Tearing Due to Block Drainage System

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Tearing Due to Block Drainage System. Kimberly Cockerham, MD, FACS Plastics-Orbit-Adult Strabismus Zeiter Eye Medical Group, Inc. Systematic Approach to Tearing. Dry Wet Other Ocular Surface Eyelid Orbit. The “Wet” Eye. Tear Lake High Delayed Dye Disappearance. - PowerPoint PPT Presentation

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Tearing Due to Block Drainage System

Kimberly Cockerham, MD, FACSPlastics-Orbit-Adult Strabismus

Zeiter Eye Medical Group, Inc.

Systematic Approach to Tearing

Dry Wet Other

Ocular Surface Eyelid Orbit

The “Wet” Eye

Tear Lake HighDelayed Dye Disappearance

2% Fluorescein in each eye Abnormal test if: Asymmetric Persistent dye at:

5 min in young 15 min in elderly

Anatomy

Puncta

Canaliculus

Lacrimal sac

Lacrimal duct

Evaluation of the Wet Eye If there is delayed dye

disappearance: Inspect the puncta Push on lacrimal sac Probe the canaliculi Irrigate the nasolacrimal system

Punctal Stenosis Inflammation Topical drops Exposure

RX = punctopexy

Punctal Infiltration

RX = Excision and Reconstruction

Canalicular Abnormality Infection (canaliculitis) Trauma Chemotherapy Topical medications (glaucoma

drops)

Canaliculitis

Actinomyces: three snip followed by topical Pen G

Nasolacrimal Duct Obstruction

Infection Inflammation

Wegner’s Sarcoidosis Steven’s Johnson Herpes

Intranasal abnormality

Dacryocystitis

Lacrimal Sac Mass

Inflammation Sarcoidosis Non-specific inflammation

Neoplasia Squamous cell carcinoma Lymphoma

Evaluation of the Wet Eye Irrigation

Flows freely to mouth or nose System not structurally blocked Functional block still possible

Jones I No irrigation Is Fluorescein detected in nose ?

Jones II Irrigate after Jones I Is Fluorescein detected in nose ?

The Role of Imaging

Endoscopic View: Canalicular Stenosis,

RX = KTP laser

Proximal Canalicular Stenosis

Extensive Stenosis

RX = Jones Tube

Dacryocystorhinostomy (DCR)

Dry: Tear Lake Low

Normal Dye DisappearanceOther:

Tear Lake Often NormalDye Disappearance Often Normal

Listen and Look for CluesWet:

Tear Lake HighDelayed Dye Disappearance

A Systematic Approach to Tearing

Questions….Concerns ?Questions….Concerns ?Questions….Concerns ?Questions….Concerns ?

Kimberly Cockerham, MD, Kimberly Cockerham, MD, FACSFACSPlastics – Orbit – Adult StrabismusPlastics – Orbit – Adult Strabismus

Zeiter Eye Medical Group, Inc.

Kimberly Cockerham, MD, Kimberly Cockerham, MD, FACSFACSPlastics – Orbit – Adult StrabismusPlastics – Orbit – Adult Strabismus

Zeiter Eye Medical Group, Inc.