1. LACRIMAL DISORDERS

2. Objectives: Preview
• Anatomy & Physiology
• Approach
• Pathology
– Cong NLD Obst
– Lacrimal system infections
• Acute
• Chronic

3. Anatomy
• Secretory
– LG
• Tears
• Excretory
– NLS
• Passive
• Active (pump)

6. Causes of tearing
Lid : Malposition,Facial palsy, Punctal stenosis
Conj&Cornea: Abrasion, FB, Keratitis
Glaucoma
NLD obstruction

7. Approach
• Symptoms
– Tearing
– Discharges
– Swelling
• POH
– med & surg

8. • Visual acuity: VA
– 6/60
– HM
– LP
– NLP

9. • Lacrimal sac swelling
• Regurgitation
– On pressure reflux of purulent material from
punctum
• Lids
– Swelling
– Punctum
• Conjunctiva
• Tear film
• Cornea

10. Dye disappearance test DDT
Place a drop of fluorescein in each eye, and monitor
with cobalt blue light; if a pool is still present after
5 minutes the test is positive.

12. Dry eye:
Tear break-up time: trachoma
Schirmer test: Sjogren syndrome

13. Pathology

14. Congenital nasolacrimal duct obstruction
•Delayed canalization
•NLD obstruction occurs in 2% of newborns
•Can be bilateral
•Reflux of purulent material from punctum

15. •Role out congenital glaucoma
•Usually resolve during the first
year of life

16. Management
Medical
• Massage of nasolacrimal duct
(hydrostatic pressure)
• Antibiotic drops..
Surgical
• Probing
• Intubation
• DCR

17. Pathology

18. • Redness
• Discharges
• Epiphora
• Canthal swelling,
below inner canthus
• Tenderness
• Usually secondary to NLD
obstruction and tear stasis

19. Acute Dacryocystitis

20. Complications
• Lacrimal abscess
• Presptal Cellulitis
• Orbital Cellulitis
– Orbital Abscess
– CST
– Brain Abscess
– Death

21. Medical SurgicalRx

22. Pathology

23. Epiphora and chronic or recurrent unilateral conjunctivitis
Expressed mucopurulent dischargePainless swelling at inner
canthus
Treatment – DCR

24. Chronic Dacryocystitis

25. Dacryocystorhinostomy
DCR

26. Review
• Anatomy
• Physiology
• Approach
• Causes of the watery eyes
• Cong NLD Obst
• Lacrimal system infections:
– Acute?
– Chronic?

27. Problem solving
• NLD obstruction + Cataract

28. Lecture Evaluation:
poor-fair-very good
1. How would you grade it
2. How would you grade yourself
3. comments

29. QuizSigns of acute dacryocystitis:
Dry eyes
Painless swelling
Proptosis
Nasolacrimal duct opens-in the nose- at:
Superior meatus
Middle meatus
Inferior meatus