The document discusses the anatomy and physiology of the lacrimal system and tear film. It describes the main structures of the lacrimal apparatus including the lacrimal gland, accessory lacrimal glands, lacrimal passages, puncta, canaliculi, lacrimal sac, and nasolacrimal duct. It discusses tear film layers, secretion, and functions. It also summarizes common lacrimal system disorders like dry eye, dacryocystitis, epiphora, dacryoadenitis and their signs, symptoms, etiologies, and treatments. Surgical procedures for these conditions like dacryocystorhinostomy are also briefly outlined.

1. Lacrimalsystem

3. Applied anatomy
Lacrimal apparatus comprises
 main lacrimal gland,
 accessory lacrimal glands,
 lacrimal passages.

4. Main lacrimal gland:
Consists of -
 orbital part
 palpebral part
Ducts of lacrimal gland - 10-12nducts pass downward from the main
gland to open in the lateral part of superior fornix.1 or 2 ducts open in the lateral
part of the inferior fornix.
Accessory lacrimal glands -
 glands of Krause
 glands of wolfring

5. Structure, blood supply and nerve supply:
Nerve supply -
 sensory supply
 sympathetic supply
 secretomotor fibers

6. Lacrimal apparatus:
 Lacrimal puncta
 Lacrimal canaliculi
 Lacrimal sac
 Nasolacrimal duct (NLD)

8. Tearflim:
Structure :
 mucus layer
 aqueous layer
 lipid layer
Functions :
act as lubricant ,provide Oxygen , wash out
debris ,prevent infection , facilitates movements.
Secretion:
basal & reflex secretion.

9. ELIMINATION OF TEARS

10. Dry eye
Etiology
 aqueous tear deficiency.
sjogren’s syndrome
non sjogren’s keratoconjunctivitis sicca
 evaporative dry eye.

11. Clinical features
Symptoms
dryness , irritation , itching , sore eyes , foreign
body sensation.
Signs
 Tearflim signs
 Conjunctival signs
 Corneal signs
 Signs of causative disease

12. Tearflim tests
 Tear flim breakup(BUT)
 Schirmers-I test
 Rose Bengal staining
Grading of dry eye severity
Treatment
 supplementation with tear substitutes
 topicalcyclosporine
 mucolytics preservation of existing tears by reducing evaporation &
decreasing drainage
 treatment of causative disease

13. TBUT

15. SJOGREN’S SYNDROME
ETIOLOGY
CHARACTERISTIC FEATURES -
 Primary sjogren’s syndrome
 secondary sjogren’s syndrome
PATHOLOGICAL FEATURES -
focal accumulation , infiltration of lymphocytes , plasma
cells with destruction of lacrimal & salivary glandular tissues.

16. WATERING EYE
ETIOLOGY
 causes of hyperlacrimation.
 primary hyperlacrimation
 reflex hyperlacrimation
 central lacrimation

17. Causes of epiphora:
 Physiological cause -
lacrimal pump failure
 Mechanical obstruction -
obstruction in lacrimal passage at the level of
punctum , canaliculus , lacrimal sac or naso lacrimal duct.

18. Clinical evaluation:
 Ocular examination with diffuse illumination.
 Regurgitation test.
 Fluorescein dye disappearance test.
 Lacrimal syringing test.
 Jones dye test.
 Dacryosystogaaphy.
 Radio nucleotide dacryocystography.

19. Dacryocystitis:
inflammation of lacrimal sac.
Congenital Dacryocystitis: (Dacryocystitis neonatorum)
 inflammation of lacrimal sac occurring in newborn infants.
Etiology:
 membranous occlusion.
 other causes of congenital NLD.
 common bacteria.

20. Congenital dacryocystitis -

21. Clinical features:
 epiphora,
 regurgitation test,
 swelling.
Differential diagnosis:
 ophthalmia neonaturum,
 congenital glaucoma.

22. Treatment:
 Massage over the lacrimal sac area and topical antibiotics
 Lacrimal syringing (irrigation) with normal saline and
antibiotic solution.
 Probing of NLD with bowman’s probe
 Balloon catheter dilation
 Intubation with silicone tube
 Dacryocystorhinostomy (DCR)

23. ADULT DACRYOCYSTITS:
Chronic dacryocystits -
 Etiology
Predisposing factors
Factors responsible for stasis of tears in
lacrimal sac
source of infection
causative organism

24. CLINICAL FEATURES:
 Stage of chronic catarrhal dacryocystits.
 Stage of lacrimal mucocele
 Stage of suppurative Dacryocystitis.
 stage of chronic fibrotic sac.
Complications:
 Chronic intractable conjunctivitis
 Ectropion of lower lid
 Chances of corneal ulceration
 High risk of developing endophthalmitis

25.  Treatment:
conservative treatment
balloon catheter dilation
dacryocystorhinostomy(DCR)
dacryocystectomy(DCT)
conjunctivodacryocystorhinostomy(CDCR)

26. Acute Dacryocystitis:
 Etiology-
as an acute exacerbation of chronic of chronic Dacryocystitis.
as an acute peridacryocystitis due to direct involvement from the
neighboring infected structures.
 Causative organisms-
streptococcus , haemolyticus , pneumococcus & staphylococcus .
 Clinical features-
stage of cellulitis
stage of lacrimal abscess
stage of fistula formation

27. Acute dacryocystitis: stage of lacrimal abscess and stage of
external lacrimal fistula .

28. treatment
cellulitis stage
systemic & topical antibiotics ,anti inflammatory drugs &
hot fomentation.
stage of lacrimal abscess.
small incision to squeeze out the pus formation
external lacrimal fistula.
systemic antibiotics , fistulectomy along with DCT or DCR
operation.

29. Surgical steps of external dacryocystorhinostomy: A, skin incision; B,
exposure of bony lacrimal fossa; C, preparation of bony osteum and exposure of nasal mucosa; D,
preparation of flaps of the nasal mucosa and lacrimal sac; E, suturing of posterior flaps; F, suturing of
anterior flaps.

30. Dacryoadenitis(swelling of lacrimal gland)
Acute dacryoadenitis
 Etiology :
secondary to systemic infections associated with mumps ,
influenza & measles .
 Clinical features :
painful swelling in the upper lid
lids are red & swollen
A fistula of upperlid may develop as dacryoadenitis.
 Treatment :
antibiotic , analgesic & anti inflammatory drugs with hot
fomentation.

31. Chronic dacryoadenitis
 Etiology -
may due to TB , syphilis ,sarcoidocis , chronic inflammation
of conjunctiva.
 clinical features -
painless swelling , ptosis ,diplopia may occur , on palpation
a firm lobulated mobile mass may felt under the upper & outer rim of
the orbit .
TREATMENT -
Consist of treating the cause.

32. A patient with bilateral dacryoadenitis: s-shaped curve of upper
eyelid.

33. Thank you