Module 1 nasolacrimal duct, dacryocystitis, pingueculae, pterygia

Question 1

nasolacrimal ducts

Answer 1

drains tears from the eyes into the nose
- complete or partial obstruction is called a nasolacrimal duct obstruction

Question 2

Nasolacrimal duct obstruction (NLDO) 2 acquired types

Answer 2

• Primary: caused by inflammation or fibrosis without any precipitating cause
• Secondary: caused by a myriad of precipitating factors; infection, inflammation, neoplasm, trauma, stenosis

Question 3

lacrimal drainage system

Answer 3

superior and inferior canaliculus
lacrimal sac
nasolacrimal duct

Question 4

NLDO patho

Answer 4

fluid enters opening in the upper and lower lid margin (puncta) before being pumped through canaliculi into the lacrimal sac
-> through rhe nasolacrimal duct -> exit into the nasal cavity through the valve of Hasner and the inferior meatus

Question 5

NLDO s/s

Answer 5

chronic tearing
ocular discharge
eyelash crusting
painful swelling below medial canthus
mucopurulent discharge from punctum

Question 6

epiphora

Answer 6

accumulation of tears in the palpebral fissure with eventual overflow down the cheeks
- denotes lacrimal outflow deficiency

Question 7

Hx assoc. with NLDO

Answer 7

chronic allergies
sinusitis
previous nasal or sinus surgery
prior midfacial fractures
radiation therapy
granulomatosis with polyangitis
sarcoidosis
crohn disease
ulcerative colitis

Question 8

NLDO physical exam

Answer 8

gross findings
- overflow of tears
- mucoid or purulent discharge
- conjunctival injection
- erythema over the lacrimal sac
- pressure over the lacrimal sac -> produce a mucoid reflux from the punctum: indicates lower system obstruction
Inspect nares for abnormality that could narrow the distal opening of the nasolacrimal duct

Question 9

dacryocystits

Answer 9

inflammation of the lacrimal gland
medial canthus swelling
fluctuance, erythema, or tenderness over the lacrimal sac
fever
leukocytosis

Question 10

NLDO non-pharm tx

Answer 10

will resolves over a 12 month period
Crigler massage: downward pressure applied on the lacrimal sac to force open a blocked valve of Hasner

Question 11

NLDO pharm tx

Answer 11

warm compresses
topical antibiotics with infection

Question 12

dacryocystitis tx

Answer 12

warm compresses
topical broad-spectrum antibiotic eye drops
oral penicillinase-resistant antibiotics till culture returns

Question 13

Pinguecula

Answer 13

benign, elevated, yellow-white nodule on the bulbar conjunctiva
- most often located nasal to the cornea

Question 14

pterygium

Answer 14

benign growth of conjunctival tissue that extends onto the surface of the cornea
- name comes from the greek work pterygion meaning wing
– wing is on the conjunctiva and tapers to a head over the cornea

Question 15

pinguecula and pterygium patho

Answer 15

elastotic degeneration of stromal collagen and disruption of the basement membrane of the conjunctival epithelium

Question 16

pterygia patho

Answer 16

corneal involvement includes infiltration of the bowman layer
- can lead to scarring and focal opacification of the cornea

Question 17

pterygia risk factors

Answer 17

exposure to UV light
heredity
sunny, dusty, sandy, windblown areas
near the equator
chronic conjunctival inflammation
viral infections

Question 18

pinguecula and pterygium s/s

Answer 18

dryness
irritation
foreign body sensation
itching
redness
bothersome cosmetic appearance
intermittent blurry vision

Question 19

pterygium may lead to

Answer 19

• persistently decreased vision
• induce astigmatism
• impair vision by extending from the periphery into the central cornea, obstructing the visual axis

Question 20

pterygium physical exam

Answer 20

can be whitish or clear and may be detectable only by changes in corneal contour and blood vessels that track from the conjunctival base

Question 21

pterygium and pinguecula tx

Answer 21

Non-pharm:
- symptomatic: dry eye, itchiness, rendess
- artificial tear drops
- UV protection
Pharm:
- low potency topical steroid drops

Question 22

NLDO risk factors

Answer 22

chronic allergies
sinusitis
prior facial trauma
radiation
systemic inflammatory diseases