Tearing Due to Block Drainage System
19
Tearing Due to Block Drainage System Kimberly Cockerham, MD, FACS Plastics-Orbit-Adult Strabismus Zeiter Eye Medical Group, Inc.
description
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
Transcript of Tearing Due to Block Drainage System
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.
