RU2479291C1 - Method of conservative treatment of dacryostenosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly ophthalmology, and aims at conservative treatment of dacryostenosis. Ofloxacin ophthalmic gel is introduced into a lachrymal duct. Ofloxacin ophthalmic gel 3ml is introduced every second day, 8-10 times.

EFFECT: method provides recovered patency of the lachrymal ducts and prevented recurrent postoperative stenosis following dacryorhinocystostomy, including due to mechanical dilatation of the duct by means of the gel the physical characteristics of which differ from those of tears.

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Description

The invention relates to ophthalmology and is intended for the conservative treatment of dacryostenoses.

The disease of the lacrimal tubules, namely cicatricial lesions, is the most common pathology of the tear ducts and one of the main causes of persistent lacrimation, purulent discharge into the conjunctival cavity and, as a result, inflammatory diseases of the eye. Regardless of the etiological factor and clinical presentation, diseases of the lacrimal sac and lacrimal duct require in most cases surgical treatment, the purpose of which is to restore the communication of the lacrimal sac cavity with the nasal cavity.

Local treatment in the form of rinsing of the tear ducts can be used both before surgical treatment and for the prevention of recurrence of scarring in the postoperative period.

It is known to use a solution of furatsilin for washing tear ducts in the conservative treatment of dacryostenosis [Sultanov M.Yu. // Vestn. ophthalmol. - 1998. - No. 33. - C.1-7], which has a bactericidal effect; a solution of chymotrypsin, which is based on its ability to break down necrotic tissues and fibrinous formations under local influence, thin out viscous secrets and exudates.

Recently, antibiotic solutions such as phloxal, cypromed, and others are most often used to rinse the tear ducts.

The closest analogue of the proposed method is a method of treating dacryostenosis by washing the tear ducts with an antibiotic solution (Mohammad A.A. Treatment of the pathology of the tear ducts using a low-energy helium-neon laser // Diss. M.D. - M., 2002).

Rinsing of the tear ducts with the above drugs in traditional conservative treatment causes only temporary clinical improvement, not leading to complete recovery. Known drugs are used in the form of aqueous solutions, and therefore, are quickly evacuated from the nasal cavity, which significantly reduces their effect. All of the above drugs have only a short-term antibacterial effect on the pathogenic flora.

Known eye gel based on the substance of the fluoroquinolone antibiotic ofloxacin.

In ophthalmology, this gel is used to treat inflammatory diseases of the anterior segment of the eye when introduced into the conjunctival cavity to cover the front surface of the eye with an air-permeable layer of an antibacterial drug (patent CN 1437947 (A), 02/02/2002). Information on the introduction of an ophthalmic gel based on ofloxacin into the tear ducts in the prior art is not found.

The objective of the invention is to develop the use of an ocular gel based on ofloxacin in the conservative treatment of patients with dacryostenoses.

The technical result of the invention is the restoration of patency of the tear ducts and the prevention of recurrence of stenosis in the postoperative period after dacryorhinocystostomy.

The technical result is achieved due to prolonged mechanical expansion of the tear ducts with a simultaneous anti-inflammatory effect by introducing ofloxacin-based gel into the tear ducts.

The basis of the proposed method is the idea of using the ability of an ocular gel based on ofloxacin to have a multifaceted effect on the mucous membrane of the tear ducts. Gels have an advantage over aqueous solutions, providing a more significant prolongation of the therapeutic effect due to high viscosity and structure.

The gel itself, in contrast to rinsing solutions, is evacuated from the tear ducts for a long time, which, firstly, has a long-lasting mechanical effect, contributing to the expansion of the tear ducts, and secondly, provides the corresponding long-lasting effect of ofloxacin, which is part of the gel, and a corresponding decrease in the intensity of the inflammatory process, thirdly, creates a protective film on the surface of the mucous membrane of the tear ducts, which prevents the aggressive action of microbial flora on it.

We carried out conservative treatment of 20 patients with dacryostenosis with partial patency, including the administration of ocular gel based on ofloxacin. Since the average volume of the tear ducts is 2 ml, a volume of 3 ml was chosen for their mechanical expansion. As clinical observations have shown, after 24 hours after administration of the gel, 20-30% of its volume is still in the tear ducts, so repeated injections of the gel should be carried out every other day. After a complete course of treatment, all patients disappeared signs of tear and suppuration. Usually, the course requires 8-10 sessions.

The method is as follows.

A patient with partial dacryostenosis through a disposable sterile cannula with a blunt tip and bent at an angle of 65-90 °, is injected with a syringe through a lacrimal opening into the lacrimal tubule of ofloxacin-based eye gel in a volume of 3 ml. Manipulation is carried out every other day until the disappearance of inflammatory manifestations. Usually, this requires 8-10 injections of the drug.

Example

Patient K.

She was referred for consultation with a diagnosis of chronic conjunctivitis of the right eye. Concomitant diseases: vasomotor rhinitis, drug allergy (skin rashes on various medications). Complained of lacrimation on the street (in cold and windy weather), purulent discharge, which appeared about 6 months ago. Conducted conventional antibiotic treatment was ineffective. On examination: the lower lacrimal opening of the usual size, adjacent to the eyeball. Tubular test results: positive through the lower tubule. When washing the tear ducts with a solution of furatsilin 1: 5000, the preservation of passive patency was revealed. An X-ray examination of the tear ducts of OD with contrast revealed a contrast introduced through the lower lacrimal opening, in an insignificant amount in the cavity of the lacrimal sac and then in the unevenly narrowed lacrimal-nasal canal and nasal cavity. Rhinoscopy revealed no pathological changes. Microscopic examination revealed Staphylococcus aurelius. The study on viruses, chlamydia and mycelium of the fungus gave a negative result. Microscopic examination of the washings revealed Staphylococcus aurelius. The patient was prescribed: the introduction of OD into the lacrimal passages through the lower tubule of the preparation of ocular ofloxacin gel in a volume of 3 ml every other day, a total of 8 sessions. On the 3rd day after administration of the drug, the patient noted a decrease in complaints of purulent discharge and lacrimation. On the 5th day after the administration of the drug, complaints of purulent discharge ceased; lacrimation decreased markedly. After a full course of treatment, complaints of purulent discharge and lacrimation were absent. Upon examination after 1, 3, 6 months and 1 year after treatment, the patient did not complain. OD lacrimal passable. No evidence of tear duct inflammation was found. Thus, a complete recovery of the patient was noted. A microscopic examination of the washings did not reveal Staphylococcus aurelius, which proves the high efficiency of the proposed treatment method.

Thus, the introduction of the ophthalmic gel ofloxacin into the tear ducts of the drug in the proposed mode leads to a complete recovery with partial dacryostenosis.

Claims (2)

1. The method of conservative treatment of dacryostenosis, characterized in that the ophthalmic gel is administered into the lacrimal tubule. 2. The method according to claim 1, characterized in that the ophthalmic gel ofloxacin is administered in a volume of 3 ml, every other day, only 8-10 times.