DACRYOCYSTITIS

From Big Medical Encyclopedia

DACRYOCYSTITIS (dacryocystitis; Greek dakryon a tear + kystis a bubble, a bag + - itis) — an inflammation of a dacryocyst. Distinguish acute (d. acuta s. phlegmonosa), chronic (d. chronica) and D. of newborn (d. neonatorum).

Clinical picture

Acute dacryocystitis (phlegmon of a dacryocyst) more often is a complication chronic and it is caused by transition of an inflammation to the cellulose surrounding a dacryocyst. Less often acute D. arises without the previous chronic. At the same time the purulent inflammation passes to cellulose from a mucous membrane of a nose or its bosoms.

Fig. 1. Eyes of the child suffering from a right-hand acute dacryocystitis: hypostasis of hypodermic cellulose and protrusion of the right dacryocyst is expressed.

The disease begins sharply and is characterized by bystry developing of very painful hypostasis and a hyperemia of area of a dacryocyst (fig. 1). Hypostasis can extend to eyelids, a ridge of the nose and a cheek. The conjunctiva is hyperemic and edematous. At the expressed hypostasis a century the palpebral fissure is narrowed or close. Klin, a picture reminds an erysipelatous inflammation, but differs from it in lack of sharp border between the struck and healthy sites of skin. During acute D. perhaps spontaneous regressing with the subsequent recurrence. Abscess which is opened on face skin is more often formed. At the same time the acute phenomena abate, however there is a fistula, from a cut slime and pus is periodically emitted. In some cases pus lays a way to a nasal cavity with formation of an internal fistula.

Chronic dacryocystitis arises owing to disturbance of passability of the nasolacrimal channel caused by diseases of a mucous membrane of a nose and anatomotopografichesky features of slezootvodyashchy ways (see. the Lacrimal bodies ). At disturbance of passability of a nasolacrimal channel the tear in a dacryocyst stagnates and loses the antibacterial properties. Pathogenic microorganisms (pneumococci, staphylococcus, streptococci, etc.), getting from a conjunctival sac into the lacrimal, breed in the lacrimal liquid and cause an inflammation of a mucous membrane. Reason hron. Can be syphilitic damages of bones of a nose or tuberculosis of a dacryocyst. At tuberculosis of a dacryocyst passability of the nasolacrimal channel partially remains.

Patients hron. Complain of a persistent slezo-and suppuration. Quite often joins blepharitis (see) and conjunctivitis (see). At a part of patients on skin of an internal corner of an eye according to location of a dacryocyst the swelling is noted. During the pressing slime or pus is emitted for this area from the lacrimal openings. At the long course of a disease there comes stretching of a dacryocyst (ectasia sacci lacrimalis), the mucous membrane atrophies, the bag is filled with transparent liquid; there is edema of a dacryocyst (hydrops sacci lacrimalis). The increased dacryocyst appears through the thinned skin in bluish color. At emergence of impassability of the lacrimal tubules the dacryocyst turns into the closed cystic cavity filled with liquid contents.

Hron D. constitutes serious danger to an eye. The virulent microorganisms nesting in a dacryocyst can cause a purulent helcoma with the subsequent education cataracts (see).

The diagnosis

the Diagnosis is made on the basis of characteristic complaints and objective data. Carry out tests with color solutions (flyuorestsein, colloid silver) which enter into a conjunctival sac; at hron. Owing to impassability of a nasolacrimal channel liquid does not come to a nasal cavity. Diagnosis hron. Can be put in attempt of washing of a nasolacrimal channel: the liquid entered into it by means of the syringe or a stupid needle does not pass in a nasal cavity.

Treatment

At acute D. — dry heat, UVCh, a diathermy, antibiotics, streptocides; at fluctuation — incision of area of a bag. After subsiding of the acute phenomena operation is shown dacryocystorhinostomies (see).

Treatment hron. Operational — a dacryocystorhinostomy.

The forecast

, as a rule, leads Timely carried out acute D.'s treatment to recovery. At timely surgical treatment hron., As a rule, comes recovery. The forecast at specific D. depends on a current of a basic disease.

Features of a dacryocystitis of newborns

Fig. 2. The scheme sounding of slezoprovodyashchy ways at a dacryocystitis: the probe is entered into the lacrimal opening horizontally, then transferred to vertical position (a dotted line and the shooter) for carrying out to the nasolacrimal canal.

At a fruit an exit of a nasolacrimal channel in a nose is closed by Gasner's membrane. By the time of the birth or in the first days after the delivery there is involution of a membrane. At a part of newborns the membrane remains. Conditions for stagnation of slime and development of a dacryocystitis are created. More rare congenital anomalies in a structure of slezootvodyashchy ways or tissues of a nose are a cause of infringement of a slezootvedeniye. At D. of newborns right after the birth or within the first 6 months accumulation of slime or pus in an internal corner of the affected eye, a moderate hyperemia of a conjunctiva, a swelling of area of a dacryocyst appears. During the pressing for this area the finger from the lacrimal openings emits slime or pus. Of newborns proceeds chronically, but at a part of children (5%) is complicated by phlegmonous process with the subsequent formation of abscess and a fistula.


At D. of newborns carry out massage of area of a dacryocyst in the direction from top to down. If it does not lead to a rupture of a membrane, make washing of a dacryocyst under pressure; at unsuccessfulness of washing — sounding of the lacrimal ways (fig. 2). In the absence of effect the dacryocystorhinostomy is shown. At a phlegmonous dacryocystitis — antibiotics parenterally and washing of slezootvodyashchy ways solutions of antibiotics.

The forecast at D. of newborns good if treatment is carried out timely.


Bibliography: Margolis M. G. and Pluzhnichenko B. V. Hirurgiya of the lacrimal bodies, M., 1965; Pilman N. I. Practical questions of children's ophthalmology, page 184, Kiev, 1967; Pole B. L. Ocherki of pathology of the lacrimal ways, Saturday. nauch. works on oftalm., page 45, L., 1947, bibliogr.; Pokhisov N. Ya. Diseases of slezootvodyashchy ways and their treatment, M., 1958; Tikhomirov P. E. Pathology and therapy of slezootvodyashchy ways, L., 1949, bibliogr.; Shamkhalovsh. And. and Beloglazoye V. G. Dacryocystites, Makhachkala, 1969; Mulier F. Erkran-kungen der Tranenorgane, in book: Der Augenarzt, hrsg. v. K. Velhagen, Bd 3, S. 79, Lpz., 1975; Sachsenweger R. Augenkrankheiten im Kindesalter, S. 33, Lpz., 1973, Bibliogr.; System of ophthalmology, ed. by S. Duke-Elder, v. 13, L., 1974; T r e y o r-R o p e r P. D. The eye and its disorders, Oxford, 1974.

A. M. Vodovozov.

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