Lacrimal System disorders

Question 1

epiphora

Answer 1

defective drainage ‘plumbing’ problem

• malposition of puncta
• obstruction of lacrimal drainage system (from puncta to nasolacrimal duct)
• lacrimal ‘pump’ failure (due to weakness of orbicularis muscle)

Question 2

hypersecretion

Answer 2

overproduction of tears

body’s response to irriation - produce tears to try flush our the cause of irritation

Question 3

diseases/disorders that affect the positioning of the puncta

can tears get into the puncta?

Answer 3

ectropion
entropion
floppy eyelid syndrome
pump failure

Question 4

can tears drain?

Answer 4

canaliculitis
dacryocystitis (infl. of lacrimal sac)
anything else that may cause stenosis of tear ducts (eg. large hordeolum or chalazion)

Question 5

dilation and irrigation

Answer 5

dilation - uses an instrument that enlarges the lower lacrimal puncta (only temporary)
(‘lacrimal lavage’)

irrigation - using a syringe filled w saline or salt water

• see if you increase pressure, if you are able to force liquid through the entire system
• may be able to get rid of what was blocking the system

Question 6

punctal stenosis

Answer 6

progressive constriction of the puncta (narrowing)

Question 7

atresia or agenesis

Answer 7

congenital absence of puncta

aka no puncta at all

Question 8

punctoplasty

Answer 8

surgical procedure used to correct punctal stenosis
(1-4 snip punctoplasty)

however, there is a potential of recurrence of punctal stenosis secondary to healing

Question 9

congenital nasolacrimal duct obstruction

Answer 9

caused by delayed canalisation near valve of Hasner

Question 10

congenital dacryocele

Answer 10

amniotic fluid that is collected in the lacrimal ac

Question 11

primary acquired nasolacrimal duct obstruction

Answer 11

caused by idiopathic inflammation / fibrosis of nasolacrimal duct
resulting in partial stenosis or complete obliteration of duct
common in 50-70yo women

Question 12

secondary acquired lacrimal drainage obstruction

Answer 12

possible causes: infectious, inflammatory, neoplastic, trauma/mechanical

Question 13

chronic canaliculitis

Answer 13

rare infection in canaliculus (lower more infected)

• freq caused by actinomyces israelii
• unilateral epiphora and chronic mucopurulent discharge

Question 14

acute dacryocystitis

Answer 14

infection of lacrimal sac
commonly caused by H.influenzae, s.aureus, strep pyogenes or pneumoniae

usually secondary to nasolacrimal duct obstruction
don’t dilate,probe or irrigate - need to REFER bc of pain and potential spread of infection

Question 15

chronic dacryocystitis

Answer 15

chronic obstruction of the nasolacrimal system
- painless swelling at inner canthus
- epiphora and chronic or recurrent unilateral conjunctivitis
REFER as this requires DCR - surgery

Question 16

dacryonadenitis

Answer 16

rare inflammation of lacrimal gland

• unilateral pain, redness and swelling of outer 1/3 upper lid
• often seen w tearing and discharge
• usually children and young adults
• associated chemosis - s-shaped upper lid margin, outer third

orbital discomfort, lid swelling, redness and discharge

• bilateral, usually associated w systemic disease
• unilateral, caused by penetrating injury, spreawd of bacterial conj

Question 17

dacryops (lacrimal gland cyst)

Answer 17

round, ductal cystic lesion, arises from palpebral portion of lacrimal gland, can be transilluminated

protrudes into superior fornix, freq bilateral