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BOARDS2: conjuntiva/cornea > Epiphora > Flashcards

Epiphora Flashcards

1
Q

Whic of these is most likely associated with NLDO?
A. Rhinitis
B. Schirmer 1 < 5mm
C. Increased lid laxity
D. Negative jones 1
E. Swelling below medial canthus tendon
F. Expression of sulfur granules from canaliculi

A

D. Negative jones 1

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2
Q

What is the treatment for NLDO?

A

DCR

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3
Q

What results in the “wrinkle sign” during nasolacrimal probing

A

Canaliculitis

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4
Q

Signs and symptoms of NLDO

A

Chronic, unilateral tearing with no other signs of ocular infection, irritation, or other abnormality.

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5
Q

Things that cause decreased tear drainage

A

Ectropion
Punctal malposition or stenosis
Problems with lacrimal sac

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6
Q

What tests are done to determine NLDO

A

Jones 1 and 2

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7
Q

DiffDx for epiphora with mild to no associated pain

A 
NLDO
DED
Blepharitis 
Punctal pathology 
Conjunctivitis (allergic and toxic)
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8
Q

DiffDx for epiphora with moderate to severe pain

A

Corneal pathology ( abrasion, RCE, FB, rust ring, etc)
Anterior uveitis
Dacryocystitis
Entropion with trichiasis

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9
Q

Infection or inflammation of the lacrimal sac that commonly occurs due to an obstruction of the nasolacrimal system, leading to bacteria within the tears infecting the lacrimal sac

A

Dacryocystitis

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10
Q

Signs and symptoms of dacryocystitis

A 
Pain 
Epiphora
Crusting
Occasional fever
Prominent edema and tendering of the lacrimal sac BELOW the medial canthal tendon
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11
Q

Swelling above the medial canthal tendon

A

Lacrimal sac tumor

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12
Q

Inflammation and infection of the canaliculi that may be caused by bacterial, fungal or viral pathologies.

A

Canaliculus

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13
Q

Signs and symptoms of canaliculitis

A

Epiphora
Mild tenderness/pain on the nasal portion of the eyelids
A tender, swollen puncta (pouting puncta)
Mucopurulent discharge upon expression of lacrimal sac
Unilateral, smoldering red eye that has been misdiagnosed as “recurrent conjunctivitis” that is resistant to topical ophthalmic Abx treatment

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14
Q

Version of the eyelid margin away from the globe of the eye, resulting in epiphora.

A

Ectropion

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15
Q

Results in ocular irritation that can lead to subsequent reflex bilateral tearing and epiphora

A

DED

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16
Q

Signs and symptoms of DED

A

Bilateral tearing and epiphora
decreased TBUT
Thin lacrimal lake
Corneal and/or conjunctival staining

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17
Q

Allergic conjunctivitis is what kind of HS reaction

A

Type 1

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18
Q

Signs and symptoms of allergic conjunctivitis

A

Epiphora associated with moderate to severe itching, conjunctival chemosis, and papillae

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19
Q

Cause of congenital NLDO

A

Blocked valve of hasner

  • 20% of newborns have this
  • only 5% are symptomatic
  • persistent epiphora
20
Q

When does opening of the valve of hasner occur

A

Spontaneous opening occurs 1-2 months after birth, and 96% of cases resolve by 1 year of age

21
Q

If valve of hasner does not spontaneously open

A

Digital massage can be performed 2-4x/day. The superior and inferior puncta are occluded with an index finger, followed by a genital downward massage over the lacrimal sac and the NLD. The majority of cases response to the massage technique

22
Q

In babies, if the NLDO does not spontaneously resolve or respond to the digital massage technique by 13 months of age or older,

A

nasolacrimal duct probing is indicated

23
Q

At what age should a baby have nasolacrimal duct probing to open the valve of hasner

A

13 months of age

24
Q

The order of treatment for congential NLDO

A

Wait
Massage
Probe
DCR

25
Q

What is indicated for babies with congential NLDO that do not respond to digital massage or NLD probing

A

DCR

26
Q

What is common for babies to get if they have congential NLDO

A

Secondary dacryocystitis

- due to stagnant tears in the lacrimal sac.

27
Q

When should you NOT do NLD probing for a baby with congential NLDO

A

If active infection is present

28
Q

Most common causes of acquired NLDO

A 
Involutional stenosis in older ages 
Additional 
-infectious (dacryocystitis)
-inflammatory (chronic sinus disease)
-neoplastic 
-mechanical sources
29
Q

Most common causes of dacryocystitis

A

Staph aureus
Staph epi
Pseudomonas
H. Flu in children

30
Q

Most common causes of canaliculitis

A 
Actinomyces Israelii (Streptothrix)
-yellow sulfur granules on expression

Additional

  • staph aureus
  • candida albicans
  • aspergillus
  • nocardia
  • herpes simplex
  • herpes zoster
  • surgery, trauma, neoplastic disorders
31
Q

Most common causes of ectropion

A 
Age related (involutional, due to loss of muscle tone within the orbicularis oculi)
Additional 
- paralytic (facial palsy, etc)
-mechanical (eyelid edema, tumor, etc)
-cicatricial (scarring)
-congenital (rare)
32
Q

Jones 1 testing

A
  • Evaluates patency of nasolacrimal system

- NaFL and 5m

33
Q

Positive jones 1

A

Patent nasolacrimal drainage system

Presence of NaFL in the back of the patient’s throat, or by having the patient blow nose and see NaFL on tissue

34
Q

Negative jones 1

A

Indicates nasolacrimal system is obstructed

Absence of NaFL on tissue or back of throat after 5m

35
Q

Jones 2 test

A

Performed after a negative jones 1

Irrigation of the nasaloacrimal system with saline to determine the location of the blockage

36
Q

How do you know the blockage has been cleared on jones 2

A

Patient tastes saline, gags, or fluid recovered from nose

37
Q

Reflex of saline from same punctum in jones 2

A

Obstruction within the canaliculus

38
Q

Reflex of saline from the opposite punctum

A

Nasolacrimal blockage

39
Q

If the jones 2 test fails to remove the obstruction within the nasolacrimal system

A

DCR needed

40
Q

DED testing

A 
Schirmer 1: <15mm in 5m
Schirmer 2: <5mm wetting in 5m
TBUT <10s
Decreased findings on phenol red thread 
Lissamine green staining (inferior and at 3 and 9 o’clock)
Variable corneal staining with NaFL
41
Q

Involutional ectropion testing

A

Snap back test

  • should return immediately
  • the longer the lid takes to return to normal, the greater the lid laxity
42
Q

What is a DCR

A

Creates an anastomoses between the nasal cavity and the lacrimal sac, allowing tears to drain around the obstruction in the NLD

43
Q

Main treatments for DED

A

AT Qday-QID
PFAT 4-8x day
Lubricating ointment at night
Restasis

44
Q

Treatment for involutional ectropion

A

Surgically

Due to horixaontlal I’d laxity, which can be corrected with a lateral tarsal strip procedure

45
Q

Treatment for dacryocystitis

A

Augmentin 500mg PO TID x 10 days

-if allergic to PCN: bactrim 1 double strength tablet PO BID x 10 days

46
Q

Treatment for canaliculitis

A

Canalicular irrigation with PCN G 100,00 U/mL

Systemic abx: PCN V 500mg PO QID x 7 days

BOARDS2: conjuntiva/cornea (7 decks)

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