Lacrimal system and dry eyes - pathology

Question 1

Define canaliculitis:

Answer 1

An infection of the canaliculi which is most commonly due to acrinomyces israelii.

Question 2

how does canaliculitis present?

Answer 2

Unilaterally, red eye with watering (epiphora) and discharge when pressure applied to the canaliculus.

Question 3

How is canaliculitis managed?

Answer 3

With topical antibiotics

Question 4

What is the name for idiopathic lacrimal gland inflammation?

Answer 4

Dacryoadenitis

Question 5

What are the risk factors for dacryoadenitis?

Answer 5

Tear stasis
viral infections e.g. mumps
If bilateral suspect sarcoidosis

Question 6

What symptom in dacryoadenitis should cause concern?

Answer 6

Paraesthesia persisting

May indicate tumour

Question 7

List some of the features of dacryoadenitis?

Answer 7

painful, tender erythematous and swollen lacrimal gland
Disturbed tear production
S shaped ptsosis of the upper eyelid
Downward and inward displacement of the globe

Question 8

Define dacryocystitis:

Answer 8

This is infection of the lacrimal sac due to an obstruction of the nasolacrimal duct.

Question 9

What are the most likely causative organisms for dacryocystitis in adults and children?

Answer 9

Adults - Staph Aureus and S. epidermidis

Children - Haemophilus influenza and Strep pneumonia

Question 10

How is dacryocystitis managed?

Answer 10

Acutely: Warm compress, systemic antibiotics
Chronic: dacryocystorhinostomy

Question 11

What are the clinical features of dacryocystitis?

Answer 11

Erythematous tender swelling over the lacrimal sac
Epiphora
Unilateral, recurrent conjunctivitis

Question 12

What is the most common tumour of the lacrimal gland and what age group does it mainly affect?

Answer 12

Pleomorphic adenoma
Middle aged patients.
Benign but has malignant potential

Question 13

What is the histopathology of pleomorphic adenomas, and list its clinical features?

Answer 13

epithelial and mesenchymal components

Painless, progressive enlargement of the upper eyelid with inferonasal dystopia.

Question 14

What investigations are appropriate for lacrimal tumours?

Answer 14

CT scan

Biopsy

Question 15

What is a rare malignant tumour of the lacrimal gland/

Answer 15

Lacrimal gland carcinoma

Question 16

What are the features of a lacrimal gland carcinoma?

Answer 16

Rapidly growing, optic disc swelling, inferonasal dystopia, choroidal folds and perineural invasion.

Question 17

Histologically, what might be seen in a lacrimal gland carcinoma?

Answer 17

Cribriform (swiss cheese) growth pattern

Question 18

How is a lacrimal gland carcinoma managed?

Answer 18

Surgical removal of the globe and surrounding tissue following biopsy.
Radiotherapy
Radical orbitectomy

Question 19

What is sjogrens syndrome?

Answer 19

An autoimmune condition in which the salivary and lacrimal glands become infiltrated with lymphocytes and the acini are progressively destroyed.

Question 20

What antibodies are found in Sjogren’s?

Answer 20

Anti-Ro and Anti-La

Question 21

What investigations are appropriate for Sjogren’s?

Answer 21

Antibodies
Schirmer test
Test tear film breakup time
Ocular staining

Question 22

What triad features are found in Sjogren’s?

Answer 22

Xerostomia
Keratoconjunctivitis sicca
Parotid gland enlargement

Question 23

List some other features of Sjogren’s:

Answer 23

Posterior blepharitis
Corneal punctate epithelial erosions
Strands of filaments of mucus and debris which stain with rose bengal

Question 24

How is Sjogren’s managed?

Answer 24

• Ocular lubricants and artificial tears
• Topical corticosteroids and/or pilocarpine orally
• Punctal occlusion or low water content bandage contact lenses

Question 25

What causes xerophthalmia?

Answer 25

Severe Vit A deficiency

Question 26

What are the features of xerophthalmia?

Answer 26

Nyctalopia 
Xerosis
Bitot's spots
Punctate corneal epithelial erosions
Keratomalacia

Question 27

How is xerophthalmia managed?

Answer 27

Vitamin A supplement and topical lubrication

Question 28

Define nyctalopia:

Answer 28

Inability to see in dim light