Options for drugs on the processes of fibrotization of tear tracks

Relevance One of the key problems of dacryology is the disruption of lacrimation caused by dacryostenosis, which develops as a result of a chronic inflammatory process in the lacrimal ducts [1]. Currently, the option for resolving dacryostenosis is dacryocystorhinostomy, but the relapse rate reaches 18%, which determines the need to develop algorithms for drug action on fibrogenesis in the lacrimal drainage system [2]. We analyzed the effectiveness of drug action of different groups of drugs on the processes of fibrotization of the lacrimal ducts. The use of the antitumor drug Mitomycin C (MMC), which inhibits RNA synthesis in fibroblasts and reduces collagen formation, was carried out after endoscopic endonasal and external dacryocystorhinostomy, as well as after balloon dacryoplasty in the form of washing the lacrimal ducts with MMC, applications of turunda with MMC lasting from 2 to 30 minutes, as well as injections into the dacryostomy area intraoperatively and in the late period [3, 4]. Observations have shown that the success of surgical treatment in combination with drug prophylaxis is 10% higher than in the absence of therapy. Glucocorticosteroids (GCS) reduce the activity of fibroblasts, preventing fibrotization. The use of triamcinolone and dexamethasone in the form of turunda applications, hemostatic sponges and intraoperative injections into the dacryostomy area also led to a better functional result compared to the control group by 5-10%. The use of hyaluronic acid-based drugs (Merogel, Antiadgesin) by tamponade of the nasal cavity with hemostatic sponges, as well as by intraoperative rinsing of the lacrimal ducts made it possible to achieve a 10% reduction in the relapse rate after 6 months. The use of the biological drug chitosan in the composition of biodegradable xerogel sponges resulted in 100% success in postoperative patency of the lacrimal ducts. Low-molecular drugs pirfenidone, which reduces the synthesis of fibroblast collagenase, and dihydroartemisinin, which inhibits the activation of fibroblasts at the RNA and protein level, were effective in vitro on a cell culture of periorbital connective tissue and require further study [5]. Nanoparticles are a new pharmacological direction that has shown effectiveness in preventing conjunctival scarring, symblepharon and fibrosis after glaucoma filtration surgery. Genetically engineered drugs, namely small RNA molecules, can affect organ fibrosis, but their use in dacryology has not yet been described. Conclusion The presented data indicate that drug prevention of dacryostomy scarring in the postoperative period is certainly effective and should be carried out with the studied drugs. In addition, there is an obvious need to study the clinical effects of such groups of drugs as low-molecular, genetically engineered drugs and nanoparticles that have shown effectiveness in laboratory studies. Key words: dacryocystorhinostomy; dacryostenosis; prevention of fibrosis