The lacrimal system consists of structures that secrete tears and drain them. Tears are secreted by the lacrimal gland and drain through the lacrimal canaliculi and sac into the nasolacrimal duct. Obstructions in the nasolacrimal duct can be diagnosed using dye tests like fluorescein dye disappearance test and Jones tests I and II. Dacryocystography uses radioopaque dye to visualize the site of any blockages. Congenital nasolacrimal duct obstruction is common in infants and may require probing and irrigation. Dry eye can result from reduced tear production or altered tear film composition. Acute dacryocystitis involves acute inflammation of the lacri

1. By/Mohamed Ahmed El –Shafie
Lecturer in ophthalmology department
KafrELShiekh University
01069201269

5. The lacrimal system consists of two parts:
• Structures that secrete tear fluid.
• Structures that facilitate tear drainage.

7. LACRIMAL GLAND ANATOMY

10. Several tiny accessory lacrimal glands
(glands of
Krause and Wolfring) located in the
superior fornix secrete additional serous
tear fluid.
ACCESSORY LACRIMAL GLAND

14. Lacrimal canaliculi

15. Lacrimal sac
Nasolacrimal duct

20. Tear Flow Physiology

28. Watering of EYE

37. 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

38. Probing and Irrigation

42. 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)

43. 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

44. 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

45. Congenital nasolacrimal duct obstruction
Delayed canalization
Can be bilateral
Reflux of purulent material from punctum

46. 31/08/201546

51. 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

52. Bitot’s spots:
interpalpebral conjunctival foamy
patches associated with severe
vitamin A & xerophthalmia

53. 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

59. 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.

60. Dacryocystorhinostomy
DCR

62. QuizSigns of acute dacryocystitis:
Dry eyes
Painless swelling
Redness &Watering
Nasolacrimal duct opens-in the nose- at:
Superior meatus
Middle meatus
Inferior meatus