Lacrimal System Flashcards
what is this condition called?
punctal stenosis
what is this condition called?
punctal malposition
what is this condition called?
dacryocystitis
what is this condition called?
canaliculitis
what is this condition called?
dacryoadenitis
which nerve innervates the lacrimal gland?
CN 5
what are the 3 protein parts of tears?
antibacterial (lysozyme), immunoglobulins (IgA) and growth factors (epidermal growth factor)
what electrolytes are present in tears?
Na, K, Cl, Ca
what are some complications that can occur to the lacrimal system flow?
trauma = lacrimal gland, conjunctiva, eyelids, nasolacrimal duct and nasal acvity
poor outflow (epiphora)
what are the 3 causes of epiphora?
- reflex over production of tears (stimulation from cornea, conjunctiva or emotions)
- pump failure (weakness of lower lid -ectropion or weakness of orbicularis muscle)
- obstruction
what are some causes of punctal stenosis and who is it common in?
idiopathic, chronic blepharitis, herpes simplex lid infection, radiation, trachoma and cicatrizing conjunctivitis
and common in the elderly
what is the management for punctal stenosis?
minor surgical procedure = punctal dilation or surgical/laser punctoplasty
what are 2 causes of punctal malposition?
ectropion and punctal eversion
what is the management for punctal malposition?
surgically realign the punctum (and lid if ectropion) = cautery and conjunctivoplasty
what are some causes of canalicular/duct obstruction?
most common - idiopathic fibrosis, chronic dacryocystitis, herpes simplex, cicatrizing conjunctivitis, or trauma
what is the treatment for canalicular/duct obstruction?
DCR (dacryocystorhinostomy) = surgical opening
why is a congenital obstruction so common in infants and what are the signs?
the nasolacrimal duct is the last part of the system to develop - frequently not open at birth
epiphora and mucous discharge
what is the treatment for a congenital obstruction?
massage 2-4 times per day, antibiotics (erythromycin ophthalmic ointment BID) and probing after 12 months
what are 4 causes of aqueous dry eye (aka keratoconjunctivitis sicca)?
sjogrens-atrophy of lacrimal glands, lacrimal gland tumors or inflammation, absence of lacrimcal gland and lacrimal scarring
what are some treatment options for aqueous dry eye?
punctal plugs, Restasis, omega 3 supplements, artifical tears, scleral lens and topical steroids for acute use
what are 2 lacrimal infections?
dacryocystitis and canaliculitis
what is dacryocystitis?
usually secondary to an abstruction - can be acute or chronic and patient has redness, swelling and pain
what is the management for dacryocystitis?
warm compresses, antibiotics (oral = augmentin, keflex or topical = polytrim QID), pain meds prn and DCR if no improvement
what causes canaliculitis?
secondary to an infection - usually actinomyces
what are the signs/symptoms of cancliculitis?
epiphora, chronic mucopurulent conjunctivitis that doesn’t respond to treatment, canalicular edema and inflammation and cancalicular concretions
what is the treatment for canaliculitis?
warm compresses, antibiotics (oral = doxycycline 100mg BID or topical = polytrim QID), curettage-scrape concretions, and canaliculotomy if no improvement with currettage
how to you differentiate between dacryocystitis and canaliculitis?
dacryocystitis has more swelling, tenderness and pain vs. canaliculitis which has punctal pouting, concretions and recurrent conjunctivitis
how do you differentiate dacryocystitis and canaliculitis from cellulitis/preseptal or orbial?
cellulitis doesn’t have punctal discharge and has an unobstructed lacrimal drainage system
how do you differentiate dacryocystitis and canaliculitis from nasolacrimal duct obstruction?
the duct obstruction has some tearing but less redness or swelling of punctum
what is inflammation of the lacrimal gland called and what are the signs/symptoms?
dacryoadenitis
redness, swelling of lateral upper eyelid, pain and possible diplopia
what are the causes of acute dacryoadenitis?
inflammatory (sarcoidosis, pseudotumor), bacterial or viral
what are the causes of chronic dacryoadenitis?
inflammatory (sarcoidosis, pseudotumor), bacterial, viral PLUS tumor, cyst, TB, syphilis, leukemia, metastasis and others
how do you evaluate dacryoadenitis and what is the treatment?
slit lamp, culture dischrage, CBC with diff, CT scan
treat specific etiology - if unsure use oral antibiotic
