Сроки и способы лечения дакриостенозов детского возраста

Abstract

Congenital dacryostenosis (congenital obstruction of the nasolacrimal duct, or CNLDO) is a congenital obstruction of the lacrimal system structures. Usually, the cause of dacryostenosis is blockage of the duct, less frequently – dysgenesis of the lacrimal pathways, including bone abnormalities, stenosis throughout the lacrimal system. Inconsistency of data on the optimal timing of probing, its impact on efficiency, lack of clear criteria for transition from probing to intubation of the lacrimal ducts and operation to create anastomosis, prompted us to this study. Aim. A retrospective analysis of the results of treatment of patients with childhood dacrystenosis and determination of the optimal tactics of their treatment. Methods.The study included patients from 0 to 15 years old with complaints of lacrimation and purulent discharge from one or both eyes from infancy. The first group consisted of patients who at the initial stage underwent probing of tear ducts according to standard procedure. The second group of the study consisted of patients who applied to the clinic after a number of ineffective probing procedures performed in medical institutions at their place of residence. Patients in this group underwent recanalization of the tear ducts with temporary intubation with a polyurethane stent. Results. The study demonstrated absence of a significant difference in the effectiveness of primary probing of tear ducts in groups of children of different ages. Recanalization of the lacrimal pathways with intubation with a polyurethane stent is a highly effective method of treating congenital dacryostenosis used in absence of recovery after twice repeated probing of the lacrimal pathways. The effectiveness of this method decreases in patients older than 3 years, which is associated with long-existing inflammation of the lacrimal sac walls, extension of the lacrimal tract above the level of stenosis, leading to the formation of foci of restenosis after removal of the stent. Conclusions. Performing primary deep probing is an effective method of treating congenital dacryocystitis in children under 2 years of age. The effectiveness of this procedure does not depend on age at the time of the procedure, however, in case of delayed execution, there is a need for general anesthesia when performing the intervention. Recanalization should be recommended to patients with the ineffectiveness of double probing of the tear ducts. Persistence of complaints of purulent discharge after removal of the stent from the lacrimal tract is an indication for endonasal dacryocystorinostomy. Key words: congenital dacryocystitis; lacrimal pathways probing; recanalization; intubation; endorhinoscopy; lacrimation; epiphora.