Nasolacrimal duct obstruction can be congenital or acquired. It results in a blockage of the lacrimal drainage system which transports tears from the eye to the nose. The document describes the anatomy of the lacrimal drainage system and classifications of NLDO. Causes include infections, inflammation, tumors, trauma, and mechanical obstruction. Diagnosis involves history, examination, Jones dye testing, and imaging. Treatment depends on the type and includes massage, probing, dacryocystorhinostomy, and occasionally intubation or stenting. Surgical treatment aims to re-establish drainage from the lacrimal sac into the nose.
This document discusses the evaluation of the nasolacrimal system. It covers the history and anatomy of the system, classification of epiphora, diagnostic tests used to evaluate the system including anatomical tests like syringing and probing, functional tests like dye disappearance tests, and secretory tests like Schirmer's test. The document also discusses differentiating anatomical obstruction from functional/physiological causes of excessive tearing and localization of blockages in the system.
Concomitant strabismus is a type of manifest squint where the amount of deviation remains constant in all directions of gaze and there is no limitation of ocular movements. It can be caused by sensory obstacles like refractive errors, motor obstacles like abnormalities of extraocular muscles, or central obstacles like deficient development of fusion faculty. The main types are esotropia (inward deviation), exotropia (outward deviation), and hypertropia (vertical deviation). Treatment involves correcting refractive errors, amblyopia treatment, orthoptic exercises, and squint surgery to weaken strong muscles or strengthen weak muscles as needed.
Bullous keratopathy refers to corneal swelling caused by insufficient pumping of fluid out of the cornea. It results in the formation of fluid-filled blisters beneath the surface of the eye. It can occur secondary to endothelial dysfunction from trauma, inflammation, dystrophies or other conditions that damage the corneal endothelial pump. Symptoms include blurred vision, glare, pain from ruptured blisters, and potentially scarring. Management involves reducing fluid buildup through hypertonic drops or lenses, lowering eye pressure if high, and corneal transplantation if vision is significantly decreased or pain becomes intolerable.
Congenital nasolacrimal duct obstruction is a common cause of tearing in infants, where the nasolacrimal duct fails to fully canalize after birth. Signs include tearing and eye discharge, especially with colds. Treatment first involves massage and antibiotics, with probing of the duct under anesthesia if not resolved by 12-18 months. Probing has a high success rate when done early. Surgery like dacryocystorhinostomy may be needed if probing fails or for membranous obstructions. The procedure involves creating a passage from the lacrimal sac to the nasal cavity with good long-term success rates over 90% typically.
This document discusses watering eye (epiphora) and its causes including hyperlacrimation and obstruction of tear outflow. It describes various mechanical obstructions that can cause epiphora such as punctal, canalicular, lacrimal sac or nasolacrimal duct obstructions. Clinical evaluation methods are outlined. Dacryocystitis, an infection of the lacrimal sac, is discussed including its congenital and acquired forms. Congenital dacryocystitis presents in newborns with epiphora, positive regurgitation test and swelling. Acquired dacryocystitis can be chronic or acute, with chronic forms including catarrhal dacryocystitis, lacrimal
- Proptosis refers to forward displacement of the eyeball beyond the orbital rim, usually due to an increased mass or volume within the orbit. Common causes include tumors, inflammation, trauma, thyroid eye disease, and vascular lesions.
- Examination involves measuring exophthalmometry, inspecting for signs of mass effect, pulsation or displacement of the globe, and evaluating for neurologic deficits. Imaging with CT or MRI is important to characterize the lesion causing proptosis.
This document discusses the evaluation of the nasolacrimal system. It covers the history and anatomy of the system, classification of epiphora, diagnostic tests used to evaluate the system including anatomical tests like syringing and probing, functional tests like dye disappearance tests, and secretory tests like Schirmer's test. The document also discusses differentiating anatomical obstruction from functional/physiological causes of excessive tearing and localization of blockages in the system.
Concomitant strabismus is a type of manifest squint where the amount of deviation remains constant in all directions of gaze and there is no limitation of ocular movements. It can be caused by sensory obstacles like refractive errors, motor obstacles like abnormalities of extraocular muscles, or central obstacles like deficient development of fusion faculty. The main types are esotropia (inward deviation), exotropia (outward deviation), and hypertropia (vertical deviation). Treatment involves correcting refractive errors, amblyopia treatment, orthoptic exercises, and squint surgery to weaken strong muscles or strengthen weak muscles as needed.
Bullous keratopathy refers to corneal swelling caused by insufficient pumping of fluid out of the cornea. It results in the formation of fluid-filled blisters beneath the surface of the eye. It can occur secondary to endothelial dysfunction from trauma, inflammation, dystrophies or other conditions that damage the corneal endothelial pump. Symptoms include blurred vision, glare, pain from ruptured blisters, and potentially scarring. Management involves reducing fluid buildup through hypertonic drops or lenses, lowering eye pressure if high, and corneal transplantation if vision is significantly decreased or pain becomes intolerable.
Congenital nasolacrimal duct obstruction is a common cause of tearing in infants, where the nasolacrimal duct fails to fully canalize after birth. Signs include tearing and eye discharge, especially with colds. Treatment first involves massage and antibiotics, with probing of the duct under anesthesia if not resolved by 12-18 months. Probing has a high success rate when done early. Surgery like dacryocystorhinostomy may be needed if probing fails or for membranous obstructions. The procedure involves creating a passage from the lacrimal sac to the nasal cavity with good long-term success rates over 90% typically.
This document discusses watering eye (epiphora) and its causes including hyperlacrimation and obstruction of tear outflow. It describes various mechanical obstructions that can cause epiphora such as punctal, canalicular, lacrimal sac or nasolacrimal duct obstructions. Clinical evaluation methods are outlined. Dacryocystitis, an infection of the lacrimal sac, is discussed including its congenital and acquired forms. Congenital dacryocystitis presents in newborns with epiphora, positive regurgitation test and swelling. Acquired dacryocystitis can be chronic or acute, with chronic forms including catarrhal dacryocystitis, lacrimal
- Proptosis refers to forward displacement of the eyeball beyond the orbital rim, usually due to an increased mass or volume within the orbit. Common causes include tumors, inflammation, trauma, thyroid eye disease, and vascular lesions.
- Examination involves measuring exophthalmometry, inspecting for signs of mass effect, pulsation or displacement of the globe, and evaluating for neurologic deficits. Imaging with CT or MRI is important to characterize the lesion causing proptosis.
- The document discusses the evaluation of proptosis, which is the abnormal forward protrusion of the eyeball. It defines different types of orbital abnormalities and provides the approach to examining a patient with proptosis, including taking a thorough history, performing a local and systemic examination, ordering appropriate imaging and lab tests, and considering histopathological studies if needed. The causes of proptosis can be divided into categories such as inflammatory, mass effect, vascular changes, and infiltrative processes. Key aspects of the evaluation are to determine if the proptosis is unilateral or bilateral and whether there are associated signs and symptoms to suggest an underlying cause.
This document discusses fluorescein angiography (FA), a technique used to examine the circulation of the retina and choroid. FA involves injecting a fluorescent dye called sodium fluorescein and then taking photographs of the retina as the dye circulates through the eye. The dye is absorbed by the blood vessels and any leaks or blockages are visible. Precautions are taken and potential side effects explained to the patient. The sequence of FA images provides information about blood flow and any pathological conditions.
This document contains questions and answers related to ophthalmology. It covers topics like optic disc findings, causes of glaucoma, cataract types, retinal diseases, and imaging findings. The questions assess knowledge of ocular examination, diagnosis, clinical presentation, risk factors, complications, and management of various eye conditions.
This document provides information on rhegmatogenous retinal detachment including:
- The pathogenesis which involves vitreoretinal traction from liquefaction of the vitreous gel creating a hole that allows fluid into the subretinal space.
- Symptoms include photopsia, floaters, and visual field defects.
- Signs include Marcus Gunn pupil, low intraocular pressure, retinal breaks, and mild iritis.
- Treatment options depend on factors like location and size of retinal break, state of vitreous gel, and include laser photocoagulation, cryotherapy, scleral buckling, pneumatic retinopexy, and drainage of subretinal fluid in
“sturm Conoid is just a representation of how rays are refracted through two different powered meridians” (eg: a sphero- cylindrical lens). So, instead of one focal point, they form two focal lines.
Sturm’s Conoid/Interval:
Etiology of Sturm’s Conoid :
Focus of Sturm’s Conoid AC/to The Types of Astigmatism:
Sympathetic ophthalmia and Vogt-Koyanagi-Harada disease are both rare granulomatous uveitides that can cause bilateral eye inflammation. Sympathetic ophthalmia occurs after trauma or surgery to one eye, while VKH disease is thought to be an autoimmune response against ocular and skin melanocytes. Both can lead to vision loss if not treated promptly with high-dose corticosteroids and immunosuppressants. Imaging like fluorescein angiography and optical coherence tomography are useful for monitoring disease activity and response to treatment.
A surgical procedure featuring a partial thickness scleral flap that creates a fistula between AC and subconjunctival space for filtration of aqueous and creation of conjunctival bleb in an effort to lower IOP
This document provides information about fundus fluorescein angiography (FFA). It begins with basic principles of FFA and the dyes used, including sodium fluorescein and indocyanine green. The purpose, indications, contraindications, technique, phases, and interpretation of FFA are described. Abnormal fluorescence patterns like hyperfluorescence and hypofluorescence are discussed. Recent advances in wide-field imaging and indocyanine green angiography are also summarized.
- Aphakia is the absence of the crystalline lens from the eye. It can be congenital or caused by surgery or trauma.
- In aphakia, the eye becomes highly hyperopic, the anterior focal point moves forward, and the retinal image is magnified. This decreases visual acuity and field of view.
- Aphakia is treated with spectacles, contact lenses, or intraocular lenses. Spectacles cause issues like increased image size, ring scotomas, and reduced field of view. Contact lenses and IOLs provide better image quality but have risks of complications.
Traumatic optic neuropathy occurs when the optic nerve is injured from blunt force trauma anywhere along its path. While high-dose steroids and optic canal decompression surgery have been used as treatments, the evidence for their efficacy is limited. For non-transected injuries, observation is typically recommended, as primary damage to the optic nerve fibers is often permanent. Effective treatment options are extremely limited, and patients should be informed of the uncertainties regarding any proposed interventions.
This document discusses aphakia and pseudophakia. It defines aphakia as the absence of the crystalline lens and lists various causes. It describes how aphakia changes the optical properties of the eye, eliminating accommodation. Treatment options for aphakia include spectacles, contact lenses, and intraocular lens implantation. Spectacles can cause issues like image magnification, roving ring scotomas, and restricted visual field. Contact lenses and intraocular lenses are better options as they avoid these problems but have disadvantages as well. Pseudophakia refers to the condition after intraocular lens implantation to correct aphakia. The document discusses calculating the power of intraocular lenses and the different refractive outcomes
This document provides information on angle closure glaucoma, including its causes, risk factors, stages, clinical presentation, diagnostic tests, and treatment options. Angle closure glaucoma results from obstruction of the aqueous outflow pathway due to apposition or adhesion of the iris to the trabecular meshwork. It is more common in individuals with anatomically narrow anterior chamber angles and certain ethnic groups. Treatment involves lowering intraocular pressure through medications, laser procedures such as peripheral iridotomy or iridoplasty, or incisional surgeries like goniosynechialysis or trabeculectomy if needed.
This document discusses hyphema, which is blood in the anterior chamber of the eye. It defines hyphema and lists its potential causes such as trauma, medical conditions, and surgeries/medications. The document outlines methods for grading hyphema based on the amount of blood in the anterior chamber. It also discusses the clinical features, workup, potential complications like increased eye pressure, and treatment approaches like medical management with anti-inflammatory drugs and surgery if needed to prevent complications. The prognosis depends on factors like the severity of hyphema and any associated eye damage.
Trabeculectomy, trabeculotomy, goniotomy and their complicationsNamrata Gupta
Trabeculectomy is the gold standard glaucoma surgery for lowering intraocular pressure. It involves creating a fistula between the anterior chamber and subconjunctival space to bypass the trabecular meshwork. Complications include hypotony from overfiltration, flat or shallow anterior chambers, elevated pressure, hemorrhage, and infection. Careful surgical technique and postoperative management can help prevent or address complications and optimize outcomes.
This document describes different procedures for dacryocystorhinostomy (DCR), which is surgery to restore tear drainage from the lacrimal sac into the nose. It discusses conventional/external DCR, endoscopic/endonasal DCR, and endolaser DCR. External DCR involves making incisions around the lacrimal sac and removing bone to open the sac into the nose. Endoscopic DCR uses an endoscope through the nose to view the procedure. Endolaser DCR uses a laser probe through the nose to make the opening. Success rates are over 90% for external and 80-85% for endoscopic DCR. Complications can include bleeding, infection, and lac
Dr. Karan Bhatia provides an overview of keratoplasty (corneal transplantation). There are different types including penetrating keratoplasty (replacing the full thickness of the diseased cornea), partial thickness lamellar keratoplasty, and rotational keratoplasty. Penetrating keratoplasty has been the standard procedure but carries risks. The history and techniques of penetrating keratoplasty are described in detail including pre-operative evaluation, donor cornea excision, recipient cornea trephination, suturing, and post-operative management. Potential complications are also reviewed. Lamellar keratoplasty is introduced as an alternative to penetrating keratoplasty to reduce risks
CHRONIC DACROCYSTITIS AND ITS MANAGEMENTJINORAJ RAJAN
Dacryocystitis is an infection of the lacrimal sac caused by obstruction of the nasolacrimal duct. The main cause is distal obstruction of the nasolacrimal duct, leading to tear retention in the lacrimal sac. Clinical evaluation includes syringing and probing to assess the level of obstruction. Treatment depends on the stage but may include intubation, balloon dacryoplasty, or dacryocystorhinostomy to surgically create a passage from the lacrimal sac to the nasal cavity.
Presbyopia is the loss of accommodation that occurs with aging. It results in a decreased ability to focus on near objects and is caused by lenticular and extralenticular changes within the eye. Symptoms typically begin around age 40 and accommodation is completely lost by ages 50-60, affecting 100% of the population. Treatment options include reading glasses, bifocal and multifocal contact lenses, refractive surgery such as LASIK, and intraocular lens implants. Newer treatments being researched include corneal inlays and injectable accommodating intraocular lenses.
This document discusses the embryology and anatomy of the cornea. It describes how the cornea develops from surface ectoderm in the 4th-5th week of gestation, with mesenchymal cells forming the stroma and endothelium. The cornea continues developing through the fetal period, with layers such as Bowman's membrane forming between 12-26 weeks. The document also discusses the cellular components, functions, and common congenital anomalies of the cornea, including microcornea, megalocornea, cornea plana, keratoconus, and others.
Papilloedema is swelling of the optic nerve head caused by increased intracranial pressure (ICP). It is nearly always bilateral and patients should be evaluated for an intracranial mass. Papilloedema can be caused by idiopathic intracranial hypertension, obstructive lesions, space occupying lesions, impaired CSF absorption, cerebral venous sinus thrombosis, cerebral edema from head trauma, or severe hypertension. Treatment involves reducing ICP through measures like mannitol infusion, CSF withdrawal, sedation, or surgery to remove masses. Complications can include visual loss or chronic headaches.
1. The lacrimal system includes the secretory portion which produces tears and the drainage system which drains tears from the eye into the nasal cavity.
2. Common lacrimal disorders in children include dry eyes, tumors/granulomas of the lacrimal gland, congenital nasolacrimal duct obstruction, and congenital or acquired abnormalities of the puncta and canaliculi.
3. Congenital nasolacrimal duct obstruction is treated initially with observation but older children may require probing or dacryocystorhinostomy to resolve persistent epiphora. Acquired nasolacrimal duct obstruction can result from trauma, infection, or inflammation.
Epiphora is caused by impairment of lacrimal drainage leading to excess tearing. It can be due to anatomical issues obstructing tear drainage pathways or functional issues with the lacrimal pump. Common anatomical causes include punctal, canalicular, lacrimal sac, or nasolacrimal duct obstructions from congenital abnormalities, infections, trauma, tumors, or other conditions. A patient's history and external/slit lamp exams can provide clues to the cause. Diagnostic tests like dye disappearance tests, probing, and imaging help localize the obstruction. Treatment targets restoring drainage or reducing tear production depending on the underlying etiology.
- The document discusses the evaluation of proptosis, which is the abnormal forward protrusion of the eyeball. It defines different types of orbital abnormalities and provides the approach to examining a patient with proptosis, including taking a thorough history, performing a local and systemic examination, ordering appropriate imaging and lab tests, and considering histopathological studies if needed. The causes of proptosis can be divided into categories such as inflammatory, mass effect, vascular changes, and infiltrative processes. Key aspects of the evaluation are to determine if the proptosis is unilateral or bilateral and whether there are associated signs and symptoms to suggest an underlying cause.
This document discusses fluorescein angiography (FA), a technique used to examine the circulation of the retina and choroid. FA involves injecting a fluorescent dye called sodium fluorescein and then taking photographs of the retina as the dye circulates through the eye. The dye is absorbed by the blood vessels and any leaks or blockages are visible. Precautions are taken and potential side effects explained to the patient. The sequence of FA images provides information about blood flow and any pathological conditions.
This document contains questions and answers related to ophthalmology. It covers topics like optic disc findings, causes of glaucoma, cataract types, retinal diseases, and imaging findings. The questions assess knowledge of ocular examination, diagnosis, clinical presentation, risk factors, complications, and management of various eye conditions.
This document provides information on rhegmatogenous retinal detachment including:
- The pathogenesis which involves vitreoretinal traction from liquefaction of the vitreous gel creating a hole that allows fluid into the subretinal space.
- Symptoms include photopsia, floaters, and visual field defects.
- Signs include Marcus Gunn pupil, low intraocular pressure, retinal breaks, and mild iritis.
- Treatment options depend on factors like location and size of retinal break, state of vitreous gel, and include laser photocoagulation, cryotherapy, scleral buckling, pneumatic retinopexy, and drainage of subretinal fluid in
“sturm Conoid is just a representation of how rays are refracted through two different powered meridians” (eg: a sphero- cylindrical lens). So, instead of one focal point, they form two focal lines.
Sturm’s Conoid/Interval:
Etiology of Sturm’s Conoid :
Focus of Sturm’s Conoid AC/to The Types of Astigmatism:
Sympathetic ophthalmia and Vogt-Koyanagi-Harada disease are both rare granulomatous uveitides that can cause bilateral eye inflammation. Sympathetic ophthalmia occurs after trauma or surgery to one eye, while VKH disease is thought to be an autoimmune response against ocular and skin melanocytes. Both can lead to vision loss if not treated promptly with high-dose corticosteroids and immunosuppressants. Imaging like fluorescein angiography and optical coherence tomography are useful for monitoring disease activity and response to treatment.
A surgical procedure featuring a partial thickness scleral flap that creates a fistula between AC and subconjunctival space for filtration of aqueous and creation of conjunctival bleb in an effort to lower IOP
This document provides information about fundus fluorescein angiography (FFA). It begins with basic principles of FFA and the dyes used, including sodium fluorescein and indocyanine green. The purpose, indications, contraindications, technique, phases, and interpretation of FFA are described. Abnormal fluorescence patterns like hyperfluorescence and hypofluorescence are discussed. Recent advances in wide-field imaging and indocyanine green angiography are also summarized.
- Aphakia is the absence of the crystalline lens from the eye. It can be congenital or caused by surgery or trauma.
- In aphakia, the eye becomes highly hyperopic, the anterior focal point moves forward, and the retinal image is magnified. This decreases visual acuity and field of view.
- Aphakia is treated with spectacles, contact lenses, or intraocular lenses. Spectacles cause issues like increased image size, ring scotomas, and reduced field of view. Contact lenses and IOLs provide better image quality but have risks of complications.
Traumatic optic neuropathy occurs when the optic nerve is injured from blunt force trauma anywhere along its path. While high-dose steroids and optic canal decompression surgery have been used as treatments, the evidence for their efficacy is limited. For non-transected injuries, observation is typically recommended, as primary damage to the optic nerve fibers is often permanent. Effective treatment options are extremely limited, and patients should be informed of the uncertainties regarding any proposed interventions.
This document discusses aphakia and pseudophakia. It defines aphakia as the absence of the crystalline lens and lists various causes. It describes how aphakia changes the optical properties of the eye, eliminating accommodation. Treatment options for aphakia include spectacles, contact lenses, and intraocular lens implantation. Spectacles can cause issues like image magnification, roving ring scotomas, and restricted visual field. Contact lenses and intraocular lenses are better options as they avoid these problems but have disadvantages as well. Pseudophakia refers to the condition after intraocular lens implantation to correct aphakia. The document discusses calculating the power of intraocular lenses and the different refractive outcomes
This document provides information on angle closure glaucoma, including its causes, risk factors, stages, clinical presentation, diagnostic tests, and treatment options. Angle closure glaucoma results from obstruction of the aqueous outflow pathway due to apposition or adhesion of the iris to the trabecular meshwork. It is more common in individuals with anatomically narrow anterior chamber angles and certain ethnic groups. Treatment involves lowering intraocular pressure through medications, laser procedures such as peripheral iridotomy or iridoplasty, or incisional surgeries like goniosynechialysis or trabeculectomy if needed.
This document discusses hyphema, which is blood in the anterior chamber of the eye. It defines hyphema and lists its potential causes such as trauma, medical conditions, and surgeries/medications. The document outlines methods for grading hyphema based on the amount of blood in the anterior chamber. It also discusses the clinical features, workup, potential complications like increased eye pressure, and treatment approaches like medical management with anti-inflammatory drugs and surgery if needed to prevent complications. The prognosis depends on factors like the severity of hyphema and any associated eye damage.
Trabeculectomy, trabeculotomy, goniotomy and their complicationsNamrata Gupta
Trabeculectomy is the gold standard glaucoma surgery for lowering intraocular pressure. It involves creating a fistula between the anterior chamber and subconjunctival space to bypass the trabecular meshwork. Complications include hypotony from overfiltration, flat or shallow anterior chambers, elevated pressure, hemorrhage, and infection. Careful surgical technique and postoperative management can help prevent or address complications and optimize outcomes.
This document describes different procedures for dacryocystorhinostomy (DCR), which is surgery to restore tear drainage from the lacrimal sac into the nose. It discusses conventional/external DCR, endoscopic/endonasal DCR, and endolaser DCR. External DCR involves making incisions around the lacrimal sac and removing bone to open the sac into the nose. Endoscopic DCR uses an endoscope through the nose to view the procedure. Endolaser DCR uses a laser probe through the nose to make the opening. Success rates are over 90% for external and 80-85% for endoscopic DCR. Complications can include bleeding, infection, and lac
Dr. Karan Bhatia provides an overview of keratoplasty (corneal transplantation). There are different types including penetrating keratoplasty (replacing the full thickness of the diseased cornea), partial thickness lamellar keratoplasty, and rotational keratoplasty. Penetrating keratoplasty has been the standard procedure but carries risks. The history and techniques of penetrating keratoplasty are described in detail including pre-operative evaluation, donor cornea excision, recipient cornea trephination, suturing, and post-operative management. Potential complications are also reviewed. Lamellar keratoplasty is introduced as an alternative to penetrating keratoplasty to reduce risks
CHRONIC DACROCYSTITIS AND ITS MANAGEMENTJINORAJ RAJAN
Dacryocystitis is an infection of the lacrimal sac caused by obstruction of the nasolacrimal duct. The main cause is distal obstruction of the nasolacrimal duct, leading to tear retention in the lacrimal sac. Clinical evaluation includes syringing and probing to assess the level of obstruction. Treatment depends on the stage but may include intubation, balloon dacryoplasty, or dacryocystorhinostomy to surgically create a passage from the lacrimal sac to the nasal cavity.
Presbyopia is the loss of accommodation that occurs with aging. It results in a decreased ability to focus on near objects and is caused by lenticular and extralenticular changes within the eye. Symptoms typically begin around age 40 and accommodation is completely lost by ages 50-60, affecting 100% of the population. Treatment options include reading glasses, bifocal and multifocal contact lenses, refractive surgery such as LASIK, and intraocular lens implants. Newer treatments being researched include corneal inlays and injectable accommodating intraocular lenses.
This document discusses the embryology and anatomy of the cornea. It describes how the cornea develops from surface ectoderm in the 4th-5th week of gestation, with mesenchymal cells forming the stroma and endothelium. The cornea continues developing through the fetal period, with layers such as Bowman's membrane forming between 12-26 weeks. The document also discusses the cellular components, functions, and common congenital anomalies of the cornea, including microcornea, megalocornea, cornea plana, keratoconus, and others.
Papilloedema is swelling of the optic nerve head caused by increased intracranial pressure (ICP). It is nearly always bilateral and patients should be evaluated for an intracranial mass. Papilloedema can be caused by idiopathic intracranial hypertension, obstructive lesions, space occupying lesions, impaired CSF absorption, cerebral venous sinus thrombosis, cerebral edema from head trauma, or severe hypertension. Treatment involves reducing ICP through measures like mannitol infusion, CSF withdrawal, sedation, or surgery to remove masses. Complications can include visual loss or chronic headaches.
1. The lacrimal system includes the secretory portion which produces tears and the drainage system which drains tears from the eye into the nasal cavity.
2. Common lacrimal disorders in children include dry eyes, tumors/granulomas of the lacrimal gland, congenital nasolacrimal duct obstruction, and congenital or acquired abnormalities of the puncta and canaliculi.
3. Congenital nasolacrimal duct obstruction is treated initially with observation but older children may require probing or dacryocystorhinostomy to resolve persistent epiphora. Acquired nasolacrimal duct obstruction can result from trauma, infection, or inflammation.
Epiphora is caused by impairment of lacrimal drainage leading to excess tearing. It can be due to anatomical issues obstructing tear drainage pathways or functional issues with the lacrimal pump. Common anatomical causes include punctal, canalicular, lacrimal sac, or nasolacrimal duct obstructions from congenital abnormalities, infections, trauma, tumors, or other conditions. A patient's history and external/slit lamp exams can provide clues to the cause. Diagnostic tests like dye disappearance tests, probing, and imaging help localize the obstruction. Treatment targets restoring drainage or reducing tear production depending on the underlying etiology.
Epiphora is caused by impairment of lacrimal drainage leading to excess tearing. It can be due to anatomical issues obstructing tear drainage pathways or functional issues with the lacrimal pump. Common anatomical causes include punctal, canalicular, lacrimal sac, or nasolacrimal duct obstructions from congenital abnormalities, infections, trauma, tumors, or other conditions. A thorough clinical evaluation includes examining the eyelids, puncta, and ocular surface as well as diagnostic tests like dye disappearance tests, probing, and imaging when needed to localize the obstruction.
This document provides an overview of salivary gland disorders. It discusses the anatomy and function of major and minor salivary glands. Common salivary gland disorders are then described, including sialolithiasis, mucoceles, ranulas, infections such as mumps, Sjögren's syndrome, and various neoplasms including pleomorphic adenoma, Warthin's tumor, and mucoepidermoid carcinoma. Diagnosis and treatment approaches are outlined for each condition.
This document discusses diseases of the lacrimal system, including epiphora caused by hypersecretion, defective drainage, punctal malposition, or lacrimal pump failure. Evaluation involves examining the puncta, lacrimal sac, and performing fluorescein disappearance testing. Obstructions can occur in the puncta, canaliculi, lacrimal sac, or nasolacrimal duct. Congenital nasolacrimal duct obstruction often resolves with massage but may require probing. Dacryocystitis results from nasolacrimal duct obstruction and is treated with dacryocystorhinostomy.
The document discusses the anatomy and diseases of the lacrimal system. It describes the secretory and excretory parts of the lacrimal system including the lacrimal glands and drainage structures. Various diseases affecting the lacrimal system are explained such as dacryoadenitis, dacryocystitis, and their classifications, symptoms, investigations, and treatment options including probing, dacryocystorhinostomy, and dacryocystectomy.
The document discusses the lacrimal system, which consists of the secretory system and excretory system. The secretory system includes the lacrimal gland and accessory glands that secrete the components of the tear film. The excretory system includes the puncta, canaliculi, lacrimal sac, and nasolacrimal duct that drain tears from the eye surface into the nose. Dacryocystitis is an infection of the lacrimal sac that can be acute or chronic. Evaluation and management of dacryocystitis as well as congenital nasolacrimal duct obstruction are discussed.
The document discusses disorders of the salivary glands, focusing on the parotid and submandibular glands. It describes the anatomy of the major salivary glands and their duct systems. Common disorders are then outlined, including developmental abnormalities, infections (viral like mumps, bacterial), obstructions (stones), and tumors. Treatment options are provided for various disorders like parotidectomy for removal of tumors while preserving the facial nerve. Complications of parotid surgery are also summarized.
Choanal atresia is a congenital abnormality where the posterior nasal openings connecting the nasal cavities to the nasopharynx are stenotic or absent. It can be unilateral or bilateral. Bilateral choanal atresia is a life-threatening condition requiring immediate intervention to establish an airway. Surgical repair typically involves transnasal or transpalatal approaches to reopen the nasal passages. Complications may include stent issues, mucosal flap necrosis, and restenosis. Associated anomalies are also common, particularly in bilateral cases.
This document provides an overview of ocular parasites, including Toxocara canis, Cysticercus cellulosae, Gnathostoma spinigerum, and Histoplasma capsulatum. It discusses the organisms, clinical presentations, diagnosis, and treatment of each parasite. Key points include that Toxocara canis causes ocular inflammation and granulomas, Cysticercus cellulosae causes cysts in eye tissues leading to uveitis, and Gnathostoma spinigerum and Histoplasma capsulatum can spread from the lungs to the eyes and cause vision changes. Diagnosis involves clinical examination, imaging, and serology testing, while treatment consists of ant
The four pairs of paranasal sinuses are located in the frontal, maxillary, ethmoid, and sphenoid bones. Sinusitis is inflammation of the paranasal sinus lining and can be acute (<1 month), subacute (1-3 months), or chronic (>3 months). The sinuses are normally lined with ciliated epithelium and function includes resonance, skull weight reduction, eye protection, and air humidification. Risk factors include common colds, cystic fibrosis, and structural abnormalities. Diagnosis is based on symptoms, and acute bacterial sinusitis is usually treated with antibiotics if symptoms persist beyond 10 days. Complications include orbital and intracranial infections. Chronic sinusitis has multiple causes
This document discusses adenoid and tonsil procedures. Adenoidectomy is performed to treat conditions like sleep apnea and ear infections caused by adenoid hypertrophy. Risks include bleeding and injury to nearby structures. Tonsillectomy is indicated for recurrent tonsillitis or sleep apnea. The dissection and snare method involves separating the tonsil from its bed and removing it with a snare. Postoperative risks include primary and reactionary bleeding in the first 24 hours, and secondary bleeding up to 2 weeks later caused by infection. Other risks include injury to nearby structures like the tongue or uvula.
This document discusses diseases of the middle ear, including acute suppurative otitis media and chronic suppurative otitis media. It describes the pathology, clinical presentation, investigations and treatment options for these conditions. Acute suppurative otitis media typically presents with otalgia, otorrhea and deafness, and is usually treated with antibiotics. Chronic suppurative otitis media can be the safe/tubotympanic type or dangerous/atticoantral type, with the former confined to the middle ear cleft and carrying less risk.
Acute dacryocystitis is an inflammation of the lacrimal sac, usually caused by nasolacrimal duct obstruction. Symptoms include painful swelling near the inner corner of the eye, tearing, discharge or fever. On examination, the swelling is reddish and tender. Treatment involves hot compresses, antibiotics, and surgery such as dacryocystorhinostomy to bypass an obstruction if inflammation persists or complications like abscess or fistula occur.
This document discusses several benign diseases of the larynx, including congenital anomalies. The most common congenital laryngeal anomaly is laryngomalacia, which involves inward collapse of supraglottic structures during inspiration. Other discussed anomalies include laryngeal cysts, laryngoceles, laryngeal webs, vocal cord paralysis, and congenital subglottic stenosis. Diagnosis is usually via laryngoscopy or imaging. Treatment depends on severity but may include observation, medical management, surgery such as supraglottoplasty, or tracheostomy for more severe cases.
Dacryocystitis is an infection or inflammation of the nasolacrimal sac, usually accompanied by blockage of the nasolacrimal duct. Dacryocystitis can be acute or chronic and congenital or acquired.
The document discusses epiphora, which is excessive tearing or watering of the eyes, describing the various causes including abnormalities of the puncta, canaliculi, lacrimal sac, or nasolacrimal duct. Evaluation methods such as syringing, dye tests, and imaging are covered. Surgical treatments for different obstructions include punctal dilation, intubation, dacryocystorhinostomy, and silicone stent placement.
Disease of external nose deviated nasal septum, fb in nose 02.05.16, dr.bini...ophthalmgmcri
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
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- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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6. PUNCTA(PUCTUM)
•6 mm temporal to the inner canthus
•Each punctum situated upon lacrimal papilla
(prominent in old age)
•Punct a dip into the lacus lacrimalis(collection
of tear fluid in the inner canthus)
7. LACRIMAL CANALICULI
• Upper and lower
• Parts:
• –– Vertical 2mm
• ---Horizontal 8 mm
• Join to form common Canaliculi canaliculus
• Open in the lacrimal Rosenmuller sac, fold of mucosa forms the
valve which prevents reflux of tears.
8.
9. LACRIMAL SAC
• Lies in the lacrimal fossa located in the anterior part of
medial orbital wall
• The lacrimal fossa is formed by lacrimal bone and frontal
process of maxilla and separate the lacrimal sac from the
middle meatus of the nasal cavity
• When distended: 15 mm in length and 5-6 mm in breadth
10. LACRIMAL SAC CONTD
• Parts:
– fundus (portion above the opening of canaliculi),
– body (middle part)
– neck (lower small part which is narrow and continuous with the
nasolacrimal duct)
• LININGS-by nonkeratinized stratified squamous epithelium and
are surrounded by elastic tissue, which permits dilation to 2 or 3
times the normal diameter.
11. NASO – LACRIMAL DUCT
• Neck of lacrimal sac to inferior meatus in the nose
• Lies in a bony canal – mainly maxilla and inferior turbinate
• 18 mm in length
• Intraosseous part 12.5mm
• Intrameatal 5.5mm
• Diameter-3mm
12. NASOLACRIMAL DUCT CONTD
• Direction- downwards, backward & laterally
• Externally its location is represented by a line joining inner
canthus to the ala of nose
• Upper end -narrowest part
• Valve of Hasner, present at the lower end of the duct and
prevents reflux from the nose
13. PHYSIOLOGY OF LACRIMAL DRAINAGE SYSTEM
• Tears secreted by the main and accessory lacrimal glands pass laterally
across the ocular surface
• Tears evaporates depending on
– size of the palpebral aperture
– blink rate
– ambient temperature
– humidity
14. PHYSIOLOGY OF NLD SYSTEM CONTD
• Tears flow along the upper
and lower marginal strips
enter the upper(30%) and
lower(70%) canaliculi by
capillarity and also possibly
by suction
15. PHYSIOLOGY OF NLD SYSTEM CONTD
• With each blink, the pretarsal orbicularis
oculi compresses the ampullae, shortens
the horizontal canaliculi and moves the
puncta medially
• The lacrimal part of the orbicularis oculi,
which is attached to the fascia of the
lacrimal sac contracts and expands the
sac creates a negative pressure sucks the
tears from the canaliculi into the sac
16. PHYSIOLOGY OF NLD SYSTEM CONTD
• When the eyes open the muscles relax.
the sac collapses and a positive pressure
is created which forces the tears down
the nasolacrimal duct into the nose
• Gravity also plays a role.
• The puncta move laterally.
• The canaliculi lengthen and fill with
tear
17. CLASSIFICATION-NLDO
• CONGENITAL: occurs approximately 5% of normal
newborn infants.
• The blockage occurs most commonly at the valve of
Hasner
• The blockage can be unilateral or bilateral.
• Spontaneous resolution in 90% within the first year of life.
18. CLASSIFICATION CONTD
• ACQUIRED NLDO
• primary acquired nasolacrimal duct obstruction (PANDO);
inflammation or fibrosis without any precipitating cause
• Secondary acquired lacrimal drainage obstruction (SALDO);
infectious(Bacteria, viruses, fungi, and parasites),
inflammatory, neoplastic, traumatic, and mechanical.
19. ETIOLOGY- CONGENITAL NLDO
1. Most commonly a membranous obstruction at the valve
of Hasner
2. General stenosis of the duct
3. Congenital proximal lacrimal outflow dysgenesis
(maldevelopment of the punctum and canaliculus)
4. Congenital lacrimal sac mucocele or dacryocystocele
21. ETIOLOGY-ACQUIRED NLDO CONTD
•INFLAMMATION; endogenous or exogenous
•Endogenous; e.g Wegener granulomatosis and
sarcoidosis
•Exogenous; causes cicatricial lacrimal drainage
obstruction e.g eye drops, radiation, systemic
chemotherapy, and bone marrow transplantation.
22. ETIOLOGY- ACQUIRED NLDO CONTD
•NEOPLASM;
•Primary neoplasms; arising from puncta,
canaliculi, lacrimal sac, or nasolacrimal duct.
•Secondary or metastatic spread; eg . eyelid
cancers, sites from the breast and prostate
23. ETIOLOGY- ACQUIRED NLDO CONTD
•TRAUMA;
•Iatrogenic; e.g lacrimal probing, orbital decompression
surgery, paranasal, nasal, and craniofacial
procedures.
•Noniatrogenic; e.g blunt or sharp trauma to the
canaliculus, lacrimal sac, and nasolacrimal duct
24. ETIOLOGY- ACQUIRED NLDO CONTD
•MECHANICAL:
•Intraluminal foreign bodies, such as dacryoliths
or casts
•External compression from rhinoliths, nasal
foreign bodies, or mucoceles.
25. EPIDEMIOLOGY
• FREQUENCY: relatively common
• Obstruction of NLD in 5% of full term newborns
• MORTALITY/ MORBIDITY; Epiphora can be a
nuisance
• RACE; No predilectionn to race has been
established
26. EPIDEMIOLOGY CONTD
•SEX; PANDO is more prevalent in women.
SALDO has no sexual predilection.
•AGE; PANDO higher in individuals aged 50-
70 years while CNLDO in new born
28. HISTORY
• Tearing, mucous discharge and
epiphora of one or both eyes in
a child
• Onset- birth or soon after birth
• symptoms are usually worse
with a concurrent upper
respiratory infection
29. HISTORY CONTD
• Increased tear lake and epiphora
without mattering---proximal
lacrimal drainage blockage or
dysgenesis
• Swelling and redness over the
lacrimal sac with a palpable mass
may be seen
30. HISTORY CONTD
•Tearing, mucoid, or purulent discharge with onset at
older age
•Recurrent dacryocystitis, recurrent conjunctivitis or
ocular pemphigus
•Painful, swelling medial canthus
•Bloody tears
•Epistaxis (nasal, sinus, or lacrimal sac tumor)
31. PAST OCULAR HISTORY
• Previous eye surgery (lid, DCR, periocular-nasal,
sinus)
• Glaucoma (antiglaucoma medications)
• Use of other topical medications
• Trauma
32. PAST MEDICAL/SURGICAL HISTORY
• Lymphoma, Wegener granulomatosis, Sarcoidosis
• Ocular cicatricial pemphigoid, Kawasaki disease,
Scleroderma, Sinus histiocytosis
• Previous radiation treatment to medial canthal area
systemic chemotherapy with 5-FU
• Previous ocular infections
• Previous Ocular and periocular surgeries
34. PHYSICAL EXAMINATION CONTD
• Mucoid or purulent eye
discharge
---Significantly distended sac
may not regurgitate with
pressure due to the
functional valve of
Rosenmüller
37. EXAMINATION-SLIT LAMP
• Punctal stenosis
• Canaliculitis - Canalicular fullness
and creamy pus when canaliculus is
pressed
• Expression of concretions from
punctum
• Pouting punctum with purulent
material at opening
38. CLINICAL TESTS
• Schirmer basic secretor testing; Ensure that epiphora is not
related to hypersecretion
• Dye disappearance testing
• Jones I dye test;
• A positive result indicates no anatomical or functional
blockage to tear
• A negative result indicates anatomical or functional
blockage).
39.
40. CLINICAL TEST CONTD
• Tear break-up time test; Normal break-up time is 15-30
seconds. 10 seconds or less is abnormal.
• Jones II dye test
• In light of a negative Jones I dye test, a positive Jones II
dye test indicates either partial obstruction of the
nasolacrimal system or a false-negative Jones I test.
• Diagnostic probing(more useful in Children + therapeutics)
43. INVESTIGATIONS-IMAGING
• Dacryocystography (DCG);
Gadolinium-enhanced magnetic
resonance dacryocystograph,
Computed tomographic
dacryocystography (CTDCG)
• Dacryoscintigraphy ;when
anatomical abnormalities of the
nasolacrimal drainage system are
suspected
• Nasal endoscopy
• X-ray Plain films; may show facial skeletal
anomalies, mass lesion , foreign bodies ,
post traumatic etiologiesas
• CT scans ;patients suspected of harboring
an occult malignancy or mass,
posttraumatic causes
• MRI ; not as useful as CT scans
• helpful in differentiating cystic lesions
from solid mass lesions
• Lacrimal sac diverticuli.
46. CONSERVATIVE/ MEDICAL
•Topical antibiotics with lacrimal
massage may be adequate for early
infections.
•Systemic antibiotics may be
necessary for more chronic or severe
infections, such as those causing
dacryocystitis, canaliculitis, or
preseptal cellulitis
47. TREATMENT....CONGENITAL NLDO
• Massage of the lacrimal sac
1. To perform this manoeuvre, the index finger is placed over the
common canaliculus to block reflux through the puncta and then
massaged firmly downwards.
2. Ten strokes are applied four times a day.
3. Massage should be accompanied by lid hygiene; topical antibiotics
should be reserved for superadded bacterial conjunctivitis.
49. PROBING OF THE LACRIMAL SYSTEM
•Probing elayed until the age of 12–
18 months because spontaneous
canalization is likely.
•Probing performed within the first
1–2 years of life has a very high
success rate, but thereafter the
efficacy decreases
50. PROBING CONTD
• The procedure should be
carried out under a general
anaesthetic.
• The rationale is to manually
overcome the obstructive
membrane at the Hasner
valve.
51. •After probing, the lacrimal system is irrigated
with saline labelled with fluorescein.
•If fluorescein can be recovered by aspiration
from the pharynx, successful probing is
confirmed.
52. • Postoperative steroid-antibiotic drops are used q.i.d. for
up to 3 weeks.
• If, after 6 weeks, there is no improvement, repeat probing
can be arranged
• Probing usually successful in 70%–97% of cases, with
many reports around 90%.
53. NLD PROBING CONTD
• Usually excellent and 90% of children are cured by the
first probing and more than half of the remainder by
the second.
• Failure is usually the result of abnormal anatomy,
which can usually be recognized by difficulty in
passing the probe and subsequent non-patency of the
drainage system on irrigation
54. NLD PROBING CONTD
• If symptoms persist despite one to two technically
satisfactory probings, temporary intubation with fine
silastic tubes with or without balloon dilatation of the
nasolacrimal duct may effect a cure.
• Patients who fail to respond to such measures can be
treated later with DCR, provided the obstruction is distal
to the lacrimal sac.
55. CONVENTIONAL DACRYOCYSTORHINOSTOMY
• The blood vessels in the middle
nasal mucosa are constricted with
ribbon gauze or cotton buds
lightly wetted with 1 : 1000
adrenaline.
• A straight vertical incision is made
10 mm medial to the inner
canthus, avoiding the angular
vein
56. CONVENTIONAL DCR CONTD
• The anterior lacrimal crest is exposed
by blunt dissection and the superficial
portion of the medial palpebral
ligament divided.
• The periosteum is divided from the
spine on the anterior lacrimal crest to
the fundus of the sac and reflected
forwards.
• The sac is reflected laterally from the
lacrimal fossa
57. CONVENT DCR CONTD
• The anterior lacrimal crest and the bone from
the lacrimal fossa are removed
• A probe is introduced into the lacrimal sac
through the lower canaliculus and the sac is
incised in an ‘H.shaped’ manner to create two
flaps.
58. • Membranous obstruction at the common canalicular opening
or distal canalicular obstruction can be opened by excision or
trephine of obstructing tissue (canaliculo-DCR).
• A vertical incision is made in the nasal mucosa to create
anterior and posterior flaps
60. • The anterior flaps are
sutured
• The medial canthal
tendon is resutured to the
periosteum and the skin
incision closed with
interrupted sutures
61. CAUSES OF DCR FAILURE
• Inadequate size and position of the ostium, unrecognized
common canalicular obstruction, scarring
• The ‘sump syndrome’, in which the surgical opening in the
lacrimal bone is too small and too high.
• There is thus a dilated lacrimal sac lateral to and below the
level of the inferior margin of the ostium, in which
secretions collect, unable to gain access to the ostium and
then the nasal cavity.
62. COMPLICATIONS OF DCR
• Cutaneous scarring
• Injury to medial canthal structures
• Haemorrhage
• Cellulitis
• Cerebrospinal fluid rhinorrhoea if the subarachnoid space
is inadvertently entered.
63. ENDOSCOPIC DCR
• Pre-injection of the agger mucosa, middle turbinate and
uncinate.
• Raising mucosal flap
• Exposing the lacrimal sac,
• Lacrimal sac intubation
• Sac incision
• sac flap creation
64. ENDOSCOPIC DCR CONTD
• The nasal mucosa is decongested with 0.1%
xylometazoline nasal spray,
• Pledgets soaked in 1:1,000 adrenaline
• The lateral nasal wall, middle turbinate and uncinate
are injected with lidocaine hydrochloride 2% with
adrenaline 1:80,000.
65. Raising mucosal flap
•A mucosal flap is
fashioned with a
crescent knife, by
creating an ‘H’ shaped
incision in the agger
mucosa
66. • Exposing the lacrimal sac
• A frontal sinus probe is used to
develop a plane between the lacrimal
sac and the lateral aspect of the
lacrimal crest of the maxilla. The
inferior aspect of frontal process of
the maxilla is removed
67. • Lacrimal sac intubation
• When lacrimal sac exposure
seems adequate, an
O’Donaghue probe and stent
is passed down the inferior
canaliculi to tent the medial
wall of the sac.
68. • Stenting/marsupialisation
and creation of the sac wall
flap
• The medial wall of the sac is
tented medially using the
end of the O’Donaghue
probe and incised vertically
using a sharp pointed Phaco
knife at its most anterior
aspect
69. ENDOSCOPIC DCR
•The aim is to create a large posterior based
sac flap, which can later be folded back
towards the uncinate process, facilitating full
sac marsupialisation.
71. CONCLUSION
• NLDO has a high rate for resolution by one or more
surgical procedures.
• The success rate of simple probing is excellent.
• Children with conditions that increase their risk of probing
failure have a poorer prognosis but can often be
successfully treated with additional procedure.
73. REFERENCES
• Linberg JV, McCormick SA. Primary acquired nasolacrimal duct obstruction. A
clinicopathologic report and biopsy technique. Ophthalmology. 1986 Aug.
93(8):1055-63.
• Bartley GB. Acquired lacrimal drainage obstruction: an etiologic classification
system, case reports, and a review of the literature. Part 1. Ophthal Plast
Reconstr Surg. 1992. 8(4):237-42.
• Paul TO. Medical management of congenital nasolacrimal duct obstruction. J
Pediatr Ophthalmol and Strabismus. 1985; 22:68-70.
• Nelson, LB, Calhoun, JH, Menduke, H. Medical management of congenital
nasolacrimal duct obstruction.Ophthalmology. 1985; 92:1187-1190.
• Petersen, RA, Robb, RM. The natural history of congenital obstruction of the
nasolacrimal duct. J Pediatr Ophthalmol and Strabismus. 1978; 15:246-250.