Phlegmon of the lacrimal sac is a rather complex disease that, 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 the advanced form of dacryocystitis.
Reasons
Dacryocystitis precedes cellulitis in most cases. First, there is a blockage of the nasolacrimal canal. In this case, an increased multiplication of bacteria begins in the lacrimal sac, which leads to inflammation. Dacryocystitis is manifested by the following symptoms:
- pain in the eye, radiating to the nose and jaw;
- swelling and redness in the inner corner of the eye;
- increased lacrimation;
- impaired vision.
With insufficient treatment, suppuration is formed in the focus of inflammation. The content breaks through the wall of the lacrimal sac and spreads through the subcutaneous tissue. This is how phlegmon is formed. The patient's condition deteriorates sharply.
However, phlegmon of the lacrimal sac occurs not only as a result of dacryocystitis. The cause of suppuration in the fiber can be sinus diseases - 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 tenth revision of the International Classification of Diseases classifies this pathology as H04. Under this general code, diseases of the lacrimal apparatus are indicated. The full code for phlegmon of the lacrimal sac according to ICD-10 is H04.3 (phlegmatic dacryocystitis). This applies to those cases when the disease develops in children older than 1 year and adults.
Dacryocystitis and phlegmon are often observed in infants. The code for phlegmon of the lacrimal sac in newborns is P39.1.
Symptoms
With phlegmon, the patient's general condition deteriorates sharply. There is weakness, malaise, fever. There is a strong edema, which spreads from the region of the lacrimal sac to the eyelid, nose, cheek. The skin on the affected area turns red and becomes hot to the touch. Severe pain is felt in the region of the lacrimal sac and is palpatedseal. 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 is formed. The skin becomes yellowish due to the accumulation of pus.
Abscess can break through the skin on its own. In this case, a wound is formed, which eventually overgrows. After that, all unpleasant symptoms subside. However, one should not count on such a favorable outcome. Without treatment, phlegmon can lead to severe complications.
In addition, suppuration can break through the nasal cavity. This forms a fistula in the duct, through which the lacrimal fluid flows through the nose. Often, long-term non-healing fistulas form 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. These formations in most cases resolve on their own in the first months of life. If this does not happen, then the baby may develop dacryocystitis. With insufficient or incorrect treatment, the disease is complicated by 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 well-being deteriorates sharply, the temperature rises, swelling is abouteyes grows. 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 break into the sinuses. In this case, the patient develops sinusitis or sinusitis. This is the most common and not the most severe complication of cellulitis.
- A more dangerous consequence is the spread of phlegmon to the eye socket. In this case, damage to the optic nerve and internal structures of the eye is noted. There is panophthalmitis. This is an extensive purulent inflammation of all 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. The penetration of infection from the organ of vision into the cranial cavity can lead to meningoencephalitis. Such a disease is often fatal.
Diagnosis
If phlegmon is suspected, an 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, an x-ray of the orbit and nasal sinuses is prescribed. 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 such a disease. Needed ASAPtake the patient to an ophthalmologist.
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:
- "Floxal";
- "Tobrex";
- "Vitabakt";
- "Levomycetin";
- "Vigamox".
Corticosteroid eye drops with dexamethasone are indicated to relieve pain and inflammation. At the same time, physiotherapeutic procedures are prescribed: UHF, electrophoresis with antibiotics, blue light treatment.
After the abscess passes into the fluctuation stage, the phlegmon of the lacrimal sac is opened. 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 the operation, the bandages are changed several times a day. Antibacterial ointments are applied to them. In the future, dressings are carried out 1 time in several days. Prescribe antibiotics in the form of tablets or injections. In the first time after the opening of the abscess, the patient needs complete rest. recovery period afteroperation is no more than 1 month.
After subsiding all acute manifestations, the patient is offered an operation to restore the patency of the nasolacrimal canal. This helps prevent recurrence of the pathology. For children, such a surgical intervention is carried out no earlier than 5-7 years.
Complete removal of the lacrimal sac is very rare these days. 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 of preventing 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, should not be ignored. In the early stages, dacryocystitis responds well to therapy, and surgery can still be avoided. You also need to treat sinusitis and other sinus diseases in time.
Special 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. Often, parents self-medicate and wash the baby's eyes with tea leaves. This only leads to an aggravation of painful manifestations, and in the future, dacryocystitis develops into phlegmon. Therefore, with persistent inflammation of the eyes in children, it is urgent to contact an ophthalmologist.
