the first 2 days it is forbidden to bathe the child in the bath. You are only allowed to rinse it carefully under running water, without washing your hair and face.

Self-use of antibiotics can cause inflammation of the conjunctiva of the eyes and bacterial infection. During rehabilitation, it is necessary to refrain from introducing new foods into the child’s diet, and also to temporarily limit the consumption of salty and fatty foods.

It is also prohibited to overheat children and take them to a sauna or bathhouse, as high temperature can cause inflammation in the operated canals.

When is a repeat probing procedure necessary?

There are cases when one probing does not help eliminate the obstruction; a repeat procedure is performed if:

• lacrimation has not recovered;
• adhesions occur in the canals;
• there is a relapse of dacryocystitis after an illness;
• Scar tissue forms.

The procedure is carried out no earlier than 2 months after the first sounding and is no different from it. If there is a physiological decrease in the lumen of the ducts, the microsurgeon may recommend installing special tubes for six months that prevent the narrowing of the ducts and the formation of adhesions.

Post-operative care

Probing helps eliminate duct obstruction in almost 98% of cases. After the procedure, you must adhere to certain rules for caring for the child. Mandatory manipulations during the rehabilitation period include massage and eye treatment.

Hygienic eye treatment

For 5-7 days, the child needs to drip special solutions and apply ointments. The type of medication, dosage and duration of treatment are prescribed by an ophthalmologist.

For treatment and disinfection, the following are often prescribed:

Massage: technique, frequency

Probing of the lacrimal canal in newborns gives a positive result only when combined with massage and drug therapy.

Before the massage you must:

• trim fingernails;
• wash your hands thoroughly;
• wear sterile gloves;
• rinse each eye with furatsilin solution.

Caution must be exercised as infants have a very soft nasal septum.

The massage technique consists of several actions:

1. Feel the edge of the orbital bone at the inner corner of the eye, closer to the bridge of the nose.
2. Lightly press the corner of your eye with your finger.
3. Then move up to the eyebrow and down to the nose. The movement should follow the shape of the comma sign.
4. Pressure should not be applied to the cartilage tissue of the nose, but only to the eye window.

When purulent contents appear in the corner, it is carefully collected with cotton pads or gauze napkins. It is also necessary to repeat 4-7 movements for each eye. During the day, massage is carried out up to 4 times. After all the manipulations, the necessary medications are instilled into the eyes.

Is it possible to avoid probing? Alternative Treatments

You can eliminate obstruction of the tear ducts with massage. But this method does not always give a positive effect: It is possible to tear the film only in 50% of cases. The technique of therapeutic massage does not differ from postoperative massage, but the pressure should be applied in a jerky manner with great effort.

Also, to treat obstruction, massage should be performed up to 10-12 times a day, 6-10 movements, after which antibacterial agents should be used.

The video shows mistakes when performing massage of the lacrimal canal, and also explains the method of correct execution:

You can also use traditional medicine:

• Mint, calendula and sage compress: mix 2 tbsp. herbs and pour 500 ml of hot water, leave for 3 hours. Apply gauze soaked in the broth every 2 hours for 10 minutes.
• Nasal drops from Kalanchoe juice: Place several leaves in the refrigerator for 2 days, then chop them and squeeze out the juice. Dilute it in a 1:1 ratio with boiled water and drip the resulting solution onto your nose. This product can cause sneezing, which contributes to the physiological rupture of the film. The product can also be used in the form of lotions.
• Boudra or chamomile decoction: 1 tbsp. Pour one of the herbs into a glass of clean water and boil for 5 minutes. The decoction should be used as a compress or to wash the eyes.

Probing of the ophthalmic ducts in newborns is carried out if the condition does not improve within 3 weeks.

In addition to the classical technology, there is another option for restoring the patency of the canals:

• Intubation without the use of a Sichel probe.
• Probing the lacrimal duct in newborns is the most effective method, but it is often replaced by the intubation procedure. It differs from it in the use of thin conductors to which silicone tubes are attached.

They are pushed through the superior and inferior ducts into the nasal cavity and removed. The tubes remain in the cavity of the canals and ensure the movement of tear fluid. The device can only be removed after six months, as new tissue forms around it, creating wider canal walls.

This method is used when:

• partial obstruction of the canals;
• unsuccessful probing;
• formation of a purulent sac in the area of ​​the ducts.

Possible complications include:

• too large hole in the corners of the eyes;
• changing the position of the tubes;
• eyeball injury;
• conjunctivitis;
• discomfort in the nasal cavity.
• Elimination of obstruction using a balloon device.

This method is rarely used due to the cost of equipment and the long duration of manipulations, but it has several advantages over classical probing.

Advantages:

• no need to insert multiple probes;
• in addition to film rupture, channels expand;
• there is no risk of injury to the ducts and the formation of adhesions.

The manipulation is performed under general anesthesia. Thin conductors with a microscopic ball are inserted into the ducts. It is pushed closer to the film and filled with air or liquid. The ball expands and breaks the film. After this, it is pulled out using a guide.

This method is used in case of increased sensitivity to local anesthetic drugs or after unsuccessful probing.

Complications include:

• relapse of dacryocystitis;
• formation of an imaginary duct;
• allergic reactions to anesthesia.

Treatment of obstruction of the lacrimal duct must be carried out immediately after diagnosing the pathology. Lack of proper and timely therapy can cause an abscess, which leads to death. It is also worth noting that probing in newborns can be performed under general anesthesia, which significantly reduces the possibility of adverse consequences.

Article format: E. Chaikina

Useful video about probing the lacrimal canal in newborns

You can learn about the causes of blockage of the tear duct and the results of successful probing from this video:

Probing the lacrimal canal in newborns is an ophthalmological operation in which the gelatinous film is eliminated, which prevents tear secretion from entering the nasal cavity. Blockage of the lacrimal canal often causes inflammation, since not only tear secretion, but also pathogens accumulate in the lacrimal sacs. The resulting conditions are favorable for them and they begin to reproduce. This in turn provokes purulent inflammation.

Under normal conditions, the tear duct opens on its own, and the gelatinous film breaks through with the first cry of the newborn. But in rare cases - about 5% of all children born - pathology is detected. The secretion of tears is an important process that performs a moisturizing and protective function for the eyes. Without them or with insufficient secretion volume, visual acuity decreases significantly over time. But how probing occurs in a newborn with dacryocystitis will help you understand this

Why is this needed - probing the lacrimal canaliculi of the eye in newborns

The cause of inflammation is blockage of the lacrimal canaliculus. During intrauterine development, the film protected the eyes, respiratory tract and nose of the fetus from amniotic fluid entering them. When she appears on the count and takes the first breath and cry, she breaks through. If this does not happen, then lacrimal secretion is disrupted, and inflammation develops due to the accumulation of secretions in the lacrimal sac and the proliferation of the pathogen there.

At first, doctors recommend coping with the problem using therapeutic methods. These include massage and medications. This approach most often justifies itself, but in those rare cases when it was not possible to break through the film with therapeutic effects, probing of the lacrimal canaliculus in a newborn is prescribed. But how eyelid massage occurs with demodicosis can be seen in this

The video shows a description of the problem and what it is prescribed for:

Usually the procedure is prescribed from 2-3 months of age, but if the indications are urgent, then it can be carried out much earlier.

With dacryocystitis, there is a risk of not only suppuration of the lacrimal ducts, but also chronicity of the process. Therefore, it is impossible to delay the procedure in order to prevent future recurrences of the pathology in the child.

But how eye presbyopia is diagnosed and how such a disease is treated is indicated

How is it carried out?

In order for the operation to be successful, parents must first prepare the child for it. A few days before the procedure, it is necessary to adjust the child’s diet so that before the operation the child does not eat for about 3 hours. This abstinence applies to children under 6 years of age.

Scheme of surgical intervention

You also need:

• Avoid medications that are incompatible with anesthesia. Consult your doctor about any medications you use.
• You cannot use medications that thin the blood, otherwise the risk of bleeding increases significantly and can lead to many complications and death of the patient. But you can read how this happens in the article at the link.
• You need to prepare diapers, the necessary underwear, and swaddle the baby tightly. This helps prevent unintentional movement of the handle during the procedure.
• Preliminarily undergo an examination to determine if the child has any contraindications to probing the lacrimal canaliculi. These are primarily low blood clotting, infectious lesions of the eyes, skin around the eyes, on the face and ENT organs. But you can see how to massage the eyes of a newborn with dacryocystitis
• Consult an otolaryngologist regarding the presence of a deviated septum, which can also cause pathology and frequent infections in the child.

The video shows how probing is carried out:

This manipulation can be carried out both in a clinic and in an eye office. The entire procedure is carried out depending on the actions of the doctor, the effect of anesthesia and other factors from 5 to 20 minutes. Manipulations are performed under local anesthesia, that is, only the intervention area is numbed. This reduces the risk and intensity of side effects. But the information on the link will help you understand how to apply it correctly.

If a diagnosis of “dacryocystitis” is made and doctors prescribe probing as a method of treatment, you cannot refuse, since there are quite serious indications for this procedure.

But how to properly use drops for chalazion in a child will help you understand this

Anesthetic drops are instilled into the patient's eye twice. When the expected effect is obtained, the doctor inserts a special instrument into the lacrimal canaliculi. The instrument has a conical shape - this is a Sichel probe. This widens the tear ducts. Next, the doctor uses a Bowman probe to reach the required depth and breaks through the barrier. After this, the cavity of the lacrimal sac is washed with saline solution, which flows into the nasal cavity without obstruction, and is disinfected with a mild antiseptic.

To make sure that the operation was successful, the doctor drops a special coloring solution into the child’s eye and inserts a cotton swab into the nose. If it turns color after 5 minutes, the procedure is considered successful.

In such cases, it is considered that the conjunctiva has been successfully cleansed, and therefore the patient is sent home with the following treatment instructions:

1. Use of antibacterial children's drops for instillation into the eyes for a week. But what drops to use after cataract surgery will help you understand this
2. Carrying out a massage in the area of ​​the lacrimal canaliculi.

Statistics show that most of these procedures take place without any complications, and the effect is achieved almost immediately. But there are exceptions when no changes occur within a month. Therefore, the doctor may decide to perform repeated probing.

If there are congenital anomalies or a deviated nasal septum, then there is no point in doing the procedure. In such cases, other surgical interventions are prescribed

Consequences for infants

After surgery, you may experience some side effects that are normal after surgery:

• A small amount of blood is released from the nose for 5-7 days.
• Nasal congestion and sneezing may occur for 1-2 days.
• Attacks of nausea and vomiting may occur in the first couple of days after surgery.
• Also, in the first two days there may be slight soreness in the operated area. But you can read what to do when the corner of your eye itches and hurts
• Watery eyes may last for about 2 weeks.

The child is allowed to rub his eyes and bathe without restrictions.

If the symptoms persist for a long time, and also if there is redness, swelling, discharge from the eye, fever, chills, moodiness and lethargy in the child, you should immediately consult a doctor.

But how to use drops against glaucoma and which drops are the best is indicated

Speaking specifically about complications, probing can provoke scar formation. Accordingly, the scar can cause re-clogging of the tubule. An eye infection may also develop. To prevent such a complication, you should carefully follow your doctor's instructions.

Quite often, newborns experience inflammation of the lacrimal sac, which is also called dacryocystitis. This disease is diagnosed already in the weeks of a child’s life, so it happens that sometimes the diagnosis is made in the maternity hospital.

But it is not always possible to recognize the disease at the earliest stage, before the stage begins inflammation of the lacrimal sac.

Obstruction of the tear ducts during the birth of the baby occurs due to the presence gelatinous plug.

This traffic jam before the baby is born protects the nasolacrimal duct from amniotic fluid.

Most often it ruptures during childbirth. If the plug does not rupture, then the tears will not enter the nasal canal, but will stagnate, resulting in the formation of pus. In this case, you should immediately contact ophthalmologist or pediatrician.

Another reason is pathology of the nose or surrounding tissues resulting from injury or inflammation.

The first signs of tear duct obstruction are:

• swelling in the inner corner of the eye;
• discharge of a mucous or mucopurulent nature;
• lacrimation;
• tears flowing from the eye when the child is not crying.

If these signs appear, you must consult a doctor!

But quite often, doctors confuse inflammation of the lacrimal sac with conjunctivitis and prescribe anti-inflammatory drops as treatment, which do not help with the disease.

Once a diagnosis of obstruction has been made tear ducts, the doctor most often prescribes massage for your baby as a treatment.

But if, after a special massage, the condition of the baby’s tear ducts remains the same, then a procedure for probing the lacrimal canal will be prescribed.

Delaying the probing procedure often leads to complications. The older the child, the more difficult it will be to cure dacryocystitis. That's why the most suitable age for the probing procedure – three or four months.

What needs to be done before the process?

Before probing, you need to take a blood clotting test, and also undergo examination by an otolaryngologist. The doctor must confirm the diagnosis, write down its reason and, if necessary, explain everything.

If the cause of dacryocystitis is pathology of the nasal cavity, then there will be a need for additional procedures in addition to probing the baby’s lacrimal canal.

The procedure is done under local anesthesia in sterile medical conditions. For anesthesia, drops of half percent alcaine are used.

Special probes are inserted into the nasolacrimal canals. With their help the tubules expand, and the doctor breaks the cork.

After this, the canal is washed with a special disinfectant solution. The effectiveness of the procedure is determined using a tinted saline solution. The procedure takes only a few minutes, which is quite a bit.

The procedure itself does not cause pain to the child, but he may be restless due to the fact that he is unable to move, and bright artificial light is directed into his eyes.

After surgery, the baby's eyes are no longer pus flowing, tearing also stops, and the swelling at the corner of the eye disappears.

Causeless secretion of tears also ends. But sometimes this may not happen immediately, you need to wait a few days or even weeks.

After probing, it is very important to follow all the doctor’s recommendations. The ophthalmologist prescribes usually a massage and putting drops into the eyes for a week after the procedure.

This helps prevent relapse, helps adhesions of the lacrimal sac, which you can ask your doctor about.

The effectiveness of probing is not observed only in cases where the disease is caused pathology of the lacrimal ducts or deviated septum. In this case, a complex surgical operation will be required, which is performed only when the child reaches six years of age.

Doctor Komarovsky about lacrimal canal massage

Dacryocystitis is inflammation of the lacrimal sac of the eye. Occurs due to narrowing of the nasolacrimal duct or when it is blocked. Often found in newborns. Probing the lacrimal canal in children under one year of age is an unpleasant but necessary ophthalmological procedure.

In infants, the main reason for probing is the formation of a gelatinous plug in the tear duct. When the baby is in the womb, it protects the canal from the entry of amniotic fluid. Normally, it ruptures on its own during childbirth. If this does not happen, the tears stagnate. In this case, the child develops:

• pus;
• swelling of the inner corner of the eye;
• the flow of tears when the newborn is calm;
• sticky eyelashes after sleep.

If you suspect a canal blockage, you should consult an ophthalmologist. Perhaps the cause of dacryocystitis was a congenital deviated nasal septum. Next, the doctor selects the appropriate treatment.

Indications for probing:

• lacrimation;
• chronic inflammation of the lacrimal sac;
• abnormalities in the development of the lacrimal duct;
• with the prescribed course of massage and drops there is no positive dynamics.

Fact! The symptoms of the disease are similar to conjunctivitis, so they are often confused. In this case, therapy with anti-inflammatory drugs is not effective.

Probing is carried out in newborns up to 4-6 months of age, after which it is ineffective.

The operation is performed before the baby is 4 months old. Eliminating the film at this age gives a positive result in 90-95% of cases. If the plug is not removed in time, it hardens. This complicates treatment. Probing of the lacrimal canal after a year is carried out if there is a relapse of the disease.

Preparing for surgery

After confirming the diagnosis, the specialist conducts the following studies before ophthalmological intervention:

• blood test to determine the rate of clotting;
• bacteriological culture of the contents of the lacrimal sac;
• biomicroscopy of the eye;
• Vesta test to check the patency of the lacrimal duct. A cotton swab is inserted into the nasal cavity. Liquid with dye is dripped into the desired eye. The patency of the canal is not impaired if a tinted spot appears on the cotton wool.

To ensure that the probing goes without consequences, you should follow the doctor’s recommendations. For children under one year old they are as follows:

• Follow the diet for several days. The baby should not eat food 3-4 hours before the expected time of surgery to avoid regurgitation.
• Do not take medications that are incompatible with drugs that will be used for ophthalmological intervention.
• Prepare diapers or other underwear that restrict the movements of the newborn’s arms during surgery.

Probing in a child is usually performed on an outpatient basis. On the same day, parents will have the opportunity to go home. Recovery will be carried out at home under the supervision of a therapist and ophthalmologist.

Probing in a child is usually performed on an outpatient basis.

It is worth noting that many clinics swaddle children themselves before surgery, so this point will be clarified during consultation.

Some medical facilities allow parents to be in the operating room. Probing the tear duct lasts about 10 minutes. It is most often performed under local anesthesia. Alcaine 0.5% is instilled as anesthesia.

The operation consists of several stages:

1. A Sichel probe is inserted into the nasolacrimal canal to expand the space.
2. A thinner Bowman probe is inserted using rotational movements. As it advances, the integrity of the plug is broken and patency is restored.
3. The eyes are cleansed of pus and disinfected. If the operation is successful, the fluid will flow out through the nose.

After removing the film, the child is examined after some time. It happens that the tear duct is still not able to function normally. In this case, a repeat operation is performed under general anesthesia.

Fact! Instead of metal probes, silicone tubes and an instrument similar to a microscopic ball are inserted inside. There it is filled with saline solution. As a result, the plug ruptures and the liquid is pumped out. The tubes remain inside for six months, after which they are removed.

Alcaine 0.5% is used as a local anesthetic when probing the lacrimal canal.

Complications and recovery after probing

After probing the canals in children, you must adhere to the prescribed therapy. Antibiotics are used in the form of drops, massage of the tear ducts. The eyes are wiped with cotton pads soaked in furatsilin, from the outer edge to the inner.

Recovery in young children occurs quite quickly. You can bathe in the bath almost immediately after fixing the problem.

In general, canal probing is successful, but sometimes complications are possible:

• the first few days, nasal congestion, nausea, vomiting;
• the appearance of blood from the nose for 7 days;
• lacrimation may continue for another 14 days.

If this condition does not improve, consult your doctor. The following signs are grounds for immediate consultation:

• tears do not come out naturally due to damage to the canal;
• severe redness of the eyes;
• elevated temperature;
• irritation of the mucous membrane of the eyelid and the formation of conjunctivitis;
• bleeding from the lacrimal canal;
• adhesions if the doctor’s advice is not followed.

In some cases, the disease relapses. Then repeated intervention is required. In children after one year of age, probing is done under general anesthesia.

Jul 11, 2017 Anastasia Tabalina