Week 7 - Lacrimal

Question 1

the two mechanism for epiphora

Answer 1

Over-production
Drainage system disorder

Question 2

What should your slit lamp examination involve

Answer 2

1) examine for ectropion/entropion
2) blepharitis or meibomian dysfunction
3) tear meniscus height
4) punctal placement

Question 3

How to examine for Nasolacrimal duct obstruction

Answer 3

Palpation - with your fingers and ask the patient if it is painful
- also look out for lumps, nodules, masses

Question 4

What does white pus discharge from the puncta indicate?

Answer 4

inflammation

Question 5

what does red (blood) discharge from the pucnta indicate?

Answer 5

tumour

Question 6

What does the Jones 1 test determine?

Answer 6

Used to determine retention of tear
obstruction in drainage apparatus

Question 7

What does a positive Jones 2 test indicate?

Answer 7

Functional blockage lower than puncta or canaliculi

Question 8

What does a negative Jones 2 test indicate?

Answer 8

Negative for NaFl & Px reports saline in throat = NaFl never entered drainage system in Jones 1.
Functional blockage at puncta or canaliculi

Question 9

What are the advantage of lavage therapy?

Answer 9

Serves as a diagnostic and therapeutic purposes
- flushes mucous plugs, concretion from lacrimal drainage system
- epiphora resolves instantly if blockages flushed out

Question 10

How to manage tear overproduction?

Answer 10

• treat the condition causing excess tear
• dry eye management

Question 11

How to manage canaliculitis?

Answer 11

• warm compress and massaging
• infection requires oral antibiotics - risk of orbital cellulitis

Question 12

How to manage dacrocystitis?

Answer 12

Warm compresses and massage
topical antibiotics
chronic dacrocystitis - curettage and antibiotic irrigation

Question 13

How to manage an obstruction lower than the lacrimal sac?

Answer 13

Surgical intervention - dacrocystorhinostomy

Question 14

What is the histology of the caruncle?

Answer 14

Stratified, non-keratinised squamous epithelium
Contributes to tear film and the filtering of debris

Question 15

What is the histology of the canaliculi?

Answer 15

Non-keratinised
Stratified squamous epithelium surrounded by elastic connective tissue

Question 16

What is the histology of lacrimal sac?

Answer 16

Lined with double layer of columnar epithelium

Question 17

What is the histology of the nasolacrimal duct?

Answer 17

double layer of coloumnar epithelium

Question 18

what is the function of the Rosenmuller valve?

Answer 18

Prevents reflux from nasolacrimal sac into canaliculi

Question 19

What is the function of the Valve of Krause?

Answer 19

Prevents reflux between the lacrimal sac and the nasolacrimal duct

Question 20

What is the function of the Valve of Hasner?

Answer 20

Prevents reflux from the nasal meatus

Question 21

Tear drainage in relation to the muscles

Answer 21

Horner’s muscle contributes to positive pressure on lid closure
On lid opening there is negative pressure into the lacrimal sac which draws tears
Valves in the system prevent reflux

Question 22

Where are T and B cell found?

Answer 22

T and B-cells are found in concentrations just below the epithelia connected by specialized vessels

Question 23

What are CALTS

Answer 23

Conjunctiva-Associated lymphoid tissue
Can be within the conjunctiva and lacrimal sac
Represent a mechanism to detect infection in the lacrimal drainage apparatus

Question 24

Which muscle is important for exerting pressure on the globe during blinking?

Answer 24

The pretarsal and preseptal portions of the orbicular muscle exert pressure on the globa during blink