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Ocular Disease: Lecture 8: Lacrimal System Flashcards

1
Q

Lacrimal System

  1. What are the 6 things?
A
  1. Lacrimal Gland
  2. Accessory Gland of Krause and Wolfring
  3. Punctum
  4. Canalicula
  5. Lacrimal Sac
  6. Nasolacrimal Duct
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2
Q

Lacrimal System

Tear Drainage System

  1. First portion?
  2. Eyes Closing causes what 3 things to occur?
  3. Eyes Open Causes what 2 things?
A
  1. Lid Margin
  2. a. Compression of Ampulla
    b. Compression and Shortening of horizontal Canaliculi
    c. Compression of Lacrimal Sac
  3. Canaliculi and Ampulla Expand; Negative Pressure
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3
Q

Lacrimal System

Epiphora

  1. What is it?
  2. Caused by what 2 things?
A
  1. Overflow of Tears
  2. Hypersecretion

and

Defective Drainage

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4
Q

Lacrimal System

Epiphora: Hypersecretion

  1. Secondary to what 2 things?
  2. Treatment involves what?
A
  1. a. Ocular Inflammation
    b. Ocular Surface Disease
  2. Treatment Involves resolving the underlying etiology
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5
Q

Lacrimal System

Epiphora: Defective Drainage

  1. Malposition of what?
  2. Obstruction?
  3. Lacrimal Pump Failure: 2 things that can cause it?
  4. Cause may not be what?
A
  1. of Puncta
  2. Can occur anywhere along the lacrimal system
  3. a. Lower Lid Laxity
    b. Weak Orbicularis Oculi
  4. May not always be obvious
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6
Q

Lacrimal System

Epiphora: Defective Drainage: Testin

  1. What 3 tests?
A
  1. NaFl disappearance test
  2. Jones Dye Testing 1
  3. Jones dye testing 2
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7
Q

Lacrimal System

Epiphora: Defective Drainage: NaFl disappearance Test

  1. Instill NaFl into what?
  2. Wait how long?
  3. Normal Result?
  4. Abnormal Result?
A
  1. Both fornices
  2. 5 minutes
  3. No or Little Dye
  4. Dye still present; Indicates possible drainage problem
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8
Q

Lacrimal System

Epiphora: Defective Drainage Testing: Jones 1

  1. What is Instilled into the FORNIX?
  2. Wait how long?
  3. How do you test for it?
  4. How do we tell if it’s a Patent System?
A
  1. NaFl
  2. 5 minutes
  3. Swab around nasal lacrimal duct opening in the nose
  4. look for traces of NaFl
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9
Q

Lacrimal System

Epiphora: Defective Drainage Testing: Jones II (irrigation test)

  1. Completed after what exam?
    a. What does it do?
    b. Irrigates what?
  2. If NaFl is detected at outflow of Nasolacrimal duct, this means what?
  3. If none is detected there, this means what?
  4. No saline noted at all?
A
  1. Jones 1 is negative
    a. Flush NaFl out of Fornix

b. the Lacrimal Sac
2. Blockage is probably of Nasolacrimal Duct
3. Blockage probably at punctum or canaliculi
4. Complete blockage somewhere

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10
Q

Congenital Anomalies of the Lacrimal System

Name the seven

A
  1. Agenesis
  2. Congenital Dacryocele
  3. Congenital Lacrimal Cutaneous Fistula
  4. Congenital Punctal Atresia
  5. Dysgenesis
  6. Nasolacrimal Duct Obstruction
  7. Supernumerary Puncta
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11
Q

Congenital Anomalies of the Lacrimal System

Nasolacrimal Duct Obstruction

  1. How common is it?
  2. Newborns: When do we see it?
  3. Blockage at what place?
    a. What is affected?
A
  1. pretty common
  2. usually in first couple wks of life
  3. at Distal Aspect of Nasolacrimal Duct
    a. Valve of Hasner: Canalization Delayed
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12
Q

Congenital Anomalies of the Lacrimal System

Nasolacrimal Duct Obstruction: Presentation

  1. Epiphora: what happens?
  2. What is chronic?
  3. What is seen on lashes?
  4. Regurgitation of what?
A
  1. Constant or intermittent
  2. Chronic Wet Appearance
  3. Mucopurulent material on Lashes/matting of lashes
  4. of mucupurulent material from the punctum with pressure applied to lacrimal sac
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13
Q

Congenital Anomalies of the Lacrimal System

Nasolacrimal Duct Obstruction: Complications

  1. Infection
  2. Acute Dacryocystitis
    a. Requires what?
    b. How common?
A
  1. Chronic Bacterial Conjunctivitis (Topical Antibiotic: POLYTRIM)
  2. a. Systemic Antibiotic (Augmentin)
    b. Very Uncommon
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14
Q

Congenital Anomalies of the Lacrimal System

Nasolacrimal Duct Obstruction: Important differential Diagnosis? (2)

A
  1. Conjunctivitis

2. Congenital Glaucoma

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15
Q

Congenital Anomalies of the Lacrimal System

Nasolacrimal Duct Obstruction: Treatment

  1. Main thing to do?
  2. % that resolve spontaneously in 1st year?
  3. Probing when?
    a. % cured with 1st probe?
  4. Last resort?
A
  1. Massage of Lacrimal sac qid
  2. 96%
  3. If no resolution at 12-18 months
    a. 90%
    b. May need additional probing
  4. Dacryocystorhinostomy as last resort
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16
Q

Congenital Anomalies of the Lacrimal System

Congenital Dacryocele

  1. How common is it?
  2. More common in whom?
  3. Uni/Bi?
  4. Variant of what obstruction?
    a. What is in the Lacrimal Sac?
    b. 2ndary to blockage at what?
A
  1. Pretty rare
  2. Females
  3. Unilateral in 88%
  4. of Nasolacrimal Duct Obstruction
    a. Amniotic Fluid/mucous in lacrimal sac
    b. at the Valve of Hasner and Common Canaliculi/Lacrimal Sac Junction
17
Q

Congenital Anomalies of the Lacrimal System

Congenital Dacryocele: Presentation

  1. At Birth: Usually how long after?
  2. What does it look like?
  3. Where can it expand into?
A
  1. NLDO typically several weeks later
  2. Bluish, Firm, Cystic Swelling just below medial canthus
  3. into Nasal Passage
18
Q

Congenital Anomalies of the Lacrimal System

Congenital Dacryocele: Treatment

  1. Major thing to do?
  2. Resolution?
  3. What to do if no resolution?
A
  1. a. Gentle Pressure
    b. Warm Compress
    c. Topical Antibiotics (Prophylaxis)
  2. > 75%
  3. Probing
19
Q

Congenital Anomalies of the Lacrimal System

Congenital Dacryocele: Compications

  1. Severe Dacrocystitis
    a. Requires what?
    b. Risk of what?
  2. Respiratory Compromise
    a. What 2 things?
A
  1. a. IV antibiotics
    b. of Sepsis
  2. a. Grunting or Labored Breathing
20
Q

Congenital Anomalies of the Lacrimal System

Congenital Punctal Atresia

  1. What is it?
    a. Frequently it’s what?
A
  1. Failure of Canalization

a. A Thin Membrane at Punctal Opening (all other structures usually normal)

21
Q

Congenital Anomalies of the Lacrimal System

Congenital Punctal Atresia: Presentation

  1. Basic what?
  2. What’s not common
A
  1. Basic Epiphora

2. Mucopurulence Not Common

22
Q

Congenital Anomalies of the Lacrimal System

Congenital Punctal Atresia: Treatment

  1. Membrane perforation with what?
  2. What other 2 things?
A
  1. with a needle
  2. a. Punctal Dilation
    b. Maybe a Topical Antibiotic
23
Q

Congenital Anomalies of the Lacrimal System

Supernumerary Puncta

  1. What is it?
  2. Usually seen where?
  3. May have what?
  4. Treatment?
A
  1. Additional Punctum
  2. on the lower lid and medial to the normal punctum
  3. intact canaliculi
  4. None needed
24
Q

Congenital Anomalies of the Lacrimal System

Congenital Lacrimal Fistula

  1. What is it?
  2. Connects skin of lower eyelid to what 2 things?
  3. May have discharge in the presence of what?
A
  1. Epithelial Lined Canal
  2. Common Canaliculi or Lacrimal Sac
  3. of NLDO
25
Q

Congenital Anomalies of the Lacrimal System

Congenital Lacrimal Fistula: Presentation

  1. Usually what?
  2. Rarely reports of what?
  3. May be discovered secondary to other conditions? (2)
A
  1. Asymptomatic
  2. Epiphora
  3. NLDO and Dacrocystitis
26
Q

Congenital Anomalies of the Lacrimal System

Congenital Lacrimal Fistula: Treatment

  1. Monitor what 2 things?
  2. Surgical Excision of Entire Tract if Symptomatic?
A
  1. a. Epiphora; Mucus Discharge

2. May need Intubation of Nasolacrimal intubation of lacrimal system to ensure potency

27
Q

Acquired Blockage of the Lacrimal System

  1. Upper System? (2)
  2. Lower System (5)
A
  1. a. Punctum
    b. Canaliculia
  2. a. Nasolacrimal Duct
    b. Dacryocystitis
    c. Dacryoliths
    d. Neoplasms
    e. Trauma
28
Q

Acquired Blockage of the Lacrimal System

Upper System: Punctal Stenosis

  1. Primary?
  2. Due to what 5 things?
A
  1. Stenosis in the absence of Punctal Eversion
  2. a. Chronic Bleph
    b. Cicatrizing Conjunctivitis
    c. Herpes Simplex/Zoster
    d. Idiopathic
    e. Trachoma
29
Q

Acquired Blockage of the Lacrimal System

Upper System: Punctal Stenosis

  1. Primary: Treatment? (2)
A
  1. a. Punctal Dilation (rarely successful)

b. Punctoplasty

30
Q

Acquired Blockage of the Lacrimal System

Upper System: Punctal Stenosis

  1. Secondary?
A
  1. Due to Eversion of Punctum
31
Q

Acquired Blockage of the Lacrimal System

Upper System: Punctal Stenosis

  1. Secondary Treatment? (3)
A
  1. Ziegler Cautery
  2. Medial Conjunctivoplasty
  3. Lower Lid Tightening (Canthal Sling)
32
Q

Acquired Blockage of the Lacrimal System

Upper System: Canaliculi

  1. Can occur where?
  2. Due to what 5 things?
A
  1. in Upper, Lower or common
  2. a. Trauma
    b. Herpes
    c. Chronic Dacryocystitis
    d. Toxic Medications (5 Fluoruracil)
    e. AI Conditions (Ocular Pemphigoid, and Stevens-Johnsons Syndrome)
33
Q

Acquired Blockage of the Lacrimal System

Upper System: Canaliculi

  1. Treatment
    a. Partial

b. Total

A
  1. Depends on sight and severity of blockage
    a. Partial: Intubation: 3-6 months
    b. Canaliculodacryocystorhinostomy (DCR) and Intubation

OR

Conjunctivodacryocystorhinostomy (CJDCR) and Lester Jones tube

34
Q

Acquired Blockage of the Lacrimal System

Lower System: Nasolacrimal Duct

  1. Idiopathic Stenosis?
  2. Naso Orbital Trauma?
  3. Granulomatous Disease?
A
  1. Most common by far
  2. Includes previous nasal and sinus surgery
  3. a. Wegener Granulomatosis
    b. Sarcoidosis
    c. Nasopharyngeal Tumors
35
Q

Acquired Blockage of the Lacrimal System

Lower System: Nasolacrimal Duct

  1. Treatment: 4 things?
A
  1. a. Balloon Dilation
    b. DCR
    c. Intubation
    d. Stent
36
Q

Acquired Blockage of the Lacrimal System

Lower System: Dacryoliths (lacrimal stones)

  1. Anywhere in what?
  2. More common in whom?
  3. Possibly 2ndary to what?
A
  1. Anywhere in Lacrimal System
  2. Males
  3. to Tear Stagnation (Other obstruction)
37
Q

Acquired Blockage of the Lacrimal System

Lower System: Dacryoliths (lacrimal stones)

Presentation

  1. When does it present?
  2. Intermittent what?
  3. Recurrent what?
  4. Possible LAcrimal Sac what?
  5. Possible what?
A
  1. Adulthood
  2. Intermittent Epiphora
  3. Recurrent Acute Dacrycystitis (PAIN)
  4. Distension (frequently no pain)
  5. Mucous Regurgitation
38
Q

Acquired Blockage of the Lacrimal System

Lower System: Dacryoliths (lacrimal stones)

  1. Treatment?

Ocular Disease (11 decks)

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