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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
What is a pemphigoid?
Blister!- unable to make mucins | ... prevelant in females and in 7th decade
26
How can chlamydial trachomitis spread?
Direct contact with others or objects Spread by flies
27
What is being presented in this image and how does it occur?
Bitots dot.... keratin debris and assoc with vit A deficiency
28
What are the key elements in Dry eye disease?
Tear film instability Hyperosmalarity Inflammation Damage
29
What aietiological resons are there for dry eye?
``` Deficiency in volume and quality Abnormal eyelid Systemic Environmental CLs Medication Reftactive surgery ```
30
What is ADDE
Aqueous deficient dry eye
31
What can ADDE lead to?
Keratoconjunctivtis sicca
32
What can cause ADDE?
LG atrophy Reduced neural input Elevated evap rate
33
What systemic problem can cause lipid layer deficiency?
Menopause- hormonal changes? | Prostrate disease- androgen tx needed
34
How can MG dystrophy viewed?
Shown on infra red
35
How are meibomian cysts managed?
Antibiotics and warm compress
36
What can abnormal eyelid function result in?
Poor post blink Poor tear pump mechanism Large palpebral aperture Elevated tear secretion rate
37
What are the 2 common eyelid abnormalities?
Ectropian | Entropian
38
What different systemic diseases link with tear dysfunction?
Steven-Johnson syndrome (mucotaneous disease) Sjogrens syndrome (effects salivary/fluid secretions) Systemic lupus erythematous (chronic inflamm in connective tissue) Hyperthyroidism Rheumatoid arthritis
39
What can cause Steven Johnson syndrome?
(ACUTE/SEVERE) Hypersensitive reaction to: ``` Drugs HSV Epstein bar virus Enteroviruses Mycoplasma pneumonia ```
40
What ocular signs can be presented in Steven Johnson syndrome?
Papillary conjunctivitis Dry Eye Epiphora (NB- MALES!)
41
Which sytemic disease can cause dry eye?
Sjogrens syndrome | Systemic lupus erythmetous
42
Which parts of the body can sjogrens syndrome effect?
Skin LG Airways (NB- Females!)
43
What is considered a major impact on rheumatoid arthritis?
Climate urbanisation
44
What potential ocular manifestation maybe presented in RA?
KCS! Episcleritis Scleritis
45
How is dry eye treated in rheumatoid arthritis?
Lubricating ointments and artificial tears If no response.... medical intervention (topical steroid)
46
What ocular signs maybe presented in hyperthyroidism?
EOM swelling | Proptosis
47
What environmental factors can cause dry eye?
Humidity- air conditioning Blink rate- VDU Pollution
48
What drugs could cause tear dysfunction?
Antimuscrinic/ anticholinergic (parkinsons disease) Antihypertensives (beta blockers/diuretics) Acrivistine (Antihistamines) Oral contraceptives (Femodette/ locstrin)
49
How can refractive surgery cause reduced lacrimation?
Sensory corneal nerve plexus damaged during surgery Damage to corneal epithelium- mucin layer disrupted
50
What symptoms would u experience with wet and dry eye?
Wet- excessive tearing, itching, soreness Dry- FB sensation, gritty eye, photophobia
51
What signs are seen in wet and dry eye?
Wet- epiphora Dry- hypereamia, corneal dessication
52
What potential test can be performed to assess tear volume?
``` Schirmir test Colour bar test Phenol red thread test Tear prism Ocular surface ass ```
53
What's the difference between schirmir test 1 and 2?
1 measures basal reflex tear secretion | 2 direct measure of reflex tear lacrimation
54
How is schirmir test done briefly?
Fold schirmir strip Hook over temporal lower lid Leave 5 minutes Encourage normal blinking
55
What is normal results in the schirmir test?
More 10mm
56
How is using anesthesia change the results?
Results will be lower as levels of secretion are lowered Less than 5mm in 5 minutes= borderline dry eye
57
What anesthesia is used for the schirmir tests?
1 drop of 0.5% proxy
58
What are normal results for schirnir test 2?
More than >15mm of tear secretion in 2 minutes
59
Whats another variation to the schirmir test?
Colour bar test... uses line of soluble strip and dye is carried along strip by tears (mm scale visible)
60
What dyes are seen when wet or dry on a 70mm phenol red thread test?
Yelloe when dry | Red when wet
61
What techniques can be used for a NITBUT?
Keratometer mires Slit lamp Heat absorbing filter and grid pattern
62
What diagnostic agents can be used to assess ocular surface damage?
Nafl Rose bengal Lissamine Green
63
Where is the 1st stain located in KCS?
Bulbar conj | Progresses to temporal inferior
64
What staining signs would be seen in bacterial conjunctivitis?
Diffuse punctuate staining
65
What is the gold standard agent for detecting ocular surface damage?
Rose bengal
66
Whats the difference b/w LG and RB?
More comfortable! Fades quickly Assess 1 eye at a time b/w 1-4 mins after instillation Stain enhanced with wratten25
67
What are the 4 requirements for artificial tear substitutes?
Non irritant Good ocular lubricating Long retention time within conj sac Not interefe with visual performance
68
Wht are the pH levels of artifical tears?
7.4 alkaline
69
What part of the formulation in tear subs increases retention?
Viscolizing agent (substitute for mucin)
70
What are the names of some tear substitute?
Systane Artelac Hyabak Clinitas soothe
71
What foods may improve tear dysfunction/dry eye)?
``` Omega 3 fatty acids Flaxseed oil Fish oil Oily fish Increase water intake ```
72
What are the different types of occlusion?
Temporary- collegen plugs Partial- PVP perforated plug Permanent- cauterization/argon laser/silicone punctual plug
73
What is the punctal plug procedure?
``` Topical anesthesia around puntum Dilate punctum c dilator Select appropriate diam plug Insert c forceps Push down below mouth of punctum ```
74
What is small lateral tarsorrhaphy?
Surgery to reduce palpebral apature
75
In what ways can you reduce the rate of evap?
``` Use room humidifier Reduce room temp Computer breaks Surgery Everset Harris- side shields reduce evap ```
76
What tests can be done to investigate drainage system?
Jones dye test 1 and 2 | Dilation and irrigation
77
What briefly is the procedure for dilation and irrigation?
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
How do we interpret the results from the dilation and irrigation?
Fluid regurgitates UPPER punctum- Blockage beyond common canaliculus Fluid regurgitates LOWER punctum- Blockage b/w inf punctum and common canaliculus
79
When is a Jones dye performed?
Suspect obstruction and a lacrimal drainage suspected
80
What can JD test differential dx that D+I cannot?
Location and degree
81
How is the JD 1 performed?
``` 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
When is JD 2 indicated?
When no dye is present in tissue from JD 1
83
What is the procedure to JD 2?
``` 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
How would the results be interpreted in a JD 2 test?
Fluid c Dye= functional block, duct narrow or lower system block Fluid s dye= functional block, upper system blockage- near punctum
85
What techniques can be used to increase tear drainage?
D+I Nasolacrimal probing Dacryocystorhinostomy (only of the above 2 fail)
86
What is the procedure for Dacryocystorhinostomy?
Hole drilled in nasal cavity at medial wall of lacrimal sac | Silicone tube inserted to main drainage
87
What are the signs of canaliculitis?
``` Chronic Unilateral Red eye Epiphora "Pouting punctum" Mucopurelent discharge ```
88
What types of infection are there in canaliculitis?
Actinomyces Israeli Candida albicans Aspergillus Herpetic
89
What are dacryoliths?
Concretions if lacrimal sac. Pockets in drainage, needs to be removed through punta direct manipulation Surgically- canaliculotomy
90
What is dacrocyctitis and how is it caused?
Bacterial infection in the nasolacrimal sac Occurs when nasolacrimal duct blocked
91
What are the signs/sxs of dacryocyctitis?
Acute- Painful, Pus in sac Chronic- conjunctivitis c epiphora, sac filled with mucoid material
92
What are the possible tx for dacryocyctitis?
Warm compress Systemic antibiotics Dacryocystorhinostomy
93
What are the tx for naslacrimal tumours?
Excision and radiation

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