lacrimal disorders
TRANSCRIPT
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LACRIMAL DISORDERS
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Objectives: Preview
• Anatomy & Physiology• Approach • Pathology – Cong NLD Obst– Lacrimal system infections• Acute• Chronic
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Anatomy
• Secretory– LG• Tears
• Excretory– NLS• Passive • Active (pump)
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HYPER
LACRIMATION
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Causes of tearing
Lid : Malposition,Facial palsy, Punctal stenosisConj&Cornea: Abrasion, FB, KeratitisGlaucoma NLD obstruction
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Approach
• Symptoms– Tearing– Discharges– Swelling
• POH– med & surg
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• Visual acuity: VA– 6/60– HM– LP– NLP
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• Lacrimal sac swelling• Regurgitation– On pressure reflux of purulent material from punctum
• Lids– Swelling – Punctum
• Conjunctiva• Tear film• Cornea
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Dye disappearance test DDT
Place a drop of fluorescein in each eye, and monitor with cobalt blue light; if a pool is still present after 5 minutes the test is positive.
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Dry eye: Tear break-up time: trachoma
Schirmer test: Sjogren syndrome
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Pathology
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Congenital nasolacrimal duct obstruction
•Delayed canalization
•NLD obstruction occurs in 2% of newborns
•Can be bilateral
•Reflux of purulent material from punctum
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•Role out congenital glaucoma
•Usually resolve during the first year of life
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Management Medical • Massage of nasolacrimal duct
(hydrostatic pressure)• Antibiotic drops..
Surgical • Probing• Intubation • DCR
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Pathology
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• Redness • Discharges • Epiphora• Canthal swelling,
below inner canthus• Tenderness
• Usually secondary to NLD
obstruction and tear stasis
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Acute Dacryocystitis
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Complications
• Lacrimal abscess• Presptal Cellulitis• Orbital Cellulitis
– Orbital Abscess– CST– Brain Abscess– Death
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Medical Surgical
Rx
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Pathology
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Epiphora and chronic or recurrent unilateral conjunctivitis
Expressed mucopurulent discharge Painless swelling at inner canthus
Treatment – DCR
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Chronic Dacryocystitis
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DacryocystorhinostomyDCR
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Review• Anatomy • Physiology• Approach• Causes of the watery eyes• Cong NLD Obst• Lacrimal system infections: – Acute?– Chronic?
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Problem solving• NLD obstruction + Cataract
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Lecture Evaluation: poor-fair-very good
1. How would you grade it2. How would you grade yourself3. comments
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QuizSigns of acute dacryocystitis:Dry eyesPainless swelling Proptosis
Nasolacrimal duct opens-in the nose- at:Superior meatus Middle meatusInferior meatus
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