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0V2022 Introduction to eye diseases > Lacrimal disorder > Flashcards

Lacrimal disorder Flashcards

1
Q

What are the 3 lacrimal disorders ?

A
  • Infection
  • Disorders of tear drainage
  • Dry eye
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2
Q

What does the lacrimal system consist of ?

A
  • structure which produces the tears and structure which drains the tears
  • could be involved with pathology.
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3
Q

What does it mean with cryo infront of the word ?

A
  • disorder of the lacrimal system
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4
Q

What is the symptoms of lacrimal gland infection (dacryoadentitis) ?

A
  • acute discomfort - of the eyelid (particularly in the upper temporal quadrant, where the lacrimal gland is located )
  • clinical signs - ptosis with hyperaemia and oedema (most pronounced in upper temporal quadrant)
  • Injection of superotemporal conjunctiva
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5
Q

Why is it difficult to deal with a px with dacryoadenitis?

A
  • would need systemic antibiotics - might look like a orbital cellulitis - so better to refer ?
  • this is an infection of the LACRIMAL GLAND
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6
Q

What can be outflow lacrimal obstruction ?

A
  • Punctal stenosis

- Canaliculitis

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7
Q

How does punctual stenosis occur ?

A

-This can follow conjunctival scarring from trauma, or as a result of an infection or inflammation (e.g. herpes simplex)
-also could be from drug therapy (e.g. anti-virals)
Punctal stenosis - when pathway is blocked (puncta) causes build up of tears/water- causing watery eye

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8
Q

How does canaliculitis occur ?

A
  • can have blockage in the canaliculi
  • Infection of canaliculus, e.g. by Actinomyces israelii (around 2% of cases of epiphora)- this bacteria tends to cause this canaliculus infection and in the process it blocks the canaliculi causing outflow obstruction
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9
Q

What is a common cause of outflow obstruction ?

A
  • Congenital outflow obstruction - tear outflow pathway at birth hasn’t been formed fully
  • 20% of eyes of babies shows evidence of symptomatic outflow obstruction

-Symptoms include epiphora and mucopurulent discharge

  • 70% of affected children are symptom-free by 3 months of age, and over 90% by their first birthday
  • could be mistaken for bacterial conjunctivis
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10
Q

What else causes outflow obstruction ?

A

a infection in the lacrimal sac

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11
Q

What are the diseases of infection in the lacrimal sac ?

A

dacryocystitis

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12
Q

What is the infection of the lacrimal gland ?

A

dacryoadenitiis

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13
Q

What is acute dacryocystitis and how does it resolve ?

A

accumulation of tears and mucus within the lacrimal sac which becomes inflamed
-resolves with topical/systemic antibiotics and warm compresss

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14
Q

What can acute dacryocystitis lead to ?

A

chronic dacryocystitis- where patients need to undergo surgery - as they have a. permanent blockage - so need surgery to unblock for tear drainage

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15
Q

What is the treatment for dacryocystitis?

A

-Systemic antibiotics

  • Incision and drainage where appropriate
  • Follow-up may include dacryocystogram (DCG) and surgery e.g. dacryocystorhinostomy (DCR-used silicone tubing to create. nw drainage channel- drill a hole in nasal bones- creates artificial outflow pathway
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16
Q

What is dry eye disease ?

A
  • most common disease to see in routine practice
17
Q

What is dry eye ( LONG DEFINITION )?

A
  • a multifactorial disease of the ocular surface characterised by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play aetiological role
  • TEAR FILM is UNSTABLE- associated with the increase of osmolarity in tear film - hyperosmolarity.
    ocular surface associated with varying degrees of inflammation which could lead to ocular surface image
18
Q

What diseases is tear deficient dry eye caused by ?

A

A Sjogren’s Syndrome (SS)
B Non-Sjogren’s Syndrome

-it happens as a result of age

19
Q

What is Evaporative dry eye caused by ?

A
  • produce normal tear volume however the tears are unstable due to meibomian gland oil is insuffienct and of the wrong compensation
    A Oil deficient
    B Lid related - position of eyelid
    C Surface change- tears evaporate to quickly
    D Contact lens-related
20
Q

What do most patients show sign of in dry eye disease ?

A

evidence of both tear deficiency and evaporative dry eye

21
Q

What is Sjogren’s Syndrome ?

A
  • is an autoimmune disorder
    consisting of dry eye (KCS) and dry mouth (xerostomia), which often involves nasal and vaginal mucous membranes
    -However tends to attack the lacrimal gland
22
Q

What is the SS associated with commonly?

A

with systemic (autoimmune_ diseases such as rheumatoid arthritis and systemic lupus erythematosus (SLE)

23
Q

How to truly diagnose SS px ?

A
  • good clinical history - to ask if they have a dry mouth as well as a dry eye
24
Q

what is the other cause of lacrimal deficiency?

A

acquired primary lacrimal disease

25
Q

what is acquired primary lacrimal disease?

A

. commonest cause of tear deficient dry eye
. only lacrimal glands involved
. histology shows infiltration by inflammatory cells, loss of normal structure , atrophy and fibrosis
. blood tests normal

26
Q

what symptoms do mild dry eye px have?

A 
. irritation
. itching
. soreness
. burning
. intermittent blurred vision
27
Q

what symptoms do moderate dry eye px have?

A

. increased discomfort and frequency symptoms

. visual effects more consistent

28
Q

what symptoms do severe dry eye px have?

A

. increasing frequency of symptoms or constant symptoms

. visual symptoms may be disabling

29
Q

what are the signs of acquired primary lacrimal disease?

A 
. conjunctival injection
. conjunctival staining
. corneal staining
. reduced tear meniscus
. filaments
. reduced tear BUT
. reduced schirmer score
. meibomian gland disease
30
Q

what is schirmer test?

A

. use strips of specialized filter paper that hook over the lower eyelid
. you are measuring how far the tears spread along those filter paper in 5 mins

31
Q

what is acquired primary lacrimal disease management?

A 
. lubricants- OCULAR LUBRICANTS
. tear preservation
. lid hygiene
. oral antibiotics
. immunosuppresants
. alternative therapies
32
Q

what are ocular lubricants?

A

. ocular lubricants in the form of eye drops, gels and ointments are used to treat discomfort associated with condition in which the tear film is reduced or unstable

33
Q

what is tear preservation?

A

. plugs are put into the puncta
. a dilator is used to open up the puncta to allow you to put the plug
. blocks the puncta
. we want to maximize tears produced by px

34
Q

what os blockage of the tear drainage system associated with?

A

. epiphora - watering of the eye

0V2022 Introduction to eye diseases (22 decks)

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