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

2. 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

3. 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

4. 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

5. Blockage
Punctal examination
Regurge test
Lacirmal Sac
Wash

6. Blockage- Lac sac wash

8. Organize The Photographs In Correct SequenceB C D

9. Lacrimal Massage

10. 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

11. Positive regurge

12. CDC

13. Complications

14. Complications

15. 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.

16. 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

17. 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

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