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My Own Deck > Disorders Of Lacrimal Gland Tumours > Flashcards

Disorders Of Lacrimal Gland Tumours Flashcards

1
Q

What are the features of the Lacrimal system

A
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2
Q

Where is the Lacrimal gland found?

A

Orbital lobe

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3
Q

Which is the main aqueous producer and accessory ducts to produce this?

A

Lacrimal gland- main

Krause and wolfring- 5-10%

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4
Q

What is the innervation of the lacrimal gland?

A

Ophthalmic division- Trigeminal nerve (lacrimal nerve branch)

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5
Q

What is secondary to the irritation of cornea and conjunctiva?

A

Reflex lacrimation

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6
Q

What is Bells palsy?

A

Lack of movement affecting 1 side of your face

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7
Q

Which muscle is effected in bells palsy?

A

Lavator muscle

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8
Q

What are the features of bells palsy?

A
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9
Q

What is dacryoadenitis?

A

Inflammation of the lacrimal gland

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10
Q

What are the features of dacryoadenitis?

A
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11
Q

What are the chronic systemic auses of dacryoadenitis?

A

Sarcoidosis

Thyroid eye disease

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12
Q

What are the presentations of lacrimal gland tumours?

A
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13
Q

What is the function of the tear film?

A 
Lubrication 
Smooth pre corneal refracting surface
Removes debris
Microbial defence 
Regulate temperature
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14
Q

What is the total tear volume?

A

7-10 microletres

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15
Q

What aspects of the tears is a realisable predictor of tear volume insufficiency?

A

Tear meniscus

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16
Q

In an emotional state, which gland would produce tears?

A

Lacrimal gland

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17
Q

How many layers of the tear film from the inner to outer?

A

Mucin
Aqueous
Lipid

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18
Q

Which is the thickest layer?

A

Aqueous

Then mucin and lipid

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19
Q

Which glands produce mucin?

A

Goblet cells
Crypt of henle
Glands of manz

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20
Q

Where does the zeiss and moll glands secrete the lipids?

A 
Zeiss= eyelash follicle
Moll= b/w eyelash follicle and grey line
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21
Q

How many meibomian glands are there in the tarsal plate?

A

25 upper

20 lower

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22
Q

What in the tear film help defend against microbes?

A

Lysozyme…Enzyme, destroys gram +ve

Lactoferin…. bacteria nutrition

Immunoglobulins…MAIN, protein

Beta-lysin… protein, destroys invading bacteri

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23
Q

What can cause loss of goblet cells in mucin deficiency?

A 
Steven Johnson syndrome 
Pemphigoid 
Burns
Trachoma
Vit- A deficiency
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24
Q

What causes Steven Johnson syndrome?

A

Adverse drug reaction… hypersensitivity to mucous membrane

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25
Q

What is a pemphigoid?

A

Blister!- unable to make mucins

… prevelant in females and in 7th decade

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26
Q

How can chlamydial trachomitis spread?

A

Direct contact with others or objects

Spread by flies

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27
Q

What is being presented in this image and how does it occur?

A

Bitots dot…. keratin debris and assoc with vit A deficiency

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28
Q

What are the key elements in Dry eye disease?

A

Tear film instability
Hyperosmalarity
Inflammation
Damage

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29
Q

What aietiological resons are there for dry eye?

A 
Deficiency in volume and quality 
Abnormal eyelid 
Systemic 
Environmental
CLs
Medication 
Reftactive surgery
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30
Q

What is ADDE

A

Aqueous deficient dry eye

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31
Q

What can ADDE lead to?

A

Keratoconjunctivtis sicca

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32
Q

What can cause ADDE?

A

LG atrophy
Reduced neural input
Elevated evap rate

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33
Q

What systemic problem can cause lipid layer deficiency?

A

Menopause- hormonal changes?

Prostrate disease- androgen tx needed

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34
Q

How can MG dystrophy viewed?

A

Shown on infra red

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35
Q

How are meibomian cysts managed?

A

Antibiotics and warm compress

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36
Q

What can abnormal eyelid function result in?

A

Poor post blink
Poor tear pump mechanism
Large palpebral aperture
Elevated tear secretion rate

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37
Q

What are the 2 common eyelid abnormalities?

A

Ectropian

Entropian

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38
Q

What different systemic diseases link with tear dysfunction?

A

Steven-Johnson syndrome (mucotaneous disease)

Sjogrens syndrome (effects salivary/fluid secretions)

Systemic lupus erythematous (chronic inflamm in connective tissue)

Hyperthyroidism

Rheumatoid arthritis

39
Q

What can cause Steven Johnson syndrome?

A

(ACUTE/SEVERE)

Hypersensitive reaction to:

Drugs
HSV
Epstein bar virus 
Enteroviruses
Mycoplasma pneumonia
40
Q

What ocular signs can be presented in Steven Johnson syndrome?

A

Papillary conjunctivitis
Dry Eye
Epiphora

(NB- MALES!)

41
Q

Which sytemic disease can cause dry eye?

A

Sjogrens syndrome

Systemic lupus erythmetous

42
Q

Which parts of the body can sjogrens syndrome effect?

A

Skin
LG
Airways

(NB- Females!)

43
Q

What is considered a major impact on rheumatoid arthritis?

A

Climate urbanisation

44
Q

What potential ocular manifestation maybe presented in RA?

A

KCS!
Episcleritis
Scleritis

45
Q

How is dry eye treated in rheumatoid arthritis?

A

Lubricating ointments and artificial tears

If no response…. medical intervention (topical steroid)

46
Q

What ocular signs maybe presented in hyperthyroidism?

A

EOM swelling

Proptosis

47
Q

What environmental factors can cause dry eye?

A

Humidity- air conditioning
Blink rate- VDU
Pollution

48
Q

What drugs could cause tear dysfunction?

A

Antimuscrinic/ anticholinergic (parkinsons disease)
Antihypertensives (beta blockers/diuretics)
Acrivistine (Antihistamines)
Oral contraceptives (Femodette/ locstrin)

49
Q

How can refractive surgery cause reduced lacrimation?

A

Sensory corneal nerve plexus damaged during surgery

Damage to corneal epithelium- mucin layer disrupted

50
Q

What symptoms would u experience with wet and dry eye?

A

Wet- excessive tearing, itching, soreness

Dry- FB sensation, gritty eye, photophobia

51
Q

What signs are seen in wet and dry eye?

A

Wet- epiphora

Dry- hypereamia, corneal dessication

52
Q

What potential test can be performed to assess tear volume?

A 
Schirmir test
Colour bar test
Phenol red thread test
Tear prism 
Ocular surface ass
53
Q

What’s the difference between schirmir test 1 and 2?

A

1 measures basal reflex tear secretion

2 direct measure of reflex tear lacrimation

54
Q

How is schirmir test done briefly?

A

Fold schirmir strip
Hook over temporal lower lid
Leave 5 minutes
Encourage normal blinking

55
Q

What is normal results in the schirmir test?

A

More 10mm

56
Q

How is using anesthesia change the results?

A

Results will be lower as levels of secretion are lowered

Less than 5mm in 5 minutes= borderline dry eye

57
Q

What anesthesia is used for the schirmir tests?

A

1 drop of 0.5% proxy

58
Q

What are normal results for schirnir test 2?

A

More than >15mm of tear secretion in 2 minutes

59
Q

Whats another variation to the schirmir test?

A

Colour bar test… uses line of soluble strip and dye is carried along strip by tears (mm scale visible)

60
Q

What dyes are seen when wet or dry on a 70mm phenol red thread test?

A

Yelloe when dry

Red when wet

61
Q

What techniques can be used for a NITBUT?

A

Keratometer mires
Slit lamp
Heat absorbing filter and grid pattern

62
Q

What diagnostic agents can be used to assess ocular surface damage?

A

Nafl
Rose bengal
Lissamine Green

63
Q

Where is the 1st stain located in KCS?

A

Bulbar conj

Progresses to temporal inferior

64
Q

What staining signs would be seen in bacterial conjunctivitis?

A

Diffuse punctuate staining

65
Q

What is the gold standard agent for detecting ocular surface damage?

A

Rose bengal

66
Q

Whats the difference b/w LG and RB?

A

More comfortable!
Fades quickly
Assess 1 eye at a time b/w 1-4 mins after instillation
Stain enhanced with wratten25

67
Q

What are the 4 requirements for artificial tear substitutes?

A

Non irritant
Good ocular lubricating
Long retention time within conj sac
Not interefe with visual performance

68
Q

Wht are the pH levels of artifical tears?

A

7.4 alkaline

69
Q

What part of the formulation in tear subs increases retention?

A

Viscolizing agent (substitute for mucin)

70
Q

What are the names of some tear substitute?

A

Systane
Artelac
Hyabak
Clinitas soothe

71
Q

What foods may improve tear dysfunction/dry eye)?

A 
Omega 3 fatty acids
Flaxseed oil
Fish oil
Oily fish
Increase water intake
72
Q

What are the different types of occlusion?

A

Temporary- collegen plugs
Partial- PVP perforated plug
Permanent- cauterization/argon laser/silicone punctual plug

73
Q

What is the punctal plug procedure?

A 
Topical anesthesia around puntum 
Dilate punctum c dilator
Select appropriate diam plug
Insert c forceps 
Push down below mouth of punctum
74
Q

What is small lateral tarsorrhaphy?

A

Surgery to reduce palpebral apature

75
Q

In what ways can you reduce the rate of evap?

A 
Use room humidifier 
Reduce room temp
Computer breaks 
Surgery 
Everset Harris- side shields reduce evap
76
Q

What tests can be done to investigate drainage system?

A

Jones dye test 1 and 2

Dilation and irrigation

77
Q

What briefly is the procedure for dilation and irrigation?

A

Anesthesia
1 drop proxy into inf conj and directly inf punctum
OR inf conj sac then wet bud and apply inf punctum for 2 minutes

Dilation: 
pull lower lid taut
Place dilator into punctum 
Rotate dilator 
Advance dilator 2mm in

Not permanent due to tissue elasticity

Irrigation:
Insert cannula vz
Advance 2mm into ampulla
Rotate 90 degrees towards nose
Pull lower lid laterally
Advance cannula 
Hard stop= cannula hits bone ✔ 
Inject saline 
At hard stop= retract 3mm and add 2-3ml saline into nasolacrimal syst
Withdraw cannula
78
Q

How do we interpret the results from the dilation and irrigation?

A

Fluid regurgitates UPPER punctum-
Blockage beyond common canaliculus

Fluid regurgitates LOWER punctum-
Blockage b/w inf punctum and common canaliculus

79
Q

When is a Jones dye performed?

A

Suspect obstruction and a lacrimal drainage suspected

80
Q

What can JD test differential dx that D+I cannot?

A

Location and degree

81
Q

How is the JD 1 performed?

A 
Instill nafl 
Wait 5 minutes 
Insert bud into nostril (10mm)
Check Nafl presence on bud (BL)
No nafl?- massage
Px occluded contralateral nostril 
Blows nose into white tissue 
Check nafl presence
82
Q

When is JD 2 indicated?

A

When no dye is present in tissue from JD 1

83
Q

What is the procedure to JD 2?

A 
Prep syringe and lacrima cannula
Fill c saline
Inject 2-3ml saline into inf canaliculus 
Px leans forward 
Kidney dish held beneath nostril
Collect fluid
Examine for Nafl presence
84
Q

How would the results be interpreted in a JD 2 test?

A

Fluid c Dye= functional block, duct narrow or lower system block

Fluid s dye= functional block, upper system blockage- near punctum

85
Q

What techniques can be used to increase tear drainage?

A

D+I
Nasolacrimal probing
Dacryocystorhinostomy (only of the above 2 fail)

86
Q

What is the procedure for Dacryocystorhinostomy?

A

Hole drilled in nasal cavity at medial wall of lacrimal sac

Silicone tube inserted to main drainage

87
Q

What are the signs of canaliculitis?

A 
Chronic
Unilateral
Red eye
Epiphora
"Pouting punctum"
Mucopurelent discharge
88
Q

What types of infection are there in canaliculitis?

A

Actinomyces Israeli
Candida albicans
Aspergillus
Herpetic

89
Q

What are dacryoliths?

A

Concretions if lacrimal sac.

Pockets in drainage, needs to be removed through punta direct manipulation

Surgically- canaliculotomy

90
Q

What is dacrocyctitis and how is it caused?

A

Bacterial infection in the nasolacrimal sac

Occurs when nasolacrimal duct blocked

91
Q

What are the signs/sxs of dacryocyctitis?

A

Acute- Painful, Pus in sac

Chronic- conjunctivitis c epiphora, sac filled with mucoid material

92
Q

What are the possible tx for dacryocyctitis?

A

Warm compress
Systemic antibiotics
Dacryocystorhinostomy

93
Q

What are the tx for naslacrimal tumours?

A

Excision and radiation

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