Lacrimal Disorders

2012

presentation

objectives
Anatomy And Physiology Approach And causes of the watery eyes Congenital NLD Obstruction Lacrimal system infections Acute Chronic
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anatomy Secretory
LG Tears Excretory NLS Passive Active (pump)
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Tearing

Over-production
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obstruction
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Lid : malposition, Facial palsy, punctal stenosis Conjunctiva Cornea: Abrasion, FB, Keratitis Glaucoma Uveitis NLD obstruction
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Causes of Tearing

Approach
Symptoms Past ophthalmic history medical & surgical Past Medical History
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Approach
Visual acuity: VA
6/60 HM LP NLP
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Approach
Lacrimal sac swelling Regurgitation Lids: Punctum Conjunctiva Cornea & Tear film
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Approach
Place a drop of fluorescein in each eye, and monitor with cobalt blue light; if a pool is still present after 5 minutes test is positive
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Dry eye
Schirmer test: Sjogren syndrome Tear break-up time: trachoma

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Congenital nasolacrimal duct obstruction

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Congenital nasolacrimal duct obstruction

Caused by delayed canalization (imperforated nasal valve ) Nasolacrimal obstruction occurs in 2% of newborns On pressure reflux of purulent material from punctum Can be bilateral Role out congenital glaucoma Usually resolve during the first year of life
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Congenital nasolacrimal duct obstruction

Management
Medical
Massage of nasolacrimal duct (hydrostatic pressure) Antibiotic drops..

Surgical
Probing Intubation DCR

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Acute dacryocystitis
Usually secondary to nasolacrimal duct obstruction and tear stasis
Epiphora Canthal swelling below inner canthus Tenderness
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Acute dacryocystitis
Lacrimal abscess Presptal Cellulitis Orbital Cellulitis Orbital Abscess

complications ophthalmic

systemic
CSTb Brain Abscess Death
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Bacterial conjunctivitis

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Chronic dacryocystitis
Epiphora and chronic or recurrent unilateral conjunctivitis

painless swelling at inner canthus

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Chronic dacryocystitis
Expressed mucopurulent discharge

Treatment
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Dacryocystorhinostomy

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To finish

To finish

Put your questions

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To finish

For your attention

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To finish
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