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DISEASES OF LACRIMAL
       SYSTEM
ANATOMY & PHYSIOLOGY
BRIEF REVIEW
Secretory and drainage parts.
Lacrimal gland [orbital and palpebral parts] and
 accessory lac glands of Krause and Wolfring Seven
 to twelve ducts open in the supero temporal part
 pf bulbar conjunctiva.
Streams running across the eye ball lead to a
 smaller meniscus along upper and another along
 the lower lid margin.
Eye closure is from temporal to nasal side thus
 pushing the tears medially in lacus lacrimalis.
Here starts drainage system.
Anatomy Continued--------
Under basic and reflex control (secretomotor fibres
 from Saliv. N, N intermedius, before facial N genu
 into GSPN, through F. Lacerum and pterygoid canal
 joins Sphenopalatine G to synapse.)
Post gang. join NV11, then zygomatico temporal and
 finally in Lacrimal nerve reach the gland substance.
Basic sec from accessory lac glands and reflex from
 main lac glands
0.9 to 2.2uL/min. Cul-de-sac capa-30uL. Rate of tear
 sec more than 100uL/min tearing occurs.
Drainage system
Two punctae just medial to the cilia bearing area of
 the lids each leads to a canaliculus which runs nasally
 to unite as common canaliculius opening into Lac.
 Sac. Lodged in lac fossa and narrows inferiorly to naso
 lacrimal duct which opens in inferiopr meatus .
FUNCTIONS:
Main component of tear film
Washes away the irritants and sloughed out
 surface cells
Contains some nutrients especially dissolved
 oxygen.
Disinfection by wash away, and bacteriostatic and
 bacteriocidal components i.e lactoferrin, lysozyme
 and immuniglobulins and a buffering prealbumin.
DISEASES OF LACRIMAL
GLAND
Dacryoadenitis ; mumps, influenza, infectious
 mononucleosis.
Mikulicz syndrome: lymphomatous
 inflammationof lac and parotid glands.
Tumours :pleomorphic adenoma; middle ages
 tumor, slowly progressive, painless swelling.
Dry eye.(Lac G atrophy, apalasia, exci, radiation)
 (Facial N, GSPN or sphenopalatine denervation)
 (systemic disease Sjogren, sarcoid, lymphoma,
 CTD and familial dysautinomia.)
Tests for dry eye.
Tear meniscus along lower lid margin less than
 0.1mm.
Mucous threads and particulate matter in tear
 film.
Filaments upon cornea
Schirmer test 1 less than 10mm (Normal 15 to
 25mm)
Basic tear sec less than 8mm (normal 8 to 15mm)
Tear film breakup time-less than 10 seconds.
Rose bengal stains red dead and decaying
 epithelium.
Diseases of lacrimal passages
Punctal stenosis.
Punctal eversion.
Canaliculitis
Dacryocystitis: acute and chronic.
Dacryolithiasis
INVESTIGATIONS FOR LAC.
PASSAGES
Punctal examination
Lid dynamics
Palpation of lac fossa & Regurgitation test
Dye disappearance test
Diagnostic probing and syringing
Jone’s dye tests
Contrast dacryocystography
Digital subtraction macrodacryocystography
Lacrimal scintillography
CONCEPT OF LACRIMATION AND
EPIPHORA
Lacrimation: Excessive reflex secretion leading to
 watering i.e weeping, conjunctivitis, keratitis,
 episcleritis and scleritis, uveitis, a c glaucoma.
Epiphora:
Obstructive and pump failure.
Punctal stenosis.
Congenital agenesis
Acquired; trachoma, HZO, S J synd, OCP,acid, alkali,
 thermal and radiational burns, concretion, FB,cilium,
 topical drugs(iud),5-FU.
Punctal dilation/one or two snip procedure
Punctal eversion
Malpositioned puncta. Visible without everting the
 lid. Punctal stenosis is also present.
Treatment: p. dilation and RPC or tarsoconjunctivo-
 plasty.
Ectropion repair may be required.
Acute dacryocystitis
Acute inflammation of sac or pericystic area
 leading to acute pain, swelling, redness and
 watering from the eye.
No interference like syringing,probing etc.
Broad spectrum antibiotic both systemic and
 local, analgesics, nsaid, hot fomentation until the
 acute phase resolves and DCR performed.
Chronic Dacryocystitis
Painless epiphora, fullness of lac fossa and
 pressure leads to regurgitation of purulent or
 muciod fluid.
Obstruction at the junction of sac and nld.
Nasal pathology may be the cause i.e polyp, inf
 turbinate hypertrophy, dns,etc.
Congenital ch dacryocystitis in Cong
 bnld.Probing at the age of one year.
DCR for those more than two years at the age of 4
 years. And for adults.
Lacrimal system
Lacrimal system
Lacrimal system
Lacrimal system

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Lacrimal system

  • 1.
  • 3. ANATOMY & PHYSIOLOGY BRIEF REVIEW Secretory and drainage parts. Lacrimal gland [orbital and palpebral parts] and accessory lac glands of Krause and Wolfring Seven to twelve ducts open in the supero temporal part pf bulbar conjunctiva. Streams running across the eye ball lead to a smaller meniscus along upper and another along the lower lid margin. Eye closure is from temporal to nasal side thus pushing the tears medially in lacus lacrimalis. Here starts drainage system.
  • 4.
  • 5.
  • 6. Anatomy Continued-------- Under basic and reflex control (secretomotor fibres from Saliv. N, N intermedius, before facial N genu into GSPN, through F. Lacerum and pterygoid canal joins Sphenopalatine G to synapse.) Post gang. join NV11, then zygomatico temporal and finally in Lacrimal nerve reach the gland substance. Basic sec from accessory lac glands and reflex from main lac glands 0.9 to 2.2uL/min. Cul-de-sac capa-30uL. Rate of tear sec more than 100uL/min tearing occurs.
  • 7. Drainage system Two punctae just medial to the cilia bearing area of the lids each leads to a canaliculus which runs nasally to unite as common canaliculius opening into Lac. Sac. Lodged in lac fossa and narrows inferiorly to naso lacrimal duct which opens in inferiopr meatus .
  • 8. FUNCTIONS: Main component of tear film Washes away the irritants and sloughed out surface cells Contains some nutrients especially dissolved oxygen. Disinfection by wash away, and bacteriostatic and bacteriocidal components i.e lactoferrin, lysozyme and immuniglobulins and a buffering prealbumin.
  • 9. DISEASES OF LACRIMAL GLAND Dacryoadenitis ; mumps, influenza, infectious mononucleosis. Mikulicz syndrome: lymphomatous inflammationof lac and parotid glands. Tumours :pleomorphic adenoma; middle ages tumor, slowly progressive, painless swelling. Dry eye.(Lac G atrophy, apalasia, exci, radiation) (Facial N, GSPN or sphenopalatine denervation) (systemic disease Sjogren, sarcoid, lymphoma, CTD and familial dysautinomia.)
  • 10. Tests for dry eye. Tear meniscus along lower lid margin less than 0.1mm. Mucous threads and particulate matter in tear film. Filaments upon cornea Schirmer test 1 less than 10mm (Normal 15 to 25mm) Basic tear sec less than 8mm (normal 8 to 15mm) Tear film breakup time-less than 10 seconds. Rose bengal stains red dead and decaying epithelium.
  • 11.
  • 12.
  • 13. Diseases of lacrimal passages Punctal stenosis. Punctal eversion. Canaliculitis Dacryocystitis: acute and chronic. Dacryolithiasis
  • 14. INVESTIGATIONS FOR LAC. PASSAGES Punctal examination Lid dynamics Palpation of lac fossa & Regurgitation test Dye disappearance test Diagnostic probing and syringing Jone’s dye tests Contrast dacryocystography Digital subtraction macrodacryocystography Lacrimal scintillography
  • 15.
  • 16.
  • 17.
  • 18.
  • 19. CONCEPT OF LACRIMATION AND EPIPHORA Lacrimation: Excessive reflex secretion leading to watering i.e weeping, conjunctivitis, keratitis, episcleritis and scleritis, uveitis, a c glaucoma. Epiphora: Obstructive and pump failure.
  • 20. Punctal stenosis. Congenital agenesis Acquired; trachoma, HZO, S J synd, OCP,acid, alkali, thermal and radiational burns, concretion, FB,cilium, topical drugs(iud),5-FU. Punctal dilation/one or two snip procedure
  • 21.
  • 22.
  • 23. Punctal eversion Malpositioned puncta. Visible without everting the lid. Punctal stenosis is also present. Treatment: p. dilation and RPC or tarsoconjunctivo- plasty. Ectropion repair may be required.
  • 24. Acute dacryocystitis Acute inflammation of sac or pericystic area leading to acute pain, swelling, redness and watering from the eye. No interference like syringing,probing etc. Broad spectrum antibiotic both systemic and local, analgesics, nsaid, hot fomentation until the acute phase resolves and DCR performed.
  • 25.
  • 26.
  • 27. Chronic Dacryocystitis Painless epiphora, fullness of lac fossa and pressure leads to regurgitation of purulent or muciod fluid. Obstruction at the junction of sac and nld. Nasal pathology may be the cause i.e polyp, inf turbinate hypertrophy, dns,etc. Congenital ch dacryocystitis in Cong bnld.Probing at the age of one year. DCR for those more than two years at the age of 4 years. And for adults.