tear duct obstruction
Introduction
Introduction to lacrimal duct obstruction Obstruction of the lacrimal duct is a disease that often occurs in the punctum, the lacrimal canal, the junction of the lacrimal sac and the nasolacrimal duct, and the lower nasolacrimal duct, with tears as the main symptom. Adults secrete 0.5 to 1.0 ml of tears every 16 hours. In addition to moisturizing the eyeballs and partially evaporating, the remaining tears are introduced into the nasal cavity by the lacrimal passage. The principle of treatment is to control the inflammation of the lacrimal sac, restore or establish the lacrimal sac to the nasal drainage channel. Mainly manifested as tears, and bring discomfort to the patient, affecting cosmetic defects. Long-term tear immersion can cause chronic irritating conjunctivitis, diarrhea and cheek eczema dermatitis. The patient has swollen tears for a long time, and the long-term effect can cause valgus valgus, which aggravates the symptoms of tears. Patients with mild lacrimal duct obstruction, probe exploration and expansion, severe lacrimal duct intubation, or other artificial lacrimal duct intubation, severe obstruction of the lacrimal canal for conjunctival lacrimal sac anastomosis. Nasal lacrimal duct obstruction is a dacryocystorhinostomy. basic knowledge Sickness ratio: 0.50% Susceptible people: no special people Mode of infection: non-infectious Complications: conjunctivitis
Cause
Lacrimal duct obstruction
Congenital factors (25%)
Congenital Hasner valve obstruction is the most common, as well as congenital lacrimal atresia (including bone deformity leading to osseous nasolacrimal duct atresia), congenital tears, and nasal septum deviation. Recently, there have been reports of cases in which ectopic teeth cause obstruction of the lacrimal passage.
Damage (30%)
Surgery (nasal and paranasal sinus surgery, oral and maxillofacial surgery), excessive frequency or improper lacrimal passage flushing, exploration. Radioactive damage caused by radiotherapy of local malignant tumors. Severe drug allergic reactions, such as post-vaccination reactions. Trauchial canal laceration is the most common, as well as mechanical damage, burns (heat or acid and alkali), nasal bone and maxillary fractures involving the lacrimal passage.
Inflammation (20%)
Local inflammation of the eyes: trachoma, acute and chronic conjunctivitis, blepharitis, acute and chronic dacryocystitis, stye, or herpes. Inflammation of adjacent tissues: hypertrophic rhinitis, nasal polyps, etc.
Foreign body (5%)
Obstruction of the lacrimal passage can be caused by dust, falling eyelashes, and the like.
Tumor (5%)
Lacrimal sac tumors, nasal and paranasal sinus tumors, etc. can cause obstruction of the lacrimal passage.
Prevention
Lacrimal duct obstruction prevention
The main symptom of occlusion is tears. For patients with tears, treat the eye disease to relieve the cause. The disease generally has no effect on the eyes and vision. It is only uncomfortable due to tearing. After proper treatment, most of the symptoms of tears are relieved.
Complication
Lacrimal duct obstruction Complications conjunctivitis
The main cause of lacrimal disease is the obstruction of the lacrimal duct. The adverse consequences include: immersing the eyeball in the eye drops all the time, which can cause keratitis and corneal ulcer. Eyeballs cannot be used for internal eye surgery: cataract surgery, glaucoma surgery, etc. The outflow of tears erodes the eyelids, the skin is dry, the pigments are easy to sink, and the jaws are everted.
Symptom
Symptoms of lacrimal passage obstruction common symptoms tears eruption eczema
Mainly manifested as tears, and bring discomfort to the patient, affecting cosmetic defects. Long-term tear immersion can cause chronic irritating conjunctivitis, diarrhea and cheek eczema dermatitis. The patient has swollen tears for a long time, and the long-term effect can cause valgus valgus, which aggravates the symptoms of tears.
Tears
2. The lacrimal passage cannot be flushed, and the liquid flows back from the punctum:
(1) occlusion of the punctum: the lacrimal punctum is membranous atresia;
(2) obstruction of the lacrimal canal: the needle is inserted from the small point of the tear, and the liquid immediately flows back from the small point of the tear;
(3) nasolacrimal duct obstruction: the needle is inserted from the lower punctum, first smooth, and then flows out from the upper punctum, no mucus or purulent discharge reflux;
(4) stenosis of the nasolacrimal duct: the needle is inserted from the small point of the tear, part of the fluid is refluxed, and a small amount of liquid flows into the nasopharynx.
Examine
Examination of lacrimal duct obstruction
Common inspection method
Lacrimal lavage test: A method of connecting a flushing needle with a syringe containing saline, injecting physiological saline from the punctum into the lacrimal canal, and judging the obstruction or stenosis of the lacrimal passage according to the discharge of the liquid.
1. The flushing fluid is injected into the nasopharynx from the lower punctum, and part of the fluid is stenosis from the upper punctum.
2. The rinsing solution is completely returned from the upper punctum to the end of the lacrimal duct or the nasolacrimal duct obstruction. If a large amount of mucous secretions are flushed out, the nasolacrimal duct obstructs chronic dacryocystitis.
3. The rinsing liquid is all returned from the lower punctum. When the rinsing is high, the resistance should be flushed from the upper tears. If the lacrimal passage is smooth, the lower tear duct is blocked, and the puncture is flushed from the original small tears. Then the tears are blocked.
4. The eyelids are swollen during rinsing, neither returning from the punctum, nasal cavity, or liquid in the mouth, indicating that the irrigation needle enters the surrounding subcutaneous tissue, should immediately stop the flushing, and give antibiotics to prevent infection.
Accurate identification of the obstruction site can be done by injecting lipiodol into the iodized oil and making an X-ray photograph.
Diagnosis
Diagnosis of lacrimal duct obstruction
Diagnostic points
Tears
2. The lacrimal passage cannot be flushed;
1 flushing without resistance, the liquid smoothly enters the nasal cavity or the pharynx, indicating that the lacrimal passage is smooth;
2 The rinsing liquid is completely returned from the original injection path, and is blocked by the lacrimal canal;
3 The rinsing liquid is injected from the small tears, and is returned from the upper punctum, which is blocked by the tear duct;
4 flushing has resistance, part of it returns from the punctum, part of it flows into the nasal cavity, and the nasolacrimal duct is narrow;
5 flushing fluid returned from the small tears at the same time, there is mucus purulent secretion, nasolacrimal duct obstruction combined with chronic dacryocystitis.
3. Drop fluorescein in the conjunctival sac, if no green liquid flows into the nasal cavity, it proves that the lacrimal duct is blocked;
4. There is resistance to exploring or expanding the lacrimal passage;
Diagnostic lacrimal passage is helpful in confirming the obstruction of the upper lacrimal passage (pleacle, tear duct, and lacrimal sac). The therapeutic lacrimal passage is mainly used for obstruction of the lacrimal passage in infants. For adult nasolacrimal duct obstruction, the lacrimal passage can not cure the root.
5, X-ray lipiodol angiography
Used to display the size of the lacrimal sac and the obstruction.
Occial duct obstruction will be secondary to dacryocystitis, acute dacryocystitis can be used hot, and antibiotics are used under the guidance of a doctor. In patients with chronic dacryocystitis, the nasolacrimal duct can be dilated with a probe under local anesthesia. In addition, patients with nasal and paranasal sinuses should be actively treated to avoid nasal septum deviation, hypertrophic rhinitis, mucosal polyps, and inferior turbinate hypertrophy.
