LACRIMAL DISORDERS

Objectives: Preview

• Anatomy & Physiology• Approach • Pathology – Cong NLD Obst– Lacrimal system infections• Acute• Chronic

Anatomy

• Secretory– LG• Tears

• Excretory– NLS• Passive • Active (pump)

HYPER

LACRIMATION

Causes of tearing

Lid : Malposition,Facial palsy, Punctal stenosisConj&Cornea: Abrasion, FB, KeratitisGlaucoma NLD obstruction

Approach

• Symptoms– Tearing– Discharges– Swelling

• POH– med & surg

• Visual acuity: VA– 6/60– HM– LP– NLP

• Lacrimal sac swelling• Regurgitation– On pressure reflux of purulent material from punctum

• Lids– Swelling – Punctum

• Conjunctiva• Tear film• Cornea

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.

Dry eye: Tear break-up time: trachoma

Schirmer test: Sjogren syndrome

Pathology

Congenital nasolacrimal duct obstruction

•Delayed canalization

•NLD obstruction occurs in 2% of newborns

•Can be bilateral

•Reflux of purulent material from punctum

•Role out congenital glaucoma

•Usually resolve during the first year of life

Management Medical • Massage of nasolacrimal duct

(hydrostatic pressure)• Antibiotic drops..

Surgical • Probing• Intubation • DCR

Pathology

• Redness • Discharges • Epiphora• Canthal swelling,

below inner canthus• Tenderness

• Usually secondary to NLD

obstruction and tear stasis

Acute Dacryocystitis

Complications

• Lacrimal abscess• Presptal Cellulitis• Orbital Cellulitis

– Orbital Abscess– CST– Brain Abscess– Death

Medical Surgical

Rx

Pathology

Epiphora and chronic or recurrent unilateral conjunctivitis

Expressed mucopurulent discharge Painless swelling at inner canthus

Treatment – DCR

Chronic Dacryocystitis

DacryocystorhinostomyDCR

Review• Anatomy • Physiology• Approach• Causes of the watery eyes• Cong NLD Obst• Lacrimal system infections: – Acute?– Chronic?

Problem solving• NLD obstruction + Cataract

Lecture Evaluation: poor-fair-very good

1. How would you grade it2. How would you grade yourself3. comments

QuizSigns of acute dacryocystitis:Dry eyesPainless swelling Proptosis

Nasolacrimal duct opens-in the nose- at:Superior meatus Middle meatusInferior meatus