Lacrimal Disorders Flashcards
What is Dacryoadenitis?
Lacrimal gland disorder
What does the prefix ‘dacryo’ indicate?
Generally indicates a disorder of the lacrimal system
What does one experience with Dacryoadenitis?
Acute discomfort of the upper temporal quadrant.
What are the clinical signs of Dacryoadenitis?
Ptosis with hyperaemia and oedema (most pronounced in the upper temporal quadrant - i.e. where the lacrimal gland is located).
What is Ptosis?
Drooping or falling of the upper eyelid.
What is Hyperaemia?
an excess of blood in the vessels supplying an organ or other part of the body.
What is epiphora?
A clinical term for a watery eye
What can epiphora occur as a result of?
Punctal Stenosis - narrowed or closed puncter Canalicutitis - infection of the canaliculi Congenitally - born with it In all three of these cases its to do with an outflow obstruction.
What can Punctal Stenosis arise as a result of?
Ca arise following conjunctival scarring from trauma or inflammation (e.g. herpes simplex). Drug therapy (e.g. anti-virals) - although rare certain drugs are known to be associated with Punctal Stenosis.
What is Punctal Stenosis?
A condition in which the puncters (a.k.a where drainage happens from) are closed or narrowed.
What is canaliculitis?
Infection of canaliculus, e.g. by Actinomyces israelii (a bacterium) - the course of the infection blocks the canaliculi - causing outflow obstruction. (This happens in 2% of cases)
Describe congenitally caused Epiphora.
20% ( 1 in five babies) of neonates (newborn children) show evidence of symptomatic outflow obstruction (basically tear outflow system isn’t fully formed yet). :( 70% of babies are symptom free by three months and over 90% of babies are symptom free by 1 year. :)
What do symptoms of congenital epiphora include?
Obviously epiphora itself and mucopurulent discharge. (mucus-pus dicharge)
What does congenital outflow obstruction often get mistaken for?
That mucus pus discharge often means it gets mistaken for bacterial conjunctivitis.
What is dacryocystitis?
An infection of the lacrimal sac
What might the treatment for Dacryocystitis include?
Systemic Antibiotics
Warm compress
Incision and drainage where appropriate
If still not gone (i.e. the dacryocystitis becomes chronic) follow-up treatment may include Dacryocystogram (DCG) (to see where the problem exactly is) then surgical procedure Dacryocystorhinostomy (DCR) occurs - this establishes a new drainage route.
What does it mean to be multifactorial?
dependent (or caused by) a number of factors, especially genetic or environmental factors.
What is dry eye disease?
Dry eye is 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 (increase in osmolarity), ocular surface inflammation and damage, and neurosensory abnormalities play an aetiological role
What are the two classic classifications of dry eye disease?
Tear deficient dry eye disease
and
Evaporative dry eye disease
What are the two causes of tear deficient dry eye disease?
Sjogren’s Syndrome (SS)
Non-Sjogren’s Syndrome - e.g. things such as age
What is the link between age and dry eye disease?
As you get older the ability of the lacrimal gland to secrete an adequate volume of tears declines.
What are the causes of evaporative dry eye disease?
Tears are unstable as Meibomian gland oil is either insufficient or of the wrong composition to retard tear evaporation.
Lid related
Surface change
Contact lens-related
Why is dry eye disease classification (i.e. whether its tear deficient or evaporative) an iffy concept?
Rather than being separate groups, the distinction is more like that of a scale with many patients showing evidence of not producing enough tears as well as having something wrong with meibomian gland oil composition and so they would be in the middle of the scale.
What is Sjorgen’s Syndrome and what is it associated with?
- Sjogren’s Syndrome is an autoimmune disorder consisting of dry eye (KCS) and dry mouth (xerostomia), which often involves nasal and vaginal mucous membranes too.
- SS is commonly associated with systemic diseases such as rheumatoid arthritis and systemic lupus erythematosus
