By. Chittranjan kumar

Enternship

Def of lacrimal Apparatus

It is physiological system has formation and drainage also give nurshiment to cornea with help of tear

Any occlusion or defect in lacrimal drainage detected to a investigation is called lacrimal syringing.

Syringing is the method to test the structural integrity of lacrimal drainage system .

HENCE

ANATOMY OF THE LACRIMAL

DRAINAGE SYSTEM

Puncta

One punctum is present at the medial

end of both the superior and inferior lid.

Vertical canaliculus

This is about 2mm long and joins the

horizontal canaliculus at a right angle

called the ampulla.

Horizontal canaliculus

This is about 8mm long and usually joins

its fellow to form the common

canaliculus

(Naso)lacrimal sac

This is about lOmm long and

funnels into the nasolacrimal duct.

Nasolacrimal duct

This is about l2mm long and

opens into the inferior nasal meatus The

Valve of Hasner closes the

Most common blockage is at junction

of sac and NLD near valve of

haustner .

Syringing should be done with lower

canaliculus .

PHYSIOLOGY OF THE LACRIMAL

DRAINAGE SYSTEM

Pre –blink :-

Tear spread on the globe

Like Tear Meniscus

During blink:-

On blinking, the attachment of the preseptal orbicularis muscle helps create positive and negative pressure.

Due to pressure in the lacrimal sac which sucks the tears.

This is called the tear pump.

Post-blink:-

Gravity then helps keep the sac empty.

PHYSIOLOGY OF THE LACRIMAL DRAINAGE

SYSTEM

Pre Blink

During Blink

Post Blink

Tear spread on the Globe

Like tear Meniscus

Lacrimal sac suck the tear

Empty the lacrimal Sac

Tear meniscus

Known as

Tear pump

Lacrimal punctum Dialatation

Vertically Dialatation

Horizontally Dialatation

Lacrimal syringing

No Regurgitation Regurgitation with

pus other punctum Regurgitation other

punctum clear without

delay

Regurgitation

same punctum

Passage patent

Sac NLD junction block Common canaliculus

block

Same canali block

Interpretation

EQUIPMENT REQUIRED

Lacrimal punctum dilator

lacrimal cannulae

3 or 5m1 disposable sterile syringes

Anaesthetic drops, e.g. 4% xylocaine

cotton

Normal saline/ Ringer lacted

antibiotic solution

pt Better to supine position

Importance of syringing

One of the most important prior to intra ocular surgery .

If syringing is abnormal first the surgery of lacrimal sac is required before cataract surgery otherwise infection can reach intra ocular causing .

Endopthalmitis

Diseases of lacrimal sac

Dacryocystitis

Inflammation of Lacrimal sac is not uncommon condition may occur in two form

- Congenital Dacrycystitis

Occurs in new born infant.

- Adult Dacrycystitis

Surgery of Lacrimal sac

Dacryocystorhinostomy(DCR)

Re stablishes the lacrimal

drainage.

Dacryostectomy (DCT)

Removal of lacrimal sac.

THANKS

FOR

YOUR

ATTENTION

Prepared by : Chittranjan kumar

DOT final yaer