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Ocular Disease > Lacrimal System > Flashcards

Lacrimal System Flashcards

1
Q

what is this condition called?

A

punctal stenosis

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2
Q

what is this condition called?

A

punctal malposition

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3
Q

what is this condition called?

A

dacryocystitis

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4
Q

what is this condition called?

A

canaliculitis

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5
Q

what is this condition called?

A

dacryoadenitis

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6
Q

which nerve innervates the lacrimal gland?

A

CN 5

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7
Q

what are the 3 protein parts of tears?

A

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

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8
Q

what electrolytes are present in tears?

A

Na, K, Cl, Ca

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9
Q

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

A

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

poor outflow (epiphora)

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10
Q

what are the 3 causes of epiphora?

A
  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
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11
Q

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

A

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

and common in the elderly

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12
Q

what is the management for punctal stenosis?

A

minor surgical procedure = punctal dilation or surgical/laser punctoplasty

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13
Q

what are 2 causes of punctal malposition?

A

ectropion and punctal eversion

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14
Q

what is the management for punctal malposition?

A

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

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15
Q

what are some causes of canalicular/duct obstruction?

A

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

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16
Q

what is the treatment for canalicular/duct obstruction?

A

DCR (dacryocystorhinostomy) = surgical opening

17
Q

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

A

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

epiphora and mucous discharge

18
Q

what is the treatment for a congenital obstruction?

A

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

19
Q

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

A

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

20
Q

what are some treatment options for aqueous dry eye?

A

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

21
Q

what are 2 lacrimal infections?

A

dacryocystitis and canaliculitis

22
Q

what is dacryocystitis?

A

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

23
Q

what is the management for dacryocystitis?

A

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

24
Q

what causes canaliculitis?

A

secondary to an infection - usually actinomyces

25
Q

what are the signs/symptoms of cancliculitis?

A

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

26
Q

what is the treatment for canaliculitis?

A

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

27
Q

how to you differentiate between dacryocystitis and canaliculitis?

A

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

28
Q

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

A

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

29
Q

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

A

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

30
Q

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

A

dacryoadenitis

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

31
Q

what are the causes of acute dacryoadenitis?

A

inflammatory (sarcoidosis, pseudotumor), bacterial or viral

32
Q

what are the causes of chronic dacryoadenitis?

A

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

33
Q

how do you evaluate dacryoadenitis and what is the treatment?

A

slit lamp, culture dischrage, CBC with diff, CT scan

treat specific etiology - if unsure use oral antibiotic

Ocular Disease (10 decks)

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