Canalicular test ophthalmology. tubular test

GOAL: diagnostic.

INDICATIONS:

CONTRAINDICATIONS: no.

EQUIPMENT: stool, cotton or gauze balls, drops of collargol 3% or fluorescein 1%, pipettes.

REQUIRED CONDITION: no.

Technique:

The patient is seated on a chair.

If after 1-2 minutes the lacrimal fluid begins to discolor, therefore, the suction function of the tubules is preserved, and the tear passes freely through them into the lacrimal sac - a positive canalicular test.

If the paint is retained in the conjunctival sac for a longer period, the tubular test is considered negative.

1. nasal test

GOAL: diagnostic.

INDICATIONS: carried out with a pathology of the lacrimal apparatus.

CONTRAINDICATIONS: no.

EQUIPMENT: stool, cotton or gauze balls, gauze pads, drops of collargol 3% or fluorescein 1%, nasal tweezers, pipettes.

REQUIRED CONDITION: no.

Technique:

The patient is seated on a chair.

A cotton or gauze swab is inserted into the lower nasal passage with nasal tweezers from the examined side.

A 3% solution of collargol or a 1% solution of fluorescein is instilled into the conjunctival sac.

After 5 minutes, the swab is removed.

The appearance of a coloring matter after 3-5 minutes on a swab (or on a napkin when blowing your nose) indicates a positive nasal test with normal lacrimal duct patency.

If there is no paint on the swab at all, or if it appears later, then the nasal test is considered negative or sharply delayed.

1. Examination of intraocular pressure by palpation

GOAL: diagnostic.

INDICATIONS: carried out for an approximate study of intraocular pressure.

CONTRAINDICATIONS: no.

EQUIPMENT: no.

REQUIRED CONDITION: no.

Technique:

The patient is asked to look down.

The index fingers of both hands are placed on the eyeball and alternately press on it through the eyelid.

At the same time, tension is felt.

About the level of intraocular pressure (tensio) judged by the compliance of the sclera. There are four degrees of eye density: T n - normal pressure; T +1 - the eye is moderately dense; T +2 - the eye is very dense; T +3 - the eye is hard as a stone.

With a decrease in intraocular pressure, three degrees of hypotension are distinguished: T -1 - the eye is softer than normal; T-2 - the eye is soft; T-3 - the eye is very soft, the finger almost does not meet resistance.

1. Determination of corneal integrity

GOAL: diagnostic.

INDICATIONS: performed in case of disease or damage to the cornea.

CONTRAINDICATIONS: no.

EQUIPMENT: chair, table, table lamp, 13 and 20 diopter lenses, binocular magnifier, slit lamp, cotton or gauze balls, 1% fluorescein solution, pipettes.

REQUIRED CONDITION: a dark room.

TECHNIQUE:

The patient is seated on a chair.

A 1% solution of fluorescein is instilled into the conjunctival sac.

Wash the conjunctival sac.

The cornea is examined with focal illumination or with the help of biomicroscopy.

The defect in the cornea turns green.

GOU VPO SOGMA Roszdrav

Ophthalmology course SOGMA

Practical skills.

Study of visual acuity according to the Sivtsev table. (3)

Irrigation of the conjunctival sac. (3)

GOU VPO SOGMA Roszdrav

Ophthalmology course SOGMA

Practical skills.

Study of visual acuity below 0.1. (3)

Instillation of drops. (3)

GOU VPO SOGMA Roszdrav

Ophthalmology course SOGMA

Practical skills.

Perimetry. (2)

Applying ointment. (3)

GOU VPO SOGMA Roszdrav

Ophthalmology course SOGMA

Practical skills.

Determination of the boundaries of the field of view in a control way. (3)

Removal of surface foreign bodies from the cornea and conjunctiva. (2)

GOU VPO SOGMA Roszdrav

Ophthalmology course SOGMA

Practical skills.

External examination of the eye and surrounding tissues. (3)

Applying a monocular bandage. (3)

GOU VPO SOGMA Roszdrav

Ophthalmology course SOGMA

Practical skills.

Eversion of the lower eyelid. (3)

Applying a binocular bandage. (3)

GOU VPO SOGMA Roszdrav

Ophthalmology course SOGMA

Practical skills.

Eversion of the upper eyelid. (3)

Diaphanoscopy. (2)

GOU VPO SOGMA Roszdrav

Ophthalmology course SOGMA

Practical skills.

Determination of the presence of pathological contents in the lacrimal sac. (3)

Fixation of young children for eye examination. (3)

GOU VPO SOGMA Roszdrav

Ophthalmology course SOGMA

Practical skills.

Examination of the eye with focal illumination. (3)

canal test. (2)

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Ophthalmology course SOGMA

Practical skills.

Ticket number 10

Study of the eye in transmitted light. (3)

Nasal test. (2)

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Ophthalmology course SOGMA

Practical skills.

Ticket number 11

Ophthalmotonometry. (3)

The study of intraocular pressure by palpation. (3)

GOU VPO SOGMA Roszdrav

Ophthalmology course SOGMA

Practical skills.

Ticket number 12

Exophthalmometry. (2)

Determination of the integrity of the cornea. (3)

general information

To start working in the Vesta.Priemka subsystem, after authentication, in the window that appears, click on the link "Acceptance"(fig.1):

Rice. 1. List of available subsystems in the Vesta system

Colored pictograms above the button "Add sample"(Fig. 2), mean:

• Green- link to | official website of Rosselkhoznadzor;
• Blue- link to the website dedicated to the state information system in the field of veterinary medicine | "Vetis" ;
• yellow- link to the help system dedicated to the automated system "Vesta" .

Rice. 8. Counterparty search form in the Vesta.Priemka subsystem (05/12/2015)

If the counterparty is not found, you can add it yourself by going to the tab "Add New".

The filling form may vary depending on the type of counterparty; for an individual, the following fields are filled in (Fig. 8):

• Counterparty type- selection of the counterparty type: Legal entity, Individual, Individual entrepreneur;
• Full name- the full name of the counterparty is indicated;
• The passport- specify the passport data of the counterparty;
• TIN- the TIN of the counterparty is indicated, if any;
• Country- selection of the country of the counterparty;
• Region- choice of region;
• Locality, The outside, House, Structure, Office/Apartment.

After filling in the fields, click on the button "Add".

Rice. 8. Filling out the form for adding a new counterparty in the Vesta.Priemka subsystem (05/12/2015)

Block "Sampling"

Contains the following fields (Fig. 9):

Rice. 9. Filling in the "Sampling" block in the "Vesta. Acceptance" subsystem (05/12/2015)

• Owner- the counterparty is indicated - the owner of the product or material from which the sample is taken. It is necessary to press the button with three white stripes;
• Selection certificate number- the number of the sampling act is indicated;
• Date of selection act- the date of the sampling act is indicated;
• Room safe package- the number of the safe package is indicated;
• Date and time of selection- indicate the date and time of sampling;
• Place of selection- the place of sampling is indicated;
• Selection made- indicated executive who took the sample.
• In the presence- the persons in whose presence the sampling was carried out, if any, are indicated.
• ND for sampling- indicated normative document, regulating sampling;
• Number of samples- the number of samples taken is indicated, as well as the type of product packaging;
• Sample weight/volume- the mass and units of measurement of the sample are indicated;
• Accompanying document- the accompanying document for the product, if any, is indicated. It can be an invoice, an inventory, a label.

Block "Origin"

Contains the following fields to fill in (Fig. 10):

Rice. 10. Filling in the "Origin" block in the "Vesta. Acceptance" subsystem (05/12/2015)

• Manufacturer- indicates the manufacturer of the product. It is necessary to press the button with three white stripes.

Rice. 11. Adding a manufacturer in the Vesta.Priemka subsystem (05/12/2015)

• Country of origin- the country of origin is indicated;
• Region of origin- the region of the country of origin is indicated;
• Origin- a text field where you can enter information about the origin of products;
• RD for the production of the product- normative document for production;
• Fishing area.

Block "Information about the party"

Contains the following fields to fill in (Fig. 12):

Rice. 12. Filling in the block "Information about the lot" in the subsystem "Vesta.Acceptance"

• Vet number. document- number of the veterinary accompanying document accompanying the batch;
• Vet date. document- date of the veterinary accompanying document accompanying the batch;
• Departure country- country-sender of products (selected from the drop-down list);
• Departure region- region of the sending country (selected from the drop-down list);
• Point of departure- point of departure of products;
• Sender- name of the sender;
• Destination country- the recipient country of the products (selected from the drop-down list);
• Destination region- region of the recipient country (selected from the drop-down list);
• Destination- the final destination where the product goes;
• Recipient- name of the recipient of the products;
• Marking- marking of cargo;
• Weight/batch volume- weight/volume of the lot with indication of the unit of measurement;
• Quantity per lot- quantity of products (material) with indication of the unit of measure;
• Production date;
• Best before date;
• Transport- you need to specify the type of transport (select from the list) and indicate the number vehicle or title, then add to the party information by clicking on the plus icon.

Alternative names: West color test, fluoroscein test, nasal test.

A color nasal tear test is one of the research methods in ophthalmology, which consists in assessing the active patency of the paths along which tears flow from the eye into nasal cavity. During the study, the doctor measures the time it takes the dye, buried in the conjunctival cavity, to get from the conjunctival cavity into the nasal passage.

The purpose of this technique is to give an integrative assessment of the active conductivity of the lacrimal fluid throughout the lacrimal ducts.

This research method is the most popular method for diagnosing diseases of the lacrimal ducts due to the simplicity of its implementation and total absence side effects and complications.

Preparing for the test. No special preparation is required. Testing is possible at any time of the day.

How is a color tear-nasal test performed?

The patient sits, one drop of dye (1% sodium fluoroscein solution or 3% collargol solution) is instilled into the conjunctival cavity with a pipette. After that, the doctor asks the patient to tilt his head forward and blink a little. After 3 and 5 minutes, the patient is asked to blow his nose into a damp cloth for each nostril separately. If necessary, the doctor introduces under the lower turbinate bellied probe, tightly wrapped with wet cotton wool or bandage. By the presence of dye on a napkin or bandage, the results are interpreted.

Interpretation of results

With normal patency of the lacrimal ducts, the dye enters the nasal cavity no later than 5 minutes later. In this case, the sample is considered positive.

Staining of a napkin or turunda from 6 to 20 minutes after the introduction of the dye is regarded as a delayed test. This fact can speak of stenosis of one of the departments of the lacrimal ducts.

If the dye appears later than after 20 minutes or does not appear at all, the sample is considered negative. This may occur with complete obstruction of the lacrimal canaliculi or the nasolacrimal duct.

Indications

The main indications for a color nasal tear test are lacrimation and lacrimation. Also, this test can be carried out as part of a comprehensive examination of the organ of vision during preventive examinations.

Contraindications for the test

The only contraindication for the test is the individual intolerance to the dye (collargol or fluorescein). Given that these substances do not have cross-allergies, with allergic reaction one drug can be tested by means of another.

Complications

Complications are not noted.

additional information

This test is highly specific, but in some cases it is possible to obtain false results. This happens in the following cases: with severe inflammation of the nasal mucosa (rhinitis) or when the dye is squeezed onto the skin with blepharospasm (involuntary contraction of the circular muscle of the eye). In these cases, it is advisable to postpone the procedure.

The color nasal tear test is the most accessible method for studying the active patency of the lacrimal ducts. The only more accurate alternative method is scintigraphy of the lacrimal ducts, which is based on the observation of the passage of a radiopharmaceutical containing the isotope of technetium-99 through the gamma camera. This study allows you to assess the degree of stenosis of the tubules and canals. However, due to the complexity of this study it is not widely used in clinical practice.

According to the results of a color nasal tear test, the question of the need for other examination methods is most often decided: diagnostic washing and probing of the lacrimal ducts, radiography of the lacrimal ducts. A comprehensive examination allows you to make the correct diagnosis and determine the tactics of treatment.

Literature:

Maybe my story will help someone who now has problems with his eyes.
When Nastya was born in the maternity hospital, they told me that she had conjunctivitis and was sent to another hospital, where we lay for 10 days, smeared the eye with tetracycline ointment, but as soon as they stopped smearing, the eye began to fester again. But when we arrived home, I called my relative, she I have a nurse and she told me: “Natasha, it doesn’t look like you have conjunctivitis, because after tetracycline it disappears on the third day, and you most likely have an obstruction of the lacrimal canal, it’s better to go to the ophthalmologist.” But we don’t go to the ophthalmologist got there, the queue is oh-oh-huge. At 1.5 months we met our nurse and she said that we would have to flush the eye, from the word “wash” to such a crumb to me like a knife to the heart, I immediately began to look for information on how to avoid this procedure and found the following article:

In the first days after birth, children often develop purulent discharge from the eyes. One of the causes of purulent discharge can be neonatal dacryocystitis- inflammation of the lacrimal sac.

Why does this disease develop?

Usually, in all people, a tear from the eye goes through the tear ducts into the nasal passage. The lacrimal ducts include: the lacrimal puncta (upper and lower), the lacrimal ducts (upper and lower), the lacrimal sac, and the lacrimal canal, which opens
under the inferior nasal concha (here the lacrimal fluid evaporates due to the movement of air during breathing), it is 1.5 - 2.0 cm from the external nasal opening. Posteriorly, the nasal cavity communicates with the upper pharynx (nasopharynx). During intrauterine life, a child has a gelatinous plug or film in the nasolacrimal duct that protects it from amniotic fluid. At the time of birth, with the first breath and cry of the newborn, the film breaks, and the canal is patency. If this does not happen, then the tear stagnates in the lacrimal sac, an infection joins, acute or chronic dacryocystitis develops.
The first signs of dacryocystitis, which are detected already in the first weeks of life, are the presence of mucopurulent discharge from the conjunctival sac of one or both eyes, lacrimation, lacrimation (rarely) in combination with mild reddening of the conjunctiva. This process is often mistaken for conjunctivitis.
The main symptom of dacryocystitis is the release of mucopurulent contents through the lacrimal openings with pressure on the area of ​​the lacrimal sac. Sometimes this symptom is not detected, which may be due to previous drug therapy. To clarify the diagnosis, a collarhead test (West test) is performed. 1 drop of a 3% solution of collargol (dye) is instilled into the eyes. First, a cotton wick is inserted into the nasal cavity. The appearance of a coloring matter on the wick 5 minutes after instillation is evaluated as a positive test. The test is considered delayed when paint is detected in the nose after 6-20 minutes and negative after 20 minutes. The test can also be considered positive if, after the instillation of collargol, the conjunctiva became clear. eyeball within 3 minutes. A negative result of the tear-nasal test indicates a conduction disorder in the lacrimal system, but does not determine the level and nature of the lesion, therefore, consultation with an ENT doctor is necessary, because. the canal is lacrimal-nasal, so if the child has a runny nose, the mucous membrane of the lacrimal ducts swells, the lumen narrows and the outflow of tears is difficult. A severe complication of unrecognized and untreated neonatal dacryocystitis may be phlegmon of the lacrimal sac, accompanied by a significant increase in body temperature and anxiety of the child. As an outcome of the disease, fistulas of the lacrimal sac are often formed.
At chronic course main process clinical sign is a copious purulent discharge from the lacrimal sac that fills the entire palpebral fissure, usually after sleep or crying.
Once the diagnosis is established, treatment should begin immediately. First, study the anatomy of the lacrimal ducts, the projection of the lacrimal sac (see above). Before starting the massage, wash your hands thoroughly, cut your nails short, and use sterile gloves.
1. Squeeze out the contents of the lacrimal sac.
2. Drop a warm solution of furacilin 1:5000 and use a sterile cotton swab to remove the purulent discharge.
3. Massage the area of ​​the lacrimal sac by gently pressing 5 times with your index finger from top to bottom with jerky movements, trying to break through the gelatinous film.
4. Drip disinfectant drops(levomycetin 0.25% or vitabact)
5. These manipulations should be carried out 4-5 times a day. Massage is carried out for at least 2 weeks. According to the literature and our data, the gelatinous plug resolves or breaks through by 3-4 months if the parents correctly and accurately follow the above recommendations.
If these manipulations did not give the desired result, then it is necessary to perform probing of the lacrimal canal in the conditions of the eye office. Probing of the lacrimal canal is a complex, painful and far from safe procedure. Under local anesthesia(pain relief), with the help of Sichel conical probes, the lacrimal puncta and lacrimal canaliculi are expanded, then the longer Bowman probe No. 6; No. 7; No. 8 is introduced into the lacrimal-nasal canal and breaks through the plug there, then the canal is washed with a disinfectant solution. After probing, it is necessary to massage for 1 week (see above) to prevent relapse associated with the formation of an adhesive process.
Probing is ineffective only in cases where dacryocystitis is due to other causes: anomaly in the development of the lacrimal canal, curvature of the nasal septum, etc. These children need a complex surgical intervention - dacryocystorhinostomy, which is performed no earlier than 5-6 years.

Dacryocystitis is an inflammation of the lacrimal sac and occurs in 1-5% of newborns. Dacryocystitis is diagnosed in the first days and weeks of life, so it happens that a baby is diagnosed already in the hospital.

The causes of the disease can be:
– Pathology of the nose and surrounding tissues due to inflammation or trauma.
- Obstruction of the nasolacrimal duct by the time of the birth of the child, due to the presence of the so-called gelatinous plug, which has not resolved by the time of birth.

Normally, free communication between the nasolacrimal duct and the nasal cavity is formed at the 8th month of intrauterine development. Until this time, the outlet of the lacrimal canal is closed by a thin membrane. By the time of birth, for the most part, the membrane resolves, or breaks through at the first cry of the child. If the film does not dissolve or does not break through, then there are problems with tear drainage. As in most cases, the outcome of the disease depends on timely diagnosis and timely treatment.

The first signs of the disease are mucous or mucopurulent discharge from the eye, swelling in the inner corner of the eye.
Quite often, pediatricians regard this as conjunctivitis and prescribe anti-inflammatory drops, but this treatment does not help.
Distinctive signs of dacryocystitis is the release of a mucopurulent character, with pressure on the area of ​​​​the lacrimal openings.

Treatment begins with a massage of the lacrimal canal. The purpose of the massage is to break through the gelatinous film. Massage of the lacrimal canal is performed with several jerky or vibrating movements of the finger with some pressure directed from top to bottom, from the top of the inner corner of the eye down. Through the creation high blood pressure in the nasal duct, the embryonic membrane breaks. (Does this remind you of the plunger principle?)
Massage should be done 8-10 times a day. If there is no effect in the coming days, then it should be continued for a month. Purulent discharge, which is squeezed out of the lacrimal sac, must be removed with a cotton ball dipped in a decoction of chamomile, tea leaves, or calendula.

If massage does not help, then hard probing of the lacrimal canal is necessary. It is better to do it in 2, 3 one month old.

To carry out this procedure, it is necessary to pass a blood test for clotting, and an examination by an ENT doctor to exclude the pathology of the nasal cavity. After the probing procedure, treatment in the form of drops continues for another week as prescribed by the doctor, and massage is preferably carried out within a month.

Keratometry. Keratometry is used already in the study of the organ of vision in a child in maternity hospital. This is necessary for early detection congenital glaucoma. Keratometry, which can be performed by almost anyone, is based on measuring the horizontal size of the cornea using a ruler with millimeter divisions or a strip of paper from a checkered notebook. Substituting the ruler as close as possible, for example, to the right eye of the child, the doctor determines the division on the ruler, which corresponds to the temporal edge of the cornea, closing his right eye, and corresponding to the nasal edge - closing his left eye. The same should be done when a “cell strip” is brought to the eye (the width of each cell is 5 mm). When performing keratometry, it is necessary to remember the age norms of the horizontal size of the cornea: 9 mm in a newborn, 10 mm in a 5-year-old child, and about 11 mm in an adult. So, if in a newborn it fits into two cells of a strip of paper and a small gap remains, then this is the norm, and if it goes beyond two cells, then pathology is possible. For a more accurate measurement of the diameter of the cornea, devices have been proposed - a keratometer, a photokeratometer (Fig. 37).

It should be noted that when examining the cornea, it is important to determine not only its transparency, sensitivity, integrity and size, but also its sphericity. Especially great importance this research acquires last years in connection with the increasing spread of contact correction of vision. Keratoscopes are used to determine the sphericity of the cornea.

Algesimetry. An important criterion in the diagnosis, assessment of the severity and dynamics of the pathological process is the state of sensitivity of the cornea. The simplest of the known methods, although crude, allowing only an approximate idea of ​​the sensitivity of the cornea, is algesimetry using a cotton wool or hair. In order not to frighten children, one should bring a lint or hair to the eye not directly, but from the temporal side, doing it slowly, as if imperceptibly, then with the right, then with the left hand, slightly pushing the eyelids (opening the palpebral fissure) with the other hand from the side of the nose . Such a study makes it possible to judge the presence of pronounced sensitivity or its significant violation.

A more complex, but quite accessible and quite informative study is the determination of the sensitivity of the cornea using a set of hairs (according to Samoilov) of different elasticity (0.5; 1.0; 3.0; 5.0; 10.0, etc.), which can be fixed in the crevice of the end of the match. Previously, on an analytical balance, the elasticity of the hairs is determined (mass, the force of movement at which the hair is bent). Prepare, as a rule, 4-6 different hairs and each of them is numbered. Store the hairs in a box (a small syringe sterilizer). First, the study is carried out at different points along the periphery and in the center of the cornea (6-8 points or more), using the least elastic hair. If sensitivity is not determined with the help of this hair, then hairs with greater elasticity are successively used. The sensitivity of the cornea is determined by the hair that caused the reaction. The sensitivity at different points may be different, in these cases the sensitivity at each point is recorded. In order to assess the dynamics of corneal sensitivity in the course of the disease and under the influence of treatment, it is necessary to compare the results of repeated studies with the original data, but it is necessary to start the study again, as in the first study, with the hairs of the least elasticity.

The most advanced devices for studying and recording the state of sensitivity of the cornea are algesimeters of various designs, which were proposed by A. N. Dobromyslov and B. L. Radzikhovsky. However, they are used, as a rule, in the course of research and clinical and experimental work. In practice, it is enough to conduct a study of the hair sensitivity of the cornea, but always in dynamics and in each eye.

Methods of research of the lacrimal ways. The study of the lacrimal ducts in children should be carried out in the maternity hospital, and then throughout the first six months of life. In almost 5% of newborns, the nasolacrimal duct is closed with a gelatinous plug, which dissolves in the first days of life as a result of exposure to the mucous-tear fluid containing the lysozyme enzyme, and the lacrimal passageway is opened. However, in about 1% of newborns, this plug does not dissolve, but is organized into a connective tissue septum, as a result of which tear drainage is impossible. In addition, the cause of the violation of the patency of the lacrimal ducts can be changes in each of their departments, as well as in the nose. The first sign of the pathology of the lacrimal ducts is a constant lacrimation, and often lacrimation. In order to establish the cause or causes of lacrimation and lacrimation, it is necessary to consistently carry out a series of studies, starting with a simple visual determination of the position of the eyelids in relation to the eyeball. Normally, the upper and lower eyelids are in contact with the eyeball, and thus, it can be considered that the lacrimal stream is fully functioning. The presence of eversion, inversion, coloboma of the eyelids, lagophthalmos and other changes mainly in the edge of the eyelids can cause lacrimation and lacrimation.

It is also very important to establish whether the newborn has lacrimal openings, how they are expressed and where they are located. To do this, slightly pull each eyelid at the inner corner. palpebral fissure and determine the status of each lacrimal opening. If, in the normal position of the eyelids, the lacrimal openings are not visible and appear only when the eyelid is gently pulled back, then it means that they are located correctly. Normally, the lacrimal openings are clearly defined as a miniature funnel-shaped depression in the lacrimal tubercle.

By pressing a finger or a glass rod on the area of ​​the lacrimal canaliculus with a retracted eyelid, they check if there is any mucous or other discharge from the lacrimal openings. As a rule, there is no discharge from the lacrimal openings during this manipulation.

The next step in the study is to determine the presence and functioning of the lacrimal sac. For this purpose, a finger or a glass rod is pressed on the skin near the lower inner corner of the orbit, i.e., in the projection area of ​​the lacrimal sac. In this case, the eyelid should be pulled away from the eyeball so that the lacrimal opening is visible. If, when pressing on this area, there is no discharge from the lacrimal punctum or it is very scarce, transparent and liquid (tear), then there is a lacrimal sac. However, it is safe to say that it functions well and has correct location and sizes are not allowed. If during this manipulation there is an abundant mucous or mucopurulent discharge from the lacrimal openings, then this indicates an obstruction of the nasolacrimal duct. In the same rare cases when, when pressing on the area of ​​the lacrimal sac, its contents do not come out through the lacrimal openings, but through the nose (under the inferior nasal concha), one can think about the irregular structure and shape of the lacrimal sac and the patency of the bone part of the nasolacrimal duct.

In conclusion, the region of the inferior turbinate is examined, the state of the nasal septum is determined. In addition, pay attention to the presence or absence (difficulty) of nasal breathing.

After conducting visual manual studies, functional lacrimal and lacrimal-nasal tests should be performed.

Functional tests are carried out in two stages. The first stage is an assessment of the functioning of the lacrimal ducts from the lacrimal punctum to the lacrimal sac (West's canalicular test), the second - from the lacrimal sac to the exit of fluid from under the inferior nasal concha (Lacrimal-Nasal West's test). Lacrimal-nasal West test is performed as follows. A loose swab of cotton wool or gauze is introduced under the lower nasal concha; 2-3 drops of a 1-3% solution of collargol or fluorescein are instilled into the conjunctival cavity; note the time of instillation and the time of disappearance of the coloring matter from the conjunctival sac (normally it should not exceed 3-5 minutes). After 5 minutes after instillation of the dye, every minute the tampon is removed from the nose with tweezers and the time of appearance of its staining is set.

The West tear-nasal test is considered positive if the staining of the tampon occurred in the first 7 minutes after the installation of the dye, and weakly positive or negative if the staining was noted after 10 minutes or did not occur at all.

In cases where the canalicular or lacrimal-nasal West tests, or both together, are slow or negative, diagnostic probing with a Bowman probe (No. 1) should be performed. In the process of careful probing, either the free patency of each of the sections of the lacrimal ducts, starting from the lacrimal opening and ending with the bone part of the nasolacrimal duct, or an obstruction in any of the sections is revealed. Before probing or after it, lacrimal ducts are washed. To do this, using a syringe and a blunt straight or curved needle under pressure, a weak solution of an antiseptic, an antibiotic, a sulfanilamide drug, an isotonic sodium chloride solution, and lidase is injected through the upper (if necessary, through the lower) lacrimal opening. If the solution is released only through the nose, then this test is positive, if both through the nose and through the second lacrimal opening, then it is weakly positive, and if only through the second lacrimal opening, then it is negative. In cases where fluid is released from the same lacrimal opening, i.e., does not pass through the tubules, the sample is considered sharply negative. In order to exclude the presence of an obstruction in the nasolacrimal duct in such cases, retrograde probing is performed together with an otorhinolaryngologist.

Finally, in order to finally establish the localization and size of the pathology of the lacrimal ducts, an x-ray examination should be carried out. Iodolipol is used as a contrast agent, which is injected through the lacrimal openings, after which an x-ray is taken. According to the X-ray contrast picture, strictures and diverticula, obstruction of various parts of the lacrimal canaliculus, lacrimal sac, bone part of the nasolacrimal duct are revealed.

Only after the consistent conduct of all diagnostic studies, it is possible to make the correct diagnosis and choose an adequate method of treatment (bougienage, probing, reconstructive operation on the lacrimal ducts, in the nose).

Due to the fact that the pathology of the lacrimal organs consists not only in impaired lacrimal drainage, but also in changes in the lacrimal apparatus (lacrimal gland), it is necessary to know that the dysfunction of the lacrimal gland can be judged by the parameters of the Shprimer test. The essence of this test is that for the lower eyelid for 3-5 minutes a strip of filter paper 0.5 cm wide and 3.5 cm long is laid. If all the paper becomes homogeneously moist during this time, then this indicates the normal functioning of the gland, if it is faster or slower, then, therefore, its hyper- or hypofunction is noted, respectively.

Fluorescein test. A fluorescein test is carried out if there is a suspicion of a violation of the integrity of the cornea (keratitis, damage, dystrophy). 1-2 drops of fluorescein solution are installed in the conjunctival cavity (on the cornea) (in cases where there is no fluorescein solution, the test can be performed using a collargol solution), and then the cavity is quickly washed with isotonic sodium chloride solution or any eye solutions of antiseptics, antibiotics, sulfa drugs. After that, the cornea and conjunctiva are examined using a combined method using a binocular loupe, a manual or stationary slit lamp. If there is a defect in the cornea (the integrity of the epithelium and its deeper layers is broken), then a yellowish-greenish coloration will be visible in this place. In the process of treating a disease (damage) of the cornea, the test is used repeatedly, which allows you to monitor the dynamics of the process, the effectiveness of treatment and the restoration of its integrity.