Phlegmon of the lacrimal sac is a rather complex disease, which without treatment can lead to serious consequences. It has an infectious etiology. Phlegmon is a purulent inflammation in the subcutaneous tissue. This pathology is most often a complication of dacryocystitis - an inflammatory process in the lacrimal sac. Suppuration under the skin does not develop in one day. It is a consequence of a neglected form of dacryocystitis.
Causes
Dacryocystitis precedes phlegmon in most cases. First, a blockage of the nasolacrimal canal occurs. At the same time, an enhanced reproduction of bacteria begins in the lacrimal sac, which leads to inflammation. Dacryocystitis is manifested by the following symptoms:
- pain in the eye, giving in the nose and jaw;
- swelling and redness in the inner corner of the eye;
- increased lacrimation;
- visual impairment.
With insufficient treatment, suppuration is formed in the focus of inflammation. Content breaks through the wall of the lacrimal sac and spreads through the subcutaneous tissue. So phlegmon is formed. The patient’s condition worsens dramatically.
However, phlegmon of the lacrimal sac occurs not only due to dacryocystitis. The cause of suppuration in the fiber can be diseases of the nasal sinuses - sinusitis and sinusitis. In this case, the infection enters the eye area through the nasolacrimal canal.
The causative agents of phlegmon of the lacrimal sac are various bacteria: staphylococci, pneumococci, streptococci, etc. The disease is usually preceded by a decrease in immunity.
ICD code
The international classification of diseases of the tenth revision refers this pathology to the department H04. Under this common code are designated diseases of the lacrimal apparatus. The complete code of phlegmon of the lacrimal sac according to ICD-10 is H04.3 (phlegmatic dacryocystitis). This applies to cases where the disease develops in children older than 1 year and adults.
Dacryocystitis and phlegmon are often observed in infants. The phlegmon code of the lacrimal sac in newborns is P39.1.
Symptoms
With phlegmon in a patient, the general condition sharply worsens. There is weakness, malaise, fever. There is a strong edema, which from the area of the lacrimal sac extends to the eyelid, nose, cheek. The skin on the affected area turns red and becomes hot to the touch. In the area of the lacrimal sac, severe pain is felt and compaction is palpated. This stage of the development of the disease is called infiltrative.
After a few days, the fluctuation stage begins. The affected area becomes soft. At this stage, an abscess forms. The skin becomes yellowish due to the accumulation of pus.
An abscess can break through the skin on its own. In this case, a wound is formed, which overgrows with time. After that, all the unpleasant symptoms subside. However, one should not count on such a successful outcome. Without treatment, phlegmon can lead to serious complications.
In addition, suppuration can break through the nasal cavity. In this case, a fistula is formed in the duct, through which tear fluid flows through the nose . Often formed long non-healing fistulas on the skin.
Features of the disease in infants
As already mentioned, phlegmon of the lacrimal sac is often observed in infants. In some newborns, the nasolacrimal duct is closed with a gelatinous plug or embryonic membrane. In most cases, these formations dissolve independently in the first months of life. If this does not happen, then the baby may appear dacryocystitis. With insufficient or incorrect treatment, the disease is complicated by a phlegmon.
With dacryocystitis, the child has redness of the eyes, yellowish-green discharge, swelling in the area of the lacrimal sac. With light pressure on the swollen area, pus is released. If the disease is complicated by phlegmon, then the baby's general state of health sharply worsens, the temperature rises, swelling near the eye increases. The baby stops eating and becomes restless.
Consequences of the disease
Phlegmon is a serious disease that requires immediate treatment. Otherwise, serious consequences and complications may occur:
- Pus can burst into the sinuses. In this case, the patient develops sinusitis or sinusitis. This is the most common and not the most serious complication of phlegmon.
- A more dangerous consequence is the spread of phlegmon to the orbit. In this case, damage to the optic nerve and internal structures of the eye is noted. Panophthalmitis arises. This is an extensive purulent inflammation of all the tissues of the eyeball. Such a disease can lead to blindness or amputation of the organ of vision.
- It is important to remember that the lacrimal sac is located close to the brain. Penetration of infection from the organ of vision into the cranial cavity can lead to meningoencephalitis. Such a disease often ends fatally.
Diagnostics
If phlegmon is suspected, the ophthalmologist examines the eye and palpates the lacrimal sac. The clinical picture of the disease is so characteristic that the diagnosis is not difficult.
Additionally prescribed x-ray of the orbit and sinuses. This allows you to identify the etiology of the disease and the presence of complications.
Treatment
Emergency care for phlegmon of the lacrimal sac should be provided immediately. However, only a specialist can treat this disease. It is necessary to deliver the patient to an ophthalmologist as soon as possible.
Therapy of the disease is carried out in a hospital. At the infiltrative stage, conservative treatment of phlegmon of the lacrimal sac is indicated. Prescribe antibiotic injections:
- "Cefazolin";
- Ampicillin;
- Ceftriaxone.
Treatment is supplemented with topical application of eye drops with antibiotics and sulfonamides. The following drugs are prescribed:
- Phloxal;
- Tobrex;
- Vitabakt;
- Chloramphenicol;
- Vigamox.
To relieve pain and inflammation, the use of corticosteroid eye drops with dexamethasone is indicated. At the same time, physiotherapeutic procedures are prescribed: UHF, electrophoresis with antibiotics, blue light treatment.
After the abscess passes into the stage of fluctuation, an autopsy of the phlegmon of the lacrimal sac is performed. Under local anesthesia, an incision is made in the affected area. The purulent cavity is washed with antiseptic solutions, and then drainage tubes are placed to drain the contents. A bandage is applied to the wound.
In the first days after surgery, the bandages are changed several times a day. They are applied antibacterial ointments. In the future, dressings are carried out 1 time in several days. Prescribe antibiotics in the form of tablets or injections. At first, after opening the abscess, the patient needs complete rest. The recovery period after surgery is no more than 1 month.
After the abatement of all acute manifestations, the patient is offered to undergo surgery to restore patency of the nasolacrimal canal. This helps prevent relapse of the pathology. Children undergo such surgery no earlier than 5-7 years.
Complete removal of the lacrimal sac today is very rarely used. Such an operation has unpleasant consequences: the patient has constant lacrimation. Therefore, such surgical intervention is resorted to only in very advanced cases.
Prevention
The main method for the prevention of phlegmon is the timely treatment of dacryocystitis. Symptoms such as pain in the eyeball, lacrimation, swelling and redness in the corner of the eye, blurred vision, cannot be ignored. In the early stages, dacryocystitis responds well to therapy, and surgery can still be avoided. It is also necessary to treat sinusitis and other diseases of the sinuses in time.
Particular attention should be paid to the treatment of dacryocystitis in young children. Symptoms of inflammation of the lacrimal sac in a child may resemble signs of conjunctivitis. Parents often self-medicate and wash their baby’s eyes with tea leaves. This leads only to aggravation of painful manifestations, and later dacryocystitis develops into phlegmon. Therefore, with persistent inflammation of the eyes in children, it is urgent to contact an ophthalmologist.