The lacrimal system consists of structures that secrete tears and structures that drain tears. Tears are secreted by the lacrimal gland and several tiny accessory glands, and drained through lacrimal canaliculi and the nasolacrimal duct into the nose. Dacryocystitis is an inflammation of the lacrimal sac that causes pain, swelling, and watering. Congenital nasolacrimal duct obstruction in infants causes intermittent epiphora and purulent discharge from puncta with pressure. Dacryocystorhinostomy is a surgical procedure to bypass an obstructed nasolacrimal duct using an opening into the nose.

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

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.

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

42. Dacryocystorhinostomy
DCR

43. Watering of EYE

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

53. Probing and Irrigation

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

61. 31/08/201561

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

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

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