LACRIMAL SYSTEM Flashcards
- Name accessory lacrimal glands!
2.lacrimal sac length…12 to 15 mm
Length of nasolacrimal duct…15 to 18 mm
- What are the 3 layers of tear film?
1.Glands of Krause …located within stroma of conjunctiva in both fornices.
Gland of wolfering…located in tarsal plates.
3.outer lipid layer…produced by meibomian,zeis and Moll glands
Middle aqueous layer by lacrimal glands
Inner mucin produced by goblet cells and gland of Henle(located in palpebral conjunctiva) and manz(located at limbus)
A 2 months infant is brought to opd with complaints of watery eyes for 3 weeks. On applying pressure over the medial canthus of eyes there is mucopurulent discharge reflux from the puncti which is a positive regurgitation test. What is the dx?
What are the treatment options?
When do we do surgical procedure.
2.What is amniontoele
It is case of congenital nasolacrimal duct obstruction.
It occurs due to non canalization of the lower end of naso lacrimal duct.it causes epiphora and secondary infection.
Complications… mucocele,acute or chronic dacryocystitis,fistula formation.
TTT
Conservative TTT… spontaneous patency occurs with 6 to 9 months.
Gentle massage over the sac. Ten strokes 4 times a day are applied.
Topical or systemic antibiotics are given.
Surgical TTT
Probing
Syringing/irrigation.
Intubation or balloon catheter dilation.
DCR… perform after 5 to 6 years of age when above procedures fail.
2.bluish grey swelling of lacrimal sac due to collection of amniotic fluid within the sac due to congenital NLD block at valve of Hasner.
Treatment is massage and topical antibiotics.
If no response then Probing
1.What are acquired causes of nasolacrimal duct obstruction?
2.types of DCR?
1.idiopathic stenosis
Nasal/ orbital fractures
Sarcoidosis
Infiltrating Nasopharyngeal tumors.
Dacryolith within lacrimal sac.
2.two types
External …skin approach …high success rate
Transnasal approach… opening bw nasal cavity and lacrimal sac is made through laser .
A 30 year old female presented to opd with complaints of painful swelling in medial canthus of eyes from 1 week. There is tenderness and redness in the preseptal area so regurgitation test cannot be performed. There is mucopurulent discharge in the eye. What is the dx? What are the complications? And how would you treat this female?
2.What are features of chronic dacrocystitis?
Dx Acute dacrocystitis mostly occurs secondary to NLD obstruction.
Complications…preseptal cellulitis,external fistula formation.
Treatment
Analgesics, systemic antibiotics and hot fomentation.
Probing and irrigation is not done…if abscess is formed drain it.
DCR is performed after infection subsides and there is persistent epiphora.
2.constant chronic watering from both eyes.
Positive regurgitation test.
Mucocele formation may occur .
Treatment is same as above.
1.A 15 year old girl is brought to opd with complaints of painful swelling in upper and outer portion of orbit and eyelid. The eyelid makes an s shaped curve and there is drooping as well. There is preauricular lymph node enlargement. What is your dx?
Treatment?
1.Acute dacroadenitis
Inflammation of lacrimal glands due to viral bacterial or fungal invasion.
In chronic dacroadenitis there is painless swelling and is caused by systemic diseases such as TB,trauma,sjogren syndrome,leukemia ,lymphoma.
TTT …hot compresses,analgesics
Topical and systemic Antibiotics
Incision and drainage if abscess is formed.
1.What is keratoconjunctivitis sicca ?
2.what are the tests to dx it?
3.Treatment?
- It is a disorder of tear film in which there is decreased tear production or increased evaporation resulting in unstable tear film.
-
Tear film breakup time is less than 10 s.(Normal is 15 to 20 sec)
Staining which include
Fluorescein …stains epithelium.
Rose Bengal …stains dead epithelium mucus and corneal filaments.
Lossamine stain…same as rose Bengal but is less irritant.
Schirmer test… Whatman filter paper is placed in conjunctiva and wetting is noted .
Impression cytology…goblet cells are reduced in dry eye.
3.artificial tears e.g methylcellulose.
Mucolytic agent… acetyl cysteine
Topical retinoids
Soft contact lenses.
1.What is lacrimation?
2.What is epiphora? What are dx tests?
1.Normal watering of eyes caused by reflex tearing in response to acute or chronic occular irritation or disease.
2.Increased tearing of eyes due to decrease drainage of tears.
- 🎟️Dye disappearance test… fluorescein dye is instilling the eyes. The disappearance of dye from tear film after 5 min is observed.retention of dye is dx of obstruction.
🎟️Jones dye test… Shows partial obstruction and includes
🎟️primary Jones dye test… fluorescein is injected into eyes and its patency is indicated if dye is recovered from the nose.
🎟️ secondary Jones test…when in primary test,dye is not recovered then irrigation is done through saline. If fluorescein stained saline is recovered it indicates partial obstruction.
If unstained saline is present in the nose it indicated canalicular obstruction or pump failure.
