LACRIMAL SYSTEM -- DISORDER AND INFX

Question 1

what is nasal lacrimal duct obstruction (NLDO)?

Answer 1

• It is obstruction of the nasolacrimal duct.

Question 2

what are the 2 types of NLDO? whate

Answer 2

• Congenital – caused by membranous blockage at the valve of Hasner.
• Acquired (older pts) – caused by involutional stenosis.

Question 3

symptoms of NLDO?

Answer 3

• Unilateral epiphora (tearing).
• Crusting
• Recurrent conjunctivitis
• No-to-mild redness or tenderness around the puncta.

Question 4

signs of NLDO?

Answer 4

• Mucous reflex from puncta after compression of the lacrimal sac
• Medial lower eyelid erythema (red)

Question 5

w/u for NLDO?

Answer 5

• jones tests – to determine whether or not the nasolacrimal duct is blocked

Question 6

Tx for NLDO?

Answer 6

• congenital NLDO – spontaneously resolves by the child’s 1st bday. If it does not then nasolacrimal duct probing may be needed to clear blockage.
• Acquired NLDO– obstruction may be clear with dilation and irrigation. If not then rx abx/steroid combo. In severe cases, surgery is required (dacryoplasty, dacryocystorhinostomy, silicone intubation).

Question 7

what is canaliculitis?

Answer 7

• It is inflammation of the canaliculi that can be caused by bacterial, viral, fungal infections.

Question 8

what bacteria is the most common cause of canaliculitis

Answer 8

actinomyces Israelii (gram +)

Question 9

symptoms of canaliculitis

Answer 9

• Medial eyelid/puncta tenderness
• epiphora

Question 10

signs of canaliculitis

Answer 10

• Unilateral epiphora
• Pouting punctum (red, swollen, rolled away from globe punctum)
• Dacryoliths (solid yellow sulfur granules) upon palpation of the lacrimal sac area.

Question 11

tx for canaliculitis

Answer 11

• Remove concretion obstruction via expression first –> then perform irrigation of the canaliculi w/ abx solution 00> then rx oral antibiotics
• In cases that do not respond to tx, surgery is required – Canaliculotomy – removal of posterior wall of the cacaliculi.
• F/U every 5-7 days

Question 12

what is
DACRYOCYSTITIS

Answer 12

• It is infection of the lacrimal sac 2/2 to nasolacrimal duct obstruction.

Question 13

how does one get affected with DACRYOCYSTITIS

Answer 13

• Backflow of bacteria from the nasolacrimal duct into the lacrimal sac due to an obstruction of the lacrimal drainage system (ex. NLDO)

Question 14

what bacteria are involved in DACRYOCYSTITIS

Answer 14

adult – streptococcus pneumoniae
children – H. influenza

Question 15

symptoms of DACRYOCYSTITIS

Answer 15

• Pain/tender medial eyelid
• Crusting
• unilateral epiphora
• Possible fever

Question 16

signs of DACRYOCYSTITIS

Answer 16

• Red, swollen, tender lacrimal sac.
• Possible fever
• mucopurulent discharge upon palpation

Question 17

tx for DACRYOCYSTITIS

Answer 17

• DONT PROB IN ACUTE INFX – may spread infx more
• Rx oral or IV abx depending on severity
• if conjunctivitis present – rx topical abx
• Dacryocystorhinostomy (DCR) – ONLY once infection has resolved!
• f/u daily

Question 18

what is DACRYOADENITIS

Answer 18

It is inflammation of the lacrimal gland.

Question 19

what are the 2 types DACRYOADENITIS

Answer 19

• acute – viral or bacterial infx
• chronic – inflammatory disorder

Question 20

what are the bacteria and virus involved in DACRYOADENITIS

Answer 20

Bacteria: Staph aureus (most common)
Viral: Mumps / Mononucleosis / Influenza /HZV

Question 21

what are the inflammatory conditions involved in DACRYOADENITIS

Answer 21

 Sarcoidosis
 Tuberculosis
 Graves disease
 Idiopathic orbital inflammation

Question 22

symptoms for DACRYOADENITIS

Answer 22

• Temporal eyelid swelling (near lacrimal gland)
• Pain
• Tenderness
• Discharge possible
• Warmth

Question 23

signs of
DACRYOADENITIS

Answer 23

• Classical S-shape ptosis
• Temporal upper eyelid pain, redness, and swelling

ACUTE:
* Fever + Preauricular lymphadenopathy
* Elevated WBC

CHRONIC:
* EOMS restriction

Question 24

tx for DACRYOADENITIS

Answer 24

acute – oral or IV meds depending on suspected bacterial or viral etiology
chronic – identify and tx underlying inflammatory disorder