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Ocular Disease > Midterm 2- Lacrimal disease > Flashcards

Midterm 2- Lacrimal disease Flashcards

1
Q

Congenital Dacryocele

A
  • Collection of amniotic fluid within an obstructed lacrimal sac
  • Appears as a firm bluish mass on the side of the nose and inferior to the medial canthus of the eyelid
  • Hot compresses and massage is the initial treatment but most infants will require probing
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2
Q

Congenital Nasolacrimal Duct Obstruction

A
  • A very common disorder in infants; occurs clinically in 2-4% full-term infants
  • Results from a failure of the nasolacrimal duct to completely canalize during gestation
  • Usually the obstruction is at the nasal end, the “valve” of Hasner
  • Unilateral or bilateral
  • Most common cause of tearing in childhood
  • Can lead to a bacterial dacryocystitis and conjunctivitis
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3
Q

Congenital Nasolacrimal Duct Obstruction signs

A

Tearing
Discharge
Crusting
Mucus reflux from the punctum with compression over the lacrimal sac

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4
Q

Congenital Nasolacrimal Duct Obstruction management

A
  • Warm compresses bid to qid
  • Topical antibiotic ointment (erythromycin bid for 1 week) if mucopurulent discharge
  • Massage bid to qid - parent places index finger over infant’s canaliculi (medial corner of eyelid) and makes several slow downward strokes
  • -The motion will send hydrostatic forces down the nasolacrimal duct to open the obstruction
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5
Q

Congenital Nasolacrimal Duct Obstruction tx

A
  • Over 90% of nasolacrimal obstruction will resolve spontaneously or with the assistance of nasolacrimal duct massage
  • Probing is considered between 6 and 13 months of age; exact timing for probing is controversial
  • If probing is not successful, treatment is usually surgical
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6
Q

Congenital Glaucoma

A

DDx congenital tearing

If the child has both
tearing and photophobia, the possibility of congenital glaucoma should be considered, even if the cornea is not cloudy or large

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7
Q

Congenital Glaucoma signs

A

Large horizontal iris diameter
HVID- horizontal visible iris diameter
Structural changes in eye

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8
Q

Acquired Nasolacrimal Duct Obstruction etiology

A

Chronic sinus disease
Age-related stenosis
Naso/orbital trauma

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9
Q

Acquired Nasolacrimal Duct Obstruction findings

A

Tearing
Discharge
Crusting
Recurrent conjunctivitis

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10
Q

Acquired Nasolacrimal Duct Obstruction dx

A 
Jones test(s)
Often leads to acute dacryocystitis
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11
Q

Acquired Nasolacrimal Duct Obstruction management

A
  • Warm compresses
  • Topical antibiotic-steroid if partial obstruction
  • Dilation/irrigation and/or probing
  • If not successful, management is usually surgical
  • -Silicone intubation
  • -Dacryocystorhinostomy (anastomosis between lacrimal sac and nasal cavity)
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12
Q

Acute Dacryocystitis

A

Infection of the lacrimal sac

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13
Q

Acute Dacryocystitis

Etiology

A

Nasolacrimal duct obstruction
Tears stagnate in lacrimal sac
Become infected

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14
Q

Acute Dacryocystitis

causes

A 
Causes of nasolacrimal duct obstruction
Long and narrow nasolacrimal ducts
Lacrimal sac diverticulum
Trauma
Dacryoliths- stones formation
Inflammatory sinus and nasal problems
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15
Q

Acute Dacryocystitis infection

A

Bacteria causing infection

  • Staphylococci
  • Streptococci
  • E. coli, Pseudomonas, other Gram negatives
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16
Q

Acute Dacryocystitis findings

A
  • Tenderness, erythema, and swelling over nasal portion of lower eyelid
  • Epiphora
  • Purulent punctal discharge particularly if pressure is applied to the lacrimal sac
  • Fever and malaise may occur
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17
Q

Acute Dacryocystitis

Complications

A
  • Preseptal cellulitis
  • Conjunctivitis
  • Cutaneous fistulas may form from the lacrimal sac
  • Less common, orbital cellulitis and sepsis
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18
Q

Acute Dacryocystitis tx

A

-Warm compress tid
-Systemic antibiotic
Oral Augmentin (amoxicillin/clavulante)
IV Unasyn (amoxicillin/sulbactam)

  • Topical antibiotic ointment (erythromycin) if conjunctivitis exists
  • Aspirate lacrimal sac contents with 19 gauge needle for culture and susceptibility testing
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19
Q

Acute Dacryocystitis follow up

A
  • If pointing abscess, consider incision and drainage
  • After infection resolved, lacrimal system dilation/irrigation and/or probing to relieve the obstruction
  • Nasal exam, possible CT scan
  • Consider dacryocystorhinostomy (DCR) with silicon tubing to correct the nasolacrimal duct obstruction and prevent future dacryocystitis
20
Q

Chronic Dacryocystitis

A

Enlarged lacrimal sac without signs of acute inflammation

21
Q

Chronic Dacryocystitis Etiology

A

Chronic infection
Chronic inflammation/granuloma
Tumor (cancer)

22
Q

Chronic Dacryocystitis test

A
  • Culture to determine antibiotic therapy; then dacryocystorhinostomy
  • If not infectious, biopsy and appropriate treatment
23
Q

Carcinoma Of The Lacrimal Sac

A

Grew – moved upward
Inner lining of sac cells get enlarged
Can penetrate orbital septum
Need immediate referral

24
Q

Acute Dacryoadenitis

A

Inflammation of the lacrimal gland
-Palpebral lobe affected more frequently than
orbital

Most cases associated -with systemic infection

25
Q

Acute Dacryoadenitis

Etiology

A 
Infection
Viral infection
Mumps
Epstein-Barr virus
Herpes zoster

Bacterial infection
Staphylococci
Neisseria gonorrhoeae

26
Q

Acute Dacryoadenitis

Clinical Features

A
  • Temporal upper eyelid inflammation
  • Tearing
  • Discharge
  • Fever
  • Proptosis if orbital lobe involved
  • s shaped lid
27
Q

Acute Dacryoadenitis work up

A
  • Culture and Gram staining of discharge
  • CBC
  • Blood culture
  • Consider orbital CT scan
28
Q

Acute Dacryoadenitis swollen palpebral lobe

A

Swollen palpebral lobe of the lacrimal gland can be easily visualized in the supratemporal fornix by elevating the upper lid while having the patient looking down

29
Q

Acute Dacryoadenitis management

A

Treat the underlying infection or inflammation

30
Q

Acute Dacryoadenitis management

Mumps/Epstein-Barr virus -

A

warm compresses

31
Q

Acute Dacryoadenitis management

Herpes simplex/zoster virus

A

systemic acyclovir or famciclovir

32
Q

Acute Dacryoadenitis management

Staphylococci and streptococci -

A

systemic antibiotic eg Augmentin

33
Q

Acute Dacryoadenitis management

Neisseria gonorrhoeae -

A

systemic antibiotic eg ceftriaxone

34
Q

Acute Dacryoadenitis management

Mycobacterium species -

A

surgical excision + systemic antibiotics eg isoniazid and rifampin

35
Q

Acute Dacryoadenitis management

Treponema pallidum -

A

systemic antibiotic eg penicillin G

36
Q

Chronic Dacryoadenitis

A

Chronic inflammation of the lacrimal gland

More common than acute
Enlarged lacrimal gland
Globe displacement
Restricted ocular motility

37
Q

Chronic Dacryoadenitis etiology

A

Sarcoidosis
Thyroid ophthalmopathy
Sjogren’s syndrome= dryness + arthritis
Tumors

38
Q

Chronic Dacryoadenitis - Sarcoid

A

Lacrimal gland sarcoidosis (granulomatous inflammation)

39
Q

Sjogrens Syndrome

A

Autoimmune disease

Triad: dry eye, dry mouth, arthritis

Lacrimal gland infiltrated with lymphocytes may be enlarged

40
Q

Lacrimal Gland Tumors

A

Enlargement of lacrimal fossa with displacement of the globe and no inflammatory signs

CT scan

41
Q

DDx of Chronic Dacryoadenitis - Dermoid Cyst

A
  • Cystic lesion seen in preschool children
  • Superotemporal mass
  • Mobile and nontender
  • Well circumscribed on CT with rare bony remodeling
  • Surgical excision
42
Q

Canaliculitis

A

Infection of the canaliculus (duct between the punctum and the lacrimal sac)

43
Q

Canaliculitis Etiology

A
  • Actinomyces Israelii (filamentous gram + rod)
  • Candida albicans (yeast)
  • Aspergillus (filamentous fungus)
  • Nocardia asteroides (filamentous rod)
  • Herpes simplex/zoster (viruses)
44
Q

Canaliculitis signs

A

Erythema and swelling of punctum and adjacent tissues

Conjunctivitis around the medial canthus

45
Q

Canaliculitis - Bottom Shows Removal Of Sulfur Granules

A

Canalicular concretion removal either by manual expression through the punctum or by scraping the canaliculus

Here sulfur granules associated with Actinomyces infection are
removed

46
Q

Canaliculitis management

A

Warm compresses
Culture
Remove concretions
Appropriate systemic and topical antibiotics

47
Q

canaliculitis testing

A

Jones Test To Determine Patency Of Drainage System

Ocular Disease (7 decks)

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