Lacrimal System

Question 1

what is this condition called?

Answer 1

punctal stenosis

Question 2

what is this condition called?

Answer 2

punctal malposition

Question 3

what is this condition called?

Answer 3

dacryocystitis

Question 4

what is this condition called?

Answer 4

canaliculitis

Question 5

what is this condition called?

Answer 5

dacryoadenitis

Question 6

which nerve innervates the lacrimal gland?

Answer 6

CN 5

Question 7

what are the 3 protein parts of tears?

Answer 7

antibacterial (lysozyme), immunoglobulins (IgA) and growth factors (epidermal growth factor)

Question 8

what electrolytes are present in tears?

Answer 8

Na, K, Cl, Ca

Question 9

what are some complications that can occur to the lacrimal system flow?

Answer 9

trauma = lacrimal gland, conjunctiva, eyelids, nasolacrimal duct and nasal acvity

poor outflow (epiphora)

Question 10

what are the 3 causes of epiphora?

Answer 10

1. reflex over production of tears (stimulation from cornea, conjunctiva or emotions)
2. pump failure (weakness of lower lid -ectropion or weakness of orbicularis muscle)
3. obstruction

Question 11

what are some causes of punctal stenosis and who is it common in?

Answer 11

idiopathic, chronic blepharitis, herpes simplex lid infection, radiation, trachoma and cicatrizing conjunctivitis

and common in the elderly

Question 12

what is the management for punctal stenosis?

Answer 12

minor surgical procedure = punctal dilation or surgical/laser punctoplasty

Question 13

what are 2 causes of punctal malposition?

Answer 13

ectropion and punctal eversion

Question 14

what is the management for punctal malposition?

Answer 14

surgically realign the punctum (and lid if ectropion) = cautery and conjunctivoplasty

Question 15

what are some causes of canalicular/duct obstruction?

Answer 15

most common - idiopathic fibrosis, chronic dacryocystitis, herpes simplex, cicatrizing conjunctivitis, or trauma

Question 16

what is the treatment for canalicular/duct obstruction?

Answer 16

DCR (dacryocystorhinostomy) = surgical opening

Question 17

why is a congenital obstruction so common in infants and what are the signs?

Answer 17

the nasolacrimal duct is the last part of the system to develop - frequently not open at birth

epiphora and mucous discharge

Question 18

what is the treatment for a congenital obstruction?

Answer 18

massage 2-4 times per day, antibiotics (erythromycin ophthalmic ointment BID) and probing after 12 months

Question 19

what are 4 causes of aqueous dry eye (aka keratoconjunctivitis sicca)?

Answer 19

sjogrens-atrophy of lacrimal glands, lacrimal gland tumors or inflammation, absence of lacrimcal gland and lacrimal scarring

Question 20

what are some treatment options for aqueous dry eye?

Answer 20

punctal plugs, Restasis, omega 3 supplements, artifical tears, scleral lens and topical steroids for acute use

Question 21

what are 2 lacrimal infections?

Answer 21

dacryocystitis and canaliculitis

Question 22

what is dacryocystitis?

Answer 22

usually secondary to an abstruction - can be acute or chronic and patient has redness, swelling and pain

Question 23

what is the management for dacryocystitis?

Answer 23

warm compresses, antibiotics (oral = augmentin, keflex or topical = polytrim QID), pain meds prn and DCR if no improvement

Question 24

what causes canaliculitis?

Answer 24

secondary to an infection - usually actinomyces

Question 25

what are the signs/symptoms of cancliculitis?

Answer 25

epiphora, chronic mucopurulent conjunctivitis that doesn't respond to treatment, canalicular edema and inflammation and cancalicular concretions

Question 26

what is the treatment for canaliculitis?

Answer 26

warm compresses, antibiotics (oral = doxycycline 100mg BID or topical = polytrim QID), curettage-scrape concretions, and canaliculotomy if no improvement with currettage

Question 27

how to you differentiate between dacryocystitis and canaliculitis?

Answer 27

dacryocystitis has more swelling, tenderness and pain vs. canaliculitis which has punctal pouting, concretions and recurrent conjunctivitis

Question 28

how do you differentiate dacryocystitis and canaliculitis from cellulitis/preseptal or orbial?

Answer 28

cellulitis doesn't have punctal discharge and has an unobstructed lacrimal drainage system

Question 29

how do you differentiate dacryocystitis and canaliculitis from nasolacrimal duct obstruction?

Answer 29

the duct obstruction has some tearing but less redness or swelling of punctum

Question 30

what is inflammation of the lacrimal gland called and what are the signs/symptoms?

Answer 30

dacryoadenitis redness, swelling of lateral upper eyelid, pain and possible diplopia

Question 31

what are the causes of acute dacryoadenitis?

Answer 31

inflammatory (sarcoidosis, pseudotumor), bacterial or viral

Question 32

what are the causes of chronic dacryoadenitis?

Answer 32

inflammatory (sarcoidosis, pseudotumor), bacterial, viral PLUS tumor, cyst, TB, syphilis, leukemia, metastasis and others

Question 33

how do you evaluate dacryoadenitis and what is the treatment?

Answer 33

slit lamp, culture dischrage, CBC with diff, CT scan treat specific etiology - if unsure use oral antibiotic