Nasolacrimal System Disorders Flashcards

1
Q

list the order of the nasolacrimal drainage system

A

superior & inferior canaliculi → common canaliculus → Valve of Rosenmuller → lacrimal sac → lacrimal duct → valve of Hasner → inferior meatus

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2
Q

what is lacrimal pump action?

what happens when the eyes are open?

A

contraction of orbicularis oculi forces tears down the nasolacrimal duct

when the eyes are open → the canaliculus & sac expand → creating a negative pressure that draws tears from the canaliculus into the sac

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3
Q

the overflow of tears at the eyelid margin

A

epiphora

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4
Q

what causes epiphora?

A

hypersecretion, defective drainage

e.g: conjunctivochalsis, punctal stenosis, canalicular obstruction (canaliculitis), acute dacryocystitis, nasolacrimal duct obstruction (congenital/acquired)

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5
Q

what is caused by anterior segment disease?

involves:

  • dry eye: paradoxical watering
  • inflammation
A

hypersecretion

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6
Q

characteristics:
compromised lacrimal drainage system

  • malposition of lacrimal puncta (ectropion)
  • obstruction along drainage system: anywhere along pathway from punctum to valve of Hasner
  • lower lid laxity or orbicularis oculi weakness: CN VII palsy

what is this called?

A

defective drainage

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7
Q

what is one or more folds of redundant conjunctiva prolapsing over lower eyelid margin called?

A

conjunctivochalsis

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8
Q

what causes conjunctivochalsis?

A

loss of conjunctival adhesion to underlying Tenon’s capsule & episclera –> frequently results in epiphora

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9
Q

which age group does conjunctivochalsis usually affect?

A

elderly pts

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10
Q

what is the management of conjunctivochalsis?

A

topical lubrication or surgery (conjunctiva secured to underlying sclera)

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11
Q

what causes punctal stenosis?

A

idiopathic, blepharitis, trauma, prior radiation therapy

meds: taxotere (breast cancer), 5-fluororacil (various cancers)

chronic secondary to infection (Actinomyces irsraelii)

autoimmune disorders: ocular cicatrical pemphigoid, Stevens Johnson syndrome

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12
Q

what causes canalicular obstruction? what can it lead to?

A

congenital, trauma, medications (taxotere), radiation, infection

lead to canalculitis

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13
Q

what bacteria causes canalculitis?

A

Actinomyces israelli

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14
Q

unilateral epiphora w/ chronic mucopurulent conjunctivitis

canalicular redness & edema

mucopurulent discharge on pressure over canaliculus (“pouting punctum”)

what condition are these signs & symptoms for?

A

canaliculitis

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15
Q

what forms within canaliculus (sulfur granules) leading to further obstruction (dacryolith)?

A

concretions

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16
Q

what is the management of canaliculitis?

A

requires surgical removal of concretions

topical antibiotics are not curative

17
Q

what is the management of punctal stenosis?

A

dilation, punctoplasty, perforated punctal plug

18
Q

what is infection of the lacrimal sac, usually due to nasolacrimal duct obstruction called?

A

acute dacryocystitis

19
Q

what are symptoms of acute dacryocystitis?

A

pain & redness below the medial canthal area, epiphora

20
Q

what are signs of acute dacryocystitis?

A

tense red swelling below the medial canthal area

tender to touch

pressure on swollen tissue → mucopurulent reflux from canaliculi

21
Q

what are treatments of acute dacryocystitis?

A

hot compresses over affected area

oral antibiotics:
augmentin 500mg PO q8h x 7-10 days
keflex 500mg PO q6h x 7-10 days

22
Q

what are complications of acute dacryocystitis?

A

preseptal cellulitis, orbital cellulitis

23
Q

what is it called when Valve of Hasner fails to open up?

A

congenital (primary) nasolacrimal duct obstruction (NLDO)

24
Q

exacerbated during upper respiratory tract infections —

epiphora, mucus discharge, matting of eyelashes, bacterial conjunctivitis

what are these signs of?

A

congenital (primary) NLDO

25
what is the differential diagnosis of congenital (primary) NLDO?
congenital glaucoma, corneal abrasion, corneal ulcer
26
what are treatments of congenital (primary) NLDO?
spontaneous resolution in over 95% of pts w/in first year massage lacrimal sac to rupture membranous obstruction by hydrostatic pressure surgical: probing of nasolacrimal duct - typically delayed until after 1 yr; can be delayed up to 2 yrs - requires general anesthesia
27
what is acquired (secondary) nasolacrimal duct obstruction (NLDO)?
trauma, infection, inflammation, neoplasm
28
what are the diagnostic & treatment procedures for nasolacrimal system disorders?
external examination, lacrimal dilation & irrigation, NaFl disappearance test, Jones test, contrast dacryocystography, dacryocystorhinostomy (DCR)
29
explain the purpose of external examination | what is the most common cause of lacrimal drainage failure?
punctal abnormality is the most common cause of lacrimal drainage failure examine the lid margins & puncta at the slit lamp → ectropion, punctal obstruction/stenosis, palpate the lacrimal sac
30
cannula hits the medial wall of the sac that lies adjacent to the lacrimal bone confirms pt canalicular system saline irrigation is performed — if it cannot be tasted in throat → there is an obstruction of nasolacrimal duct what is this called in lacrimal dilation & irrigation treatment?
hard stop
31
cannula does not reach wall of lacrimal sac due to canalicular obstruction if saline returns through the same punctum → the obstruction is in the canaliculus if saline returns through the opposite punctum → the obstruction is in the common canaliculus (Valve of Rosenmuller) what is this called in the lacrimal dilation & irrigation treatment?
soft stop
32
what is the range of normal tear meniscus?
0.2-0.4mm
33
Name this procedure: instill NaFl drops into both conjunctival fornices → examine ocular surface after 5 minutes → minimal dye should remain prolonged retention of dye indicates inadequate lacrimal drainage
NaFl disappearance test
34
Name this procedure: - radio-opaque contrast medium injected into canaliculi, followed by imaging of nasolacrimal drainage pathway - should not be performed if active infection is present - unnecessary if site of obstruction is obvious
contrast dacryocystography
35
what are indications of contrast dacryocystography?
confirms precise site of obstruction for surgery guidance aids in diagnosis of diverticuli, fistulae, & filling defects due to presence of a mass (stone, tumor)
36
Name this treatment: surgical procedure that connects the lacrimal sac to the middle nasal meatus (when probing not possible or can't recreate pathway) - creates a new drainage pathway for tears that bypasses the nasolacrimal ducct - general anesthesia usually required
dacryocystorhinostomy (DCR)
37
what age group is DCR usually performed on?
adults