DISEASES OF THE LACRIMAL SYSTEM Dr. Ayesha S. Abdullah 07.10.2017

Learning Outcomes By the end of this class the students would be able to Outline the clinical evaluation protocol for a patient presenting with epiphora Differentiate between the various common conditions leading to watery eyes in children and adults Diagnose a case of acute and chronic dacrocystitis, recommend management plan for such a patient and list possible complications

Watery Eyes- Differential Diagnosis Increased production- lacrimation Decreased Drainage Pump Failure Lacrimal Obstruction/ Blockage Lids Conjunctiva Trauma Cong. Glaucoma Large eyes- Buophthalmos, hazy cornea Dry eyes Entropion Malposition Ectropion Conjunctivitis Trichiasis Facial Palsy Allergic-Itchy, seasonal, papillae Blepharitis Bacterial-purulent discharge, papillae Viral – watery discharge, follicles, LN

Nasolacrimal Duct Obst Lacrimal Obstruction/ Blockage Punctal Obst Congenital- atresia/ Stenosis Acquired- Stenosis, scarring Lacrimal Sac Obst Granulomas Tumours- Primary & secondary Lymphoma Nasolacrimal Duct Obst Canalicular Obst. Fibrosis (infections; HSV, Actinomyces, 5- FU) Chronic Dacrocystitis Congenital Traumatic Nasal Pathology- Inflammation/ polyps Tumours Post-irradiation fibrosis

Blockage Punctal examination Regurge test Lacirmal Sac Wash

Blockage- Lac sac wash

Organize The Photographs In Correct Sequence B C D

Lacrimal Massage

Chronic Dacrocystitis Chronic inflammation secondary to NLD blockage Symptoms Long history of epiphora and intermittent eye discharge Painless swelling along the side of the nose at the medial canthus. Signs Mucocoele Regurge test is positive Irrigation of the sac reveals the site of obstruction at NLD DCR is the treatment Conventional Open technique Endoscopic DCR Staphylococcal or streptococcal in aetiology

Positive regurge

CDC

Complications

Complications

DCR Conventional (external approach) dacryocystorhinostomy (DCR) is indicated for obstruction distal to the medial opening of the common canaliculus, and consists of anastomosis of the lacrimal sac to the mucosa of the middle nasal meatus.

Acute Dacrocystitis Symptoms Acute or subacute onset of pain in the medical canthal area along the side of the nose with swelling and redness Past history of watery eyes/ discharge If the infection is severe the person may present with pre-septal cellulitis Signs Tender, red, hot swelling at the medial canthal area Regurgre test should not be attempted

Acute Dacrocystitis Treatment NO PROBING & IRRIGATION Antobiotics NSAIDs Warm compresses DCR after the acute episode settles An abscess may require drainage The most common gram-positive organisms include Streptococcus pneumonia and Staphylococcus aureus, while Haemophilus influenza, Pseudomonas aeruginosa and Serratia marcescens are the leading the gram-negative bacteria

DACROADENITIS Inflammation Of the lacrimal gland Usually a manifestation of systemic problem