TACTICS OF SURGICAL TREATMENT OF IMPAIRED PASSAGE OF THE NASOLACRIMAL DUCT IN PEOPLE OF DIFFERENT AGES

Abstract

Objective: to evaluate the effectiveness of different methods of treatment of patients of different ages with the obstruction of the nasolacrimal duct and determine the rational tactics of their treatment. Materials and methods. A total of 327 patients (394 eyes) were examined: 285 children aged 2 weeks to 18 years with atresection of the nasolacrimal duct (346 eyes) and 42 patients 18-85 years old with a nasolacrimal duct obstruction (48 eyes) acquired or in time not eliminated. Taking into account the age, the children were treated with a therapeutic massage of the lacrimal sac, washing (probing) of the lacrimal passages, and with their inefficiency - bougiezing of the tear ducts (including intubation with silicone thread), dacryocystorhinostomy and lacoprosthetics. Adults performed dacryocystorhinostomy, and in the absence of the effect of repeated such interventions, as well as in cases of previous extirpation of the lacrimal sac - lacoprosthetics. Results. The effectiveness of therapeutic massage of the lacrimal sac is maximum in the first weeks of the child’s life, however, it did not exceed 33%. Complete restoration of sludge removal after probing of the nasolacrimal duct was noted in 93.6%, but only in cases when it was carried out during the period from the second to the fourth month of the child’s life, after bougaining - in 46.7%, bougies with intubation with silicone thread - in 58.3%, after dacryocystorhinostomy - in 77.8%% of cases. In adults, the efficiency of dacryocystorhinostomy performed by external access was 82.4%, and endoscopic endonasal 88.9%. Lakoprosthesis (silicone prosthesis with fixation in the nasolacrimal duct) for children and adults is performed in the absence of the effect of previous plastic interventions. Conclusion. Reconstructive surgery of the nasolacrimal duct has age specificity, characterized by phased implementation of lacrimal sac massage, sensing, bougiezing of the nasol- acrimal duct and dacryocystorhinostomy - in children and dacryocystorhinostomy - in adults. Each subsequent intervention is performed in the absence of the result of the previous procedure. Multiple unsuccessful dacryocystorhinostomies serve as an indication for lacoprosthetics (bibliography: 10 refs).