Lacrimal disorder Flashcards
What are the 3 lacrimal disorders ?
- Infection
- Disorders of tear drainage
- Dry eye
What does the lacrimal system consist of ?
- structure which produces the tears and structure which drains the tears
- could be involved with pathology.
What does it mean with cryo infront of the word ?
- disorder of the lacrimal system
What is the symptoms of lacrimal gland infection (dacryoadentitis) ?
- 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
Why is it difficult to deal with a px with dacryoadenitis?
- would need systemic antibiotics - might look like a orbital cellulitis - so better to refer ?
- this is an infection of the LACRIMAL GLAND
What can be outflow lacrimal obstruction ?
- Punctal stenosis
- Canaliculitis
How does punctual stenosis occur ?
-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
How does canaliculitis occur ?
- 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
What is a common cause of outflow obstruction ?
- 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
What else causes outflow obstruction ?
a infection in the lacrimal sac
What are the diseases of infection in the lacrimal sac ?
dacryocystitis
What is the infection of the lacrimal gland ?
dacryoadenitiis
What is acute dacryocystitis and how does it resolve ?
accumulation of tears and mucus within the lacrimal sac which becomes inflamed
-resolves with topical/systemic antibiotics and warm compresss
What can acute dacryocystitis lead to ?
chronic dacryocystitis- where patients need to undergo surgery - as they have a. permanent blockage - so need surgery to unblock for tear drainage
What is the treatment for dacryocystitis?
-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
What is dry eye disease ?
- most common disease to see in routine practice
What is dry eye ( LONG DEFINITION )?
- 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
What diseases is tear deficient dry eye caused by ?
A Sjogren’s Syndrome (SS)
B Non-Sjogren’s Syndrome
-it happens as a result of age
What is Evaporative dry eye caused by ?
- 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
What do most patients show sign of in dry eye disease ?
evidence of both tear deficiency and evaporative dry eye
What is Sjogren’s Syndrome ?
- 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
What is the SS associated with commonly?
with systemic (autoimmune_ diseases such as rheumatoid arthritis and systemic lupus erythematosus (SLE)
How to truly diagnose SS px ?
- good clinical history - to ask if they have a dry mouth as well as a dry eye
what is the other cause of lacrimal deficiency?
acquired primary lacrimal disease
what is acquired primary lacrimal disease?
. 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
what symptoms do mild dry eye px have?
. irritation . itching . soreness . burning . intermittent blurred vision
what symptoms do moderate dry eye px have?
. increased discomfort and frequency symptoms
. visual effects more consistent
what symptoms do severe dry eye px have?
. increasing frequency of symptoms or constant symptoms
. visual symptoms may be disabling
what are the signs of acquired primary lacrimal disease?
. conjunctival injection . conjunctival staining . corneal staining . reduced tear meniscus . filaments . reduced tear BUT . reduced schirmer score . meibomian gland disease
what is schirmer test?
. 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
what is acquired primary lacrimal disease management?
. lubricants- OCULAR LUBRICANTS . tear preservation . lid hygiene . oral antibiotics . immunosuppresants . alternative therapies
what are ocular lubricants?
. 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
what is tear preservation?
. 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
what os blockage of the tear drainage system associated with?
. epiphora - watering of the eye
