1. The lacrimal system

4. Abnormalities of lacrimal system
tear flow and evaporation
Drainage system abnormalities

6. Abnormalities in tear flow and evaporation – dry eye
Dry eye is a condition of the ocular surface due to a defi ciency of tear quantity or composition or excessive evaporation
characterized by hyperosmolarity and leading to ocular surface damage, inflammation and symptoms of discomfort
and visual loss
An alternative term is keratoconjunctivitis sicca ( KCS ).

7. Tear composition abnormalities
Abnormal aqueous production
Abnormal mucus production
Abnormal meibomian secretion

8. Aqueous insufficiency
Deficiency of lacrimal secretions occur with age and results in KeratoConjuctivitis Sicca (KCS )
Primary Sjogren syndrome : dry eye and mouth, is an autoimmune disease
Secondary Sjogren : when associated with connective tissue disease with Rheumatoid Arthritis as the commonest .

9. Symptom & Signs
Non-specific symptoms as FB sensation , tiredness ,grittiness ,burning ,heaviness photophobia and ocular fatigue .
These symptoms are worse at the end of the day and when exposed to dry or windy atmosphere .

10. Signs
In mild cases may show staining of the cornea with fluorescence (punctate staining )
In severe cases Tags of mucus attached to the corneal surface ( filamentary keratitis )
Very severe cases may show structural corneal changes .

11. Management Tear supplementations Humidify the surrounding atmosphere
Occlude the punci to preserve tears .
Prognosis depend on the severity and the underlying cause .

12. Inadequate mucus production
Destruction of goblet cells can occur in many conditions .
Causes : Cicatricial conjuctival conditions
Chemical burns
Trachoma
Vit. A deficiency (Xerophthalmia )
e.g of cicatricial conj. Disorders is Steven_Johnson syndrome .

13. Management
Artificial Tear
Vit A supplement for Xerophthalmia

14. Abnormal or inadequate meibomian gland secretion
It will cause tear film instability
Giving symptoms of dry eye
Treatment is the same .
Ttt : artificial tear
Omega 3
Cyclosporine a

15. Malposition of the eyelid margin
Causes : Ectropion
Entropion
Facial palsy
Proptosis
All of these will cause unstable pre-ocular tear film .

16. Tear drainage disorders
When tear production exceeds the drainage the tear will overflow on the cheeks
Can be caused by :
* Ocular surface irritation as in foreign body or infection causing (Lacrimation )
* Occlusion part of the drainage system
(Epiphora)

17. NasoLacrimal Duct Obstruction
Congenital
Acquired

18. Congenital NLD obstruction
Normally the NLD develops as a solid cord which completes canalization just before birth
Sometimes incomplete canalization occur specially for the lower part .
Leading to epiphora ,mucocele formation and sometimes dacrocystitis ( infection of the lacrimal sac )
Pressure on the sac will cause mucus to be expressed from puncti .

20. allert
When seeing lacrimation in infant do not forget the most important cause congenital glaucoma

21. Congenital NLD obstruction management
Spontaneous opening occur in most of the cases .
If not lacrimal sac massage can be tried
Lacrimal sac syringing and probing can help in resistant cases .

22. Acquired NLD obstruction
Causes : Infection
Trauma
Tumour
Radiation

23. History Symptoms of watering eye May be aggravated by windy atmosphere
Eye stickiness
History of trauma or radiation .

24. Examination Punctal occlusion can be seen using slit lamp .
Syringing and saline injection
Dacrocystogram .

26. Management Exclude other ocular causes of lacrimation as blepharitis
Syringing and probing can be tried .
DacroCystoRhinostomy (DCR) or other modifications ,to create a fistula between the lacrimal sac and nasal mucosa by destroying the intervening bone .

28. Infections of the naso-lacrimal system
Dacryocystitis : infection of the lacrimal sac ,predisposed by closure ,MC organism is the Staph.species
Presentation with painful medial cantha swelling
Treatment with systemic AB
Mucocele : accumulation of mucus in the lacrimal sac ( not infected ) .
Dacrycystitis : progressive process
Closure either by canalicular stone , polyps ,sinusis
Not cause orbital cellulitis

29. ????i think : medial canth swelling and redness assosiated with periorbital swelling , epiphoria, sticking eye

31. Lacrimal gland : orbital
palpebral