10. Several tiny accessory lacrimal glands
(glands of
Krause and Wolfring) located in the
superior fornix secrete additional serous
tear fluid.
ACCESSORY LACRIMAL GLAND
31. Acute dacryocystitis
Acute inflammation of sac or pericystic area leading to
acute pain, swelling, redness and watering from the eye.
No interference like syringing,probing etc.
32.
33.
34.
35.
36.
37.
38. Congenital nasolacrimal ductobstruction
. Children manifest evidence of NLD obstruction in 1st year of life
• Epiphora and matting of lashes may be constant or intermittent when the
child has a cold .
• Gentle pressure over the lacrimal sac causes reflux of purulent material
from the puncta
52. FLUORESCEIN DYE DISAPPEARANCE TEST
Instill 2 drops of fluorescein dye in the conjunctival sac
and observe after 2 minutes
Normally no dye is seen
Prolonged retention of dye indicate inadequate drainage
57. JONES TEST I
Instill 2 drops 2% fluorescein dye in the conjunctival
sac, place a cotton bud dipped in 1% xylocaine in the
inferior meatus, inspect the bud after 5 minutes.
Positive test-
patent passages
(may be hypersecretion)
No staining- Negative test
(obstruction or pump failure)
58. JONES TEST II
If Jones I is negative, do Jones II
Place a bud similarly and perform lacrimal syringing
Positive test-
lacrimal pump failure
Negative test-
mechanical obstruction
59. DACRYOCYSTOGRAPHY
To visualize the passage and know the exact site,
nature and extent of block.
Inject radioopaque material in the sac.
Take X-rays
after 5 and 30 minutes
60. Congenital nasolacrimal duct obstruction
Delayed canalization
Can be bilateral
Reflux of purulent material from punctum
67. may be due to one of two causes:
• Reduced tear production (such as Sjögren’s syndrome and
rheumatoid arthritis) or atrophy or destruction of the lacrimal
gland.
• Altered composition of the tear film due to vitamin A
deficiency, medications (such as oral contraceptives), or certain
environmental influences (such as nicotine smoking, or air
conditioning).
DRY EYE
68. Patients complain of
• Burning, reddened eyes.
•excessive lacrimation (reflex lacrimation) from slight
environmental causes such as wind, cold, low humidity,
or reading for an extended period of time.
• A foreign body sensation is also present.
• Vision is usually minimally compromised .
DRY EYE SYMPTOMS