1. DUCT

2. LACRIMAL DUCT PATTENCY  Anatomy of the lacrimal apparatus  It is situated in upper orbital outer lacrimal side  Function of the lacrimal apparatus  Lacrimal tears which secretates from lacrimal gland enters into cornea through palpebral conjunctiva ductless conjunctival sac. This helps to make cornea transparent and fertile

3. Parts of the lacrimal sac  Punctum  Canaliculai  Lacrimal sac  Naso lacrimal duct  Lacrimal gland

4. Punctum  Punctum is surrounded by fibrous tissue  Two types of punctum  Upper punctum ( 6mm from medial canthus )  Lower punctum ( 6.5mm from medial canthus )  Punctum diameter – 0.2mm  Interval between upper and lower punctum was 0.5mm  If it touches, punctum blocks

5. canaliculai  Types of canaliculi  Upper canaliculi  Lower canaliculi  Junction of upper and lower canaliculi is called common canaliculi  Another name – Ampulla  Vertical diameter a 1 – 2 mm  Horizontal diameter a 7 – 8 mm

6. Lacrimal sac  Parts of lacrimal sac  Fundus of the sac ( 3mm from lacrimal sac)  Body of the sac ( 10 mm from lacrimal sac)  Two layers  Epithelium layer  Subtantia Propia layer  Sac diameter a 11 – 13 mm  Thickness a 2 -3 mm

7. Naso lacrimal duct  Naso lacrimal duct is presented below the lacrimal sac  Two parts  Intra ascessary part ( bone part )  Intra mural part ( muscles part )  Diameter 18mm

8. Examination of lacrimal duct  Helps to find out the block in the lacrimal sac and naso lacrimal duct  Things needed  2cc syringe  Normal saline ( Ringer lactate )  Anaesthetic drops ( Iignox 4% )  Sterile wipper  26 gauge sharpless & crooked needle  Kidney tray

9. Practical Explain to the patient Make the patient to lie down Nurses should wash and dry her hands Before putting anaesthetic drops, explain the burning sensation and ask them to look up. Put the drosp in pouching method without touch of cornea Duct should no be seen in dark places First put the drops, then dry with wiper, take 11/2cc saline from the 2cc syringe, insert the duct needle into the syringe, check the flow of the fluid.

10. Then find the duct Make the patient to look up, then pull the lower lid down and insert the needle into the punctum correctly and turn it towards the nose, press the biston slowly. When the fluid freely enters into the nose, throat, the duct is free When half of the fluid came out through the upper punctum the duct is partially free with clear fluid. When it fully came out through the upper punctum, the duct is not free with clear fluid When pus came out of the upper punctum, the duct is not free with pus ( yelow ) When it fully came out through the same punctum, the duct is not free with clear fluid through the same punctum. When half of the fluid came out through the same punctum the duct is partially free with clear fluid through the same punctum.

11. When mucous came out of the upper punctum, the duct is not free with mucous ( white jelly ) Underline the result the with red ink except free duct. Occasionally when we press the sac area, mucous or pus came out through the lower punctum, it is called regurgitation of over pressure of the lacrimal sac ( ROPLAS +ve ) Some times the fluid came out through the near the hole is called fistula. If the sac area swells, when we press it half fluid enter into the throat and the remains went out, it is called A – tonic sac. If we cannot press the biston into the upper and lower punctum it is called canaliculi block. If the punctum does not appear clear, it is called punctum block

12. Duct should be must  Watering discharge  Corneal ulcer  All surgery patients ( expects children )  Post op DCT, DCR  Should not be seen  Conjunctivitis  ACCO  Lacrimal abscess  Lid tear