Disorders Of The Lacrimal Drainage System Flashcards
Causes of excessive watering
Epiphora
Lacrimation
Lacrimal pump failure
caused by reflex over-production of tears from stimulation of CNV by irritation of the cornea or conjunctiva
Lacrimation
caused by mechanical obstruction of tear drainage
Epiphora
due to lower lid laxity or weakness of the orbicularis muscle
Lacrimal pump failure
Evaluation of the watering eye:
External examination
1.Eyelids – malposition
2.Dynamics of eyelid closure
3.Puncta – malposition, stenosis, obstruction
4.Lacrimal sac
5.Marginal tear strip
6.Fluorescein disappearance test – 2 min.
INFECTIONS OF LACRIMAL PASSAGES
- Congenital nasolacrimal duct obstruction
- Congenital dacryocele
- Chronic canaliculitis
- Dacryocystitis
Caused by delayed canalization near valve of Hasner
Congenital nasolacrimal duct obstruction
On pressure reflux of purulent material from punctum
Congenital nasolacrimal duct obstruction
Treatment of congenital nasolacrimal duct obstruction
Massage of nasolacrimal duct and antibiotic drops 4 times daily
Improvement by age 12 months in 95% of cases
Distension of lacrimal sac by trapped amniotic fluid (amniontocele)
caused by imperforate valve of Hasner
Congenital dacryocele
Bluish cystic swelling or below medial canthus
Congenital dacryocele
Treatment for congenital dacryocele
Initially massage
Probing if massage fails
Frequently caused by Actinomyces (Streptothrix sp
Chronic canaliculus
Unilateral epiphora and chronic mucopurulent discharge
Chronic canaliculus
Epiphora and chronic or recurrent unilateral conjunctivitis
Chronic dacryocystitis
