Lacrimal system and dry eyes - pathology Flashcards
Define canaliculitis:
An infection of the canaliculi which is most commonly due to acrinomyces israelii.
how does canaliculitis present?
Unilaterally, red eye with watering (epiphora) and discharge when pressure applied to the canaliculus.
How is canaliculitis managed?
With topical antibiotics
What is the name for idiopathic lacrimal gland inflammation?
Dacryoadenitis
What are the risk factors for dacryoadenitis?
Tear stasis
viral infections e.g. mumps
If bilateral suspect sarcoidosis
What symptom in dacryoadenitis should cause concern?
Paraesthesia persisting
May indicate tumour
List some of the features of dacryoadenitis?
painful, tender erythematous and swollen lacrimal gland
Disturbed tear production
S shaped ptsosis of the upper eyelid
Downward and inward displacement of the globe
Define dacryocystitis:
This is infection of the lacrimal sac due to an obstruction of the nasolacrimal duct.
What are the most likely causative organisms for dacryocystitis in adults and children?
Adults - Staph Aureus and S. epidermidis
Children - Haemophilus influenza and Strep pneumonia
How is dacryocystitis managed?
Acutely: Warm compress, systemic antibiotics
Chronic: dacryocystorhinostomy
What are the clinical features of dacryocystitis?
Erythematous tender swelling over the lacrimal sac
Epiphora
Unilateral, recurrent conjunctivitis
What is the most common tumour of the lacrimal gland and what age group does it mainly affect?
Pleomorphic adenoma
Middle aged patients.
Benign but has malignant potential
What is the histopathology of pleomorphic adenomas, and list its clinical features?
epithelial and mesenchymal components
Painless, progressive enlargement of the upper eyelid with inferonasal dystopia.
What investigations are appropriate for lacrimal tumours?
CT scan
Biopsy
What is a rare malignant tumour of the lacrimal gland/
Lacrimal gland carcinoma
What are the features of a lacrimal gland carcinoma?
Rapidly growing, optic disc swelling, inferonasal dystopia, choroidal folds and perineural invasion.
Histologically, what might be seen in a lacrimal gland carcinoma?
Cribriform (swiss cheese) growth pattern
How is a lacrimal gland carcinoma managed?
Surgical removal of the globe and surrounding tissue following biopsy.
Radiotherapy
Radical orbitectomy
What is sjogrens syndrome?
An autoimmune condition in which the salivary and lacrimal glands become infiltrated with lymphocytes and the acini are progressively destroyed.
What antibodies are found in Sjogren’s?
Anti-Ro and Anti-La
What investigations are appropriate for Sjogren’s?
Antibodies
Schirmer test
Test tear film breakup time
Ocular staining
What triad features are found in Sjogren’s?
Xerostomia
Keratoconjunctivitis sicca
Parotid gland enlargement
List some other features of Sjogren’s:
Posterior blepharitis
Corneal punctate epithelial erosions
Strands of filaments of mucus and debris which stain with rose bengal
How is Sjogren’s managed?
- Ocular lubricants and artificial tears
- Topical corticosteroids and/or pilocarpine orally
- Punctal occlusion or low water content bandage contact lenses
