The document discusses various disorders of the lacrimal system, particularly obstruction of the nasolacrimal duct (NLD) leading to symptoms like tearing, discharge, and pain. It outlines causes, clinical presentations, and treatments for conditions such as dacryocystitis, acute dacryoadenitis, and keratoconjunctivitis sicca. Epidemiologically, women are more affected than men, and treatment options vary from medications to surgical interventions.

1. Disease of lacrimal system

2. ACQUIRED NLD
• obstruction is the blockage of the lacrimal outflow system that may
be complete or incomplete and will be and as a various degrees of
tearing, discharge and infection.
• Exquisite pain, acute distention of lacrimal sac, (dacryolithiasis or
dacryocystitis)

3. Epidemiology
• Women are two time more affected than men.
• Young adults:
• Canalicular obstruction/ Herpes simplex virus HSV
• Facial trauma (male)
• Middle age: women and smokers

4. Causes:
• Involutional stenosis: idiopathic cause
• Dacrolithiasis: cast or stones formation in lacrimal sac
• Trauma: mid face or nasal and sinus surgery

5. • inflammatory diseases: sarcoidosis, granulomatous disease.
• Neoplasms: lymphoma, squamous cell carcinoma, sinonasal tumors
and also the periorbital radiation therapies for malignancies.
• Dental impaction
• Nasal pathologies
• Chronis sinusitis/rhinitis

6. Clinical Presentation
• Tearing
• Discharge
• Recurrent dacryocystitis
• Recurrent conjunctivitis
treatment
DCR

8. dacryolithiasis

9. Acute dacrocystitis
• Secondary to NLDO
• It can be acute or chronic
• Staphylococcal and streptococcal
• sign and symptom
• Pain, red tender medial canthus swelling
• Associated preseptal cellulitis

10. • Treatment
• Warm compression
• Oral antibiotics (co-amoxiclav)
• Irrigation and probing
• Incision and drainage
• DCR (infection subside)

11. Chronic Dacryocystitis
• Chronic epiphora
• Chronic unilateral conjunctivitis
• Secondary infection by low virulence organism
• Reg +ve
• Mucocele formation
• Treatment:
• DCR
• External approach
• Endolaser DCR

13. Lacrimal gland
• Acute Dacryoadenitis
• It is the acute inflammation of the lacrimal gland.
• Sign and symptoms.
• Painfull swelling in upper outer angle of orbit..
• Watering.
• Chemosis (conjunctival oedema).
• Cause:
• Viral infection( cytomegalovirus,mumps,etc)
• Bacterial infection( staphylococcus, streptococcus, gonococcus)

14. • Treatment.
• Hot compression.
• analgesic
• Antibiotic oral,
• Incision for drainage

15. Chronic Dacryadenitis
• Chronic inflammation
• Causes:
• Infection( TB, SYPHILIS)
• Trauma(
• Autoimmune (Sjogren’s syndrome)
• Tumors (lymphoma)

17. Clinical presentation
• S shaped curved
• Restricted ocular movements (upward direction)
• Diplopia
• Painless
• Investigation
• Physical examination
• MRI AND CT SCAN
• Treatment: underlying cause

18. Keratoconjuntivitis sicca( DES 0R DED)
• KCS is a condition where aqueous tear production in insufficient to maintain
normal tear film.
• Causes:
• Congenital alacrima
• Denervation hyposeretion
• Primary sjogren syndrome(autoimmune disorder)
• Secondary SS ( systemic involvement), Rheumatoid arthritis, SLE
• Trauma
• Trachoma
• Tumors

19. Clinical signs
• Marginal tear strip decreased
• Increased mucous products
• Corneal filaments
• Punctate erosions
• Posterior blepharitis
• Management:
• PUNCTUM PLUGS
• ARTIFICIAL TEARS
• VIT A serums
• Mucolytic agents( acetylcystine)
• Anti inflammatory ( cyclosporine, omega-3)