RU2342657C1 - Diagnostics method for dacryostenosis stages - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to ophthalmology, namely to dacryology. To determine dacryostenosis stages, cytologycal examination of lacrimal sac and nasolacrimal duct fluids is fulfilled, sampled after single lavage with coloured solution, via higher or lower lacrimal point and respective tubule, until the solution appears in nasolacrimal duct ostium. Inflammation stage of dacryostenosis is determined by detection of microbe colonies, leucocytic infiltration, raised desquamation of dystrophic epitheliocytes, lining nasolacrimal duct. Fibroisation stage is determined in the infiltrate by presence of whole layers of necrotic epithelium, prevalence of fibroblasts, concluded in dense, membrane-like material.

EFFECT: allows conducting adequate therapy depending on specific stage of dacryostenosis clinical course.

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Description

The present invention relates to ophthalmology, in particular dacryology, and is intended to increase the effectiveness of the treatment of dacryostenosis.

The level of technology.

Currently, there is no information in the literature regarding the stages of dacryostenosis.

However, there are works in which one of the stages was determined, which did not allow evaluating the effectiveness of treatment in dynamics.

Khomyakova N.V. as a result of pathomorphological studies of biopsy samples of the mucous membrane of the nasal cavity, at a certain stage of the disease, in patients with idiopathic obstruction of the nasolacrimal duct established the presence of mixed changes in order to establish the pathogenesis of idiopathic obstruction of the nasolacrimal duct (Khomyakova N.V. Idiopathic obstruction of the nasolacrimal duct and pathogenetic substantiation of the principle of their treatment. Diss. candidate of medical sciences, M., 1994).

Linberg and McCormick using a biopsy of the nasolacrimal duct in patients with dacryostenoses and dacryocystitis determined the picture of the inflammatory process and pathological changes that led to obliteration of the nasolacrimal duct at different levels for cases with different duration of the disease from several months to 10 years (Linberg JV, Me Cormick SA, Primary acquired nasolacrimal duct obstruction, a clinicopathologic report and biopsy technique. // Ophthalmology, 1986, 93: 1055-1063).

However, in none of the works there are indications of determining the stages of dacryostenosis.

Disclosure of the invention.

The objective of the invention is to develop a method for determining the stages of dacryostenosis based on cytological examination of the contents obtained from the nasolacrimal duct.

The absence in the existing methods of the possibility of a clear differentiated study of the contents of the lacrimal passages and nasal mucosa requires the development of new technologies for selecting material for research, which allow to diagnose and control the treatment process in dynamics.

The technical result of the invention is the ability to choose the appropriate treatment, depending on the pathogenetic features of the stages of the course of dacryostenosis.

The technical result is achieved by determining the stage of the course of dacryostenosis using a cytological study of the contents of the lacrimal sac and nasolacrimal duct after preliminary sanitation of the mucous membrane of the nasal cavity at the mouth of the nasolacrimal duct.

The implementation of the invention.

The method is as follows.

The mouth of the nasolacrimal duct is sanitized from mucus with a sterile cotton swab.

Through a cannula inserted through the lower (or upper) lacrimal opening into the corresponding tubule, the lacrimal sac and nasolacrimal duct are washed once with a colored solution (furatsilin, rivanol, fluorescein, etc.) using a syringe with medium pressure on the piston. After the appearance of a solution with the contents of the nasolacrimal duct in the area of the mouth, it is collected with a sterile swab, transferred to a glass slide, fixed with methyl alcohol and stained according to Romanovsky-Giemsa. The obtained cytological preparations are studied on a research photomicroscope III (Opton, Germany) at magnification × 40 or × 100 with immersion.

As the authors of the study showed, to determine the stage of dacryostenosis, it is necessary to determine the nature of the cellular composition, the exudate of the contents of the nasolacrimal duct, and the presence of microflora in it. As a result, the authors suggest that the obtained contents of the nasolacrimal duct be examined by the cytological method: after preliminary drying and fixation on a slide, stain according to Romanowsky-Giemsa.

Microscopy of a stained cytological preparation

The following must be considered:

a) the presence and condition of the epithelial lining, the degree of its dystrophic changes;

b) the presence and nature of inflammatory infiltrates (leukocyte, lymphocytic, mixed);

c) the amount and viscosity of the mucous secretion;

d) the presence of exudation (protein, hemorrhagic, purulent), fibrin filaments, fibroplastic activity (proliferation of fibrous tissue), the presence and nature of the infection (coccal, rod, fungal, protozoal, viral).

Studies using the proposed method make it possible to determine the main cause of dacryostenosis against the background of inflammatory and fibroplastic reactions that narrow the lumen with the exception of an error caused by the incorrect technique of taking a smear print.

If microorganism colonies were found in the contents of the nasolacrimal duct, leukocyte infiltration, increased desquamation of dystrophically altered epithelial cells lining the nasolacrimal duct, the inflammatory stage of dacryostenosis was determined. If the contents of the nasolacrimal duct determined the presence of whole layers of necrotic altered epithelium, the predominance of fibroblasts immersed in a dense membrane-like material in the infiltrate, the stage of fibrotization of dacryostenosis was determined.

Clinical cases.

Example 1

Patient M., born 1953 filed complaints of lacrimation from the OU on the street and indoors for one year.

Objectively:

Lacrimal openings of normal size.

Rhinoscopy within the age norm.

Color tests:

Tubular test 50 sec.

Nasal test 5.5 minutes.

Schirmer's test (as modified by Yu.V. Yudina) is within normal limits.

X-ray of the tear ducts:

contrast medium introduced through the lower lacrimal openings is determined on both sides in the cavities of the lacrimal sacs, in the nasolacrimal ducts and in the nasal cavity.

The paranasal sinuses are satisfactorily pneumatized. Conclusion: OU - uneven narrowing of the nasolacrimal duct throughout.

Cytological examination of the mouth and contents of the nasolacrimal duct was carried out as follows.

The mouth of the nasolacrimal duct was sanitized from mucus with a sterile cotton swab. Through a cannula inserted through the lower lacrimal opening into the corresponding tubule, the lacrimal sac and nasolacrimal duct were washed once with a 1: 5000 solution of furatsilin using a syringe with medium pressure on the piston. After the appearance of a solution with the contents of the nasolacrimal duct in the area of the mouth, it was collected with a sterile swab, transferred to a glass slide, fixed with methyl alcohol and stained according to Romanovsky-Giemsa. The obtained cytological preparations were studied on a research photomicroscope III (Opton, Germany) at magnification × 40 or × 100 with immersion. Conclusion: the contents of the nasolacrimal duct are represented by mucosal fibrinous exudate surrounded by desquamated atrophied epithelial cells with signs of infection of the coccal flora.

Based on a cytological study, the diagnosis was made - the inflammatory stage of dacryostenosis and the corresponding pathogenetic treatment was prescribed:

- a course of washing of the tear ducts with a solution of antibiotic phloxal No. 8,

3 weeks after treatment, complaints of lacrimation disappeared, and the tubular test was 35 seconds.

After 6 months, there were no complaints of lacrimation, a tubular sample of 35 seconds, with a cytological examination of microflora was not detected, single inflammatory cells, individual dense mucous filaments were determined.

Thus, a course of antibacterial therapy selected on the basis of a cytological study turned out to be pathogenetically adequate, which led to a stable cure and the absence of relapses over the next 6 months.

Example 2

Patient M., born in 1940, complained of lacrimation from the OU on the street and indoors for four years. Objectively:

Lacrimal openings of normal size.

Rhinoscopy within the age norm.

Color tests:

Tubular test 1 minute.

Nasal test 6 minutes.

Schirmer's test (as modified by Yu.V. Yudina) is within normal limits.

X-ray of the tear ducts:

contrast medium introduced through the lower lacrimal openings is determined on both sides in the cavities of the lacrimal sacs, in the nasolacrimal ducts and in the nasal cavity.

The paranasal sinuses are satisfactorily pneumatized. Conclusion: OU - narrowing of the nasolacrimal duct, most pronounced at the exit to the nasal cavity.

Cytological examination of the mouth and contents of the nasolacrimal duct was carried out as follows.

The mouth of the nasolacrimal duct was sanitized from mucus with a sterile cotton swab. Through a cannula inserted through the lower lacrimal opening into the corresponding tubule, the lacrimal sac and nasolacrimal duct were washed once with a 1: 5000 solution of furatsilin using a syringe with medium pressure on the piston. After the appearance of a solution with the contents of the nasolacrimal duct in the area of the mouth, it was collected with a sterile swab, transferred to a glass slide, fixed with methyl alcohol and stained according to Romanovsky-Giemsa. The obtained cytological preparations were studied on a research photomicroscope III (Opton, Germany) at magnification × 40 or × 100 with immersion.

Conclusion: the contents of the nasolacrimal duct are represented by a mucosal fibrinous exudate with desquamated cells and fibroblasts along the periphery in the form of an intermittent “cover”. No signs of inflammation or infection were detected.

Based on a cytological study, the diagnosis was made - the fibrinous stage of dacryostenosis and the corresponding pathogenetic treatment was prescribed:

- two courses of washing of the tear ducts with a solution of the enzyme preparation collalysine 800-1000 KE (800-1000 KE diluted in 10.0 ml of physical solution, 5.0 ml for each washing) No. 8, a repeated course of washing 10 days after the end of the first, after 6 weeks, complaints of lacrimation significantly decreased, and the tubular test was 45 seconds.

After 6 months, complaints of lacrimation in cold windy weather, tubular test 50-55 sec - within the upper limit of normal. A control cytological examination of the contents of the nasolacrimal duct revealed a dense mucous base, a moderate amount of necrotic altered desquamated epithelial cells, fibroblast-like cells. There are no signs of infection or inflammation.

As a result of the proposed cytological study of the nasolacrimal duct, a pathogenetically adequate treatment was prescribed, which led to a decrease in lacrimation, however, given the chronic nature, stage of the disease and organic changes in the composition of the wall of the nasolacrimal duct, repeated courses of treatment for this condition are necessary.

Thus, the proposed method for cytological examination of the contents of the directly nasolacrimal duct makes it possible to make an outpatient diagnosis of etiopathogenetic dacryostenosis, to prescribe adequate treatment in a timely manner and to monitor the effectiveness of the treatment with repeated studies. The peculiarity of taking the contents of the nasolacrimal duct after preliminary sanitation of the area of its mouth in the lower nasal passage excludes the possibility of contamination from the side of the nasal mucosa, which differs in its microflora.

Claims (1)

A method for determining the stage of dacryostenosis, including a cytological examination of the contents of the lacrimal sac and nasolacrimal duct obtained after a single wash with a stained solution through the upper or lower lacrimal opening and the corresponding tubule with the appearance of it in the mouth of the nasolacrimal duct and detecting the inflammatory stage of dacryostenosis in the presence of colonies of microorganisms, leukocyte , increased desquamation of dystrophically altered epithelial cells lining the nasolacrimal duct, fibrotization division stage in the presence of whole layers of necrotic changes epithelium, infiltration predominance of fibroblasts embedded in a dense membrane-like material.