This document discusses the anatomy and physiology of the lacrimal system and tear production. It describes the structures that make up the lacrimal system, including the lacrimal gland and accessory glands. It then discusses tear flow physiology and various conditions that can disrupt tear production, such as dry eye. The document outlines symptoms of dry eye and tests used to evaluate tear drainage and nasolacrimal duct obstruction, including fluorescein dye tests and dacryocystography. It also describes acute dacryocystitis and its treatment with dacryocystorhinostomy.

2. By/Mohamed Ahmed El –Shafie
Assistant Lecturer in ophthalmology department KafrELShiekh
University

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

6. It lies beneath the superior temporal margin of the
orbital bone in the lacrimal fossa of the frontal bone
It is neither visible nor palpable
A palpable lacrimal gland is usually a sign of a
pathologic change such as dacryoadenitis or tumors.
LACRIMAL GLAND ANATOMY

7. The tendon of the levator palpebrae muscle
divides the lacrimal gland into a larger
orbital part (two-thirds) and a smaller
palpebral part (one-third).
LACRIMAL GLAND PARTS

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

11. Tear Flow Physiology

12. may be due to one of two causes:
• Reduced tear production in certain systemic disorders
(such as Sjögren’s syndrome and rheumatoid arthritis) or as a
result of 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).
The tear film breaks up too quickly and causes corneal
DRY EYE

13. Patients complain of
• Burning, reddened eyes, and excessive lacrimation
(reflex lacrimation) from only slight environmental
causes such as wind, cold, low humidity, or reading
for an extended period of time.
• A foreign body sensation is also present.
• May be accompanied by intense pain.
• Vision is usually minimally compromised .
DRY EYE SYMPTOMS

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

22. 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

25. 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

26. 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

27. 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

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

29. 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.

31. Dacryocystorhinostomy
DCR

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