The lacrimal apparatus

By
Dr. Ashraf Albahla
ANATOMY
• The lacrimal apparatus for each eye consists of
secretory and excretory parts :
• 1. Secretory system:
• i. Lacrimal gland and its ducts.
• This is serous gland situated at the upper
and outer angle of the orbit.
• ii. Accessory lacrimal glands.
• These are very small glands of exactly the
same structure as the lacrimal glands.
Follow....ANATOMY
• 2. Excretory system:
• i. Lacrimal puncta.
• ii. Lacrimal canaliculi.
• iii. Lacrimal sac.
• iv. Nasolacrimal duct.
TEARS
• Tear is a secretion from the lacrimal
gland.
• It is slightly alkaline and consists mainly
of water, small quantities of salts, such
as sodium chloride, sugar, urea, protein
and lysozyme, a bactericidal enzyme.
The Tear Film
• The fluid which fills the conjunctival sac
consists of 3 layers namely:
• 1. Mucous layer.
• 2. Aqueous layer.
• 3. Lipid layer.
Function of tear film.
• The surface of the eyeball must remain wet for
comfort and normal functioning.
• 1. It washes away irritating material, e.g. dust and
grit. It contains protective substances such as
lysozyme, immunoglobulin, lactoferrin,
compliments.
• 2. The bactericidal lysozyme prevents microbial
infection.
• 3. The oiliness of this mixed fluid delays
evaporation and prevents drying of the conjunctiva
and cornea.
EPIPHORA
• an abnormal overflow of tears down the cheek.

• common causes of epiphora.

• 1. Congenital absence of lacrimal puncta.

• 2. Congenital non-canalization or delayed
canalization of nasolacrimal duct.
Follow..COMMON CAUSES OF EPIPHORA

• 3. Occlusion of puncta—foreign body, hair, etc.

• 4. Chronic dacryocystitis with blockage of
nasolacrimal duct.
• 5. Growth or inflammation of inferior meatus.
• 6. Functional insufficiency for draining the tear
in to the nose, e.g. Bell’s palsy, ectropion.
DACRYOCYSTITIS
• Dacryocystitis is the inflammation of the
lacrimal sac.
• Classification
CONGENITAL DACRYOCYSTITIS
• Inflammation of the lacrimal sac in the
newborn may present as an acute or chronic
process.
• Etiology
• There is failure in canalization of the
nasolacrimal duct, the lumen being blocked by
epithelial debris.
• It may be a bilateral condition.
• Symptom
• 1. There is epiphora or continuous watering of
the eyes usually evident in 2nd week of life.
• 2. There may be purulent discharge or
conjunctivitis in infected cases.
• Signs
• 1. Stricky mucopurulent discharge and
persistent epiphora are two important signs.
• 2. There is regurgitation of mucopurulent
discharge on pressure over the sac area.
• Treatment
• 1. Conservative treatment is indicated in early
cases.
• i. Massage over the lacrimal sac area and
clean the discharge several times a day.
• ii. Broad-spectrum antibiotic eyedrops.

• 2. Surgical treatment—Aim—To recanalise the

nasolacrimal duct.
ACUTE DACRYOCYSTITIS
• It is acute suppurative inflammation of the
lacrimal sac.

• Etiology
• It is caused by infection
• Pneumococcus,
• Staphylococcus,
• Streptococcus, etc.
• Symptoms
• 1. There is marked swelling, redness and
tenderness of the skin over the sac and
adjacent area.
• 2. Conjunctival congestion and submaxillary
lymph node enlargement may be present.
• 3. Fluctuation is present on palpation over the
sac area when there is abscess formation.
• 4. Lacrimal fistula may be present if the
abscess bursts open repeatedly.
• Complication

• 1. Osteomyelitis of the lacrimal bone may

occur.
• 2. Orbital cellulitis is a dangerous complication.
• 3. Cavernous sinus thrombosis is a very serious
condition.
• Treatment
• 1. Hot compresses, systemic antibiotics,
analgesics and anti-inflammatory are effective.
• 2. In case of lacrimal abscess, drainage .
• 3. In case of lacrimal fistula, excision of the
fistulous tract and removal of sac is done.
CHRONIC DACRYOCYSTITIS
• chronic suppurative inflammation of the
lacrimal sac.
• Etiology
• It is usually due to stricture of the nasal duct as
a result of:
• • Chronic inflammation of the nasal mucosa.
• • Pressure of nasal polypi.
• • Hypertrophied inferior turbinate bone.
• • Extreme deviation of the nasal septum.
• Symptoms
• 1. There is constant epiphora or passive
overflow of tears over the lid margin which is
aggravated by exposure to wind.
• 2. There is swelling, pain and redness at the
site of the sac (mucocele) in cases of acute or
recurrent infection.
• Signs
• 1. Persistent congestion of the neighbouring
conjunctiva and skin may be seen.
• 2. Regurgitation of mucopurulent fluid by
pressure over the sac area is present.
Treatment
• 1. In recent cases
• Repeating syringing of the nasolacrimal duct
and frequent instillation of antibiotic drops is
indicated in recent cases.
• 2. In recalcitrant cases—The following surgical
procedures are advised:
• i. Dacryocystectomy.
• ii. Dacryocystorhinostomy.
• iii. Insertion of special tubes.
Thank you