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Epiphora
1. P R E S E N T E R : S U R E N D R A P R A S A D S A H
M . O P T O M ( 2 N D S E M )
( 1 6 / 0 3 / 2 0 1 5 )
Epiphora
1
Epiphora ,s.sah 3/16/2015
2. Epiphora implies to overflowing of tears due to impairment
lacrimal drainage.
OR
due to a disruption in the balance between tear production
and tear loss.
2
Epiphora ,s.sah 3/16/2015
7. Eyelids
Horizontal laxity and floppy lids
Lower lid entropion with orb.oculi overriding
Lower lid ectropion with ineffective orb.oculi
Loss of skin / orbicularis
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Epiphora ,s.sah 3/16/2015
18. Functional tests
To access functioning of lacrimal apparatus under
physiologic conditions
Performed only when there is no evidence of
obstruction in anatomical tests
Flourescein dye disappearance test
Jones dye test (jones primary and secondary )
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Epiphora ,s.sah 3/16/2015
21. Eyelids
Treatment of the cause
Ectropion surgery.
Tarsorraphy
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Epiphora ,s.sah 3/16/2015
22. Punctal Causes
Dilation of punctum
Punctoplasty
Ziegler cautery
Medial conjunctivoplasty
Lower lid tightening
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Epiphora ,s.sah 3/16/2015
23. Canaliculi
Depends on the site and degree of obstruction
Intubation
Anastomosis of the patent part of the canaliculus
into the lacrimal sac and intubation
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Epiphora ,s.sah 3/16/2015
24. Nasolacrimal duct
Massage of the lacrimal sac increases the hydrostatic
pressure and may rupture membranous obstruction
Probing of the lacrimal system
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Epiphora ,s.sah 3/16/2015
25. Lacrimal surgery
Dacryocystorhinostomy (DCR)
Indicated for obstruction beyond the medial opening of the
common canaliculus
Anastomosing the lacrimal sac to the nasal mucosa of the
middle nasal meatus
Procedure is performd under general hypotensive
anaesthesia
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Epiphora ,s.sah 3/16/2015
27. Conclusion
Diagnosis of the condition and ruling out the cause is
important.
Treatment of the cause will depend on the cause of
watering.
Optometrist should treat the causes to anterior
segment disease.
Cases requiring surgery should be referred to
ophthalmologist.
Cases of systemic disease should be referred to
physician.
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Epiphora ,s.sah 3/16/2015
28. References
3/16/2015Epiphora ,s.sah
28
Books
Thimothy L. Jackson Moorfields manual of
ophthalmology ,1:212-228
Mark W Leitman Manual for eye examination
and diagnosis.7th ed.
Ak khurana Comprehensive Ophthalmology
5th ed, 1 :271 :302
Kanski J Jack Clinical ophthalmology a
systematic approach 2011,7th ed,1: 151-172