Lacrimal system and dry eyes - pathology Flashcards

1
Q

Define canaliculitis:

A

An infection of the canaliculi which is most commonly due to acrinomyces israelii.

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2
Q

how does canaliculitis present?

A

Unilaterally, red eye with watering (epiphora) and discharge when pressure applied to the canaliculus.

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3
Q

How is canaliculitis managed?

A

With topical antibiotics

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4
Q

What is the name for idiopathic lacrimal gland inflammation?

A

Dacryoadenitis

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5
Q

What are the risk factors for dacryoadenitis?

A

Tear stasis
viral infections e.g. mumps
If bilateral suspect sarcoidosis

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6
Q

What symptom in dacryoadenitis should cause concern?

A

Paraesthesia persisting

May indicate tumour

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7
Q

List some of the features of dacryoadenitis?

A

painful, tender erythematous and swollen lacrimal gland
Disturbed tear production
S shaped ptsosis of the upper eyelid
Downward and inward displacement of the globe

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8
Q

Define dacryocystitis:

A

This is infection of the lacrimal sac due to an obstruction of the nasolacrimal duct.

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9
Q

What are the most likely causative organisms for dacryocystitis in adults and children?

A

Adults - Staph Aureus and S. epidermidis

Children - Haemophilus influenza and Strep pneumonia

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10
Q

How is dacryocystitis managed?

A

Acutely: Warm compress, systemic antibiotics
Chronic: dacryocystorhinostomy

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11
Q

What are the clinical features of dacryocystitis?

A

Erythematous tender swelling over the lacrimal sac
Epiphora
Unilateral, recurrent conjunctivitis

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12
Q

What is the most common tumour of the lacrimal gland and what age group does it mainly affect?

A

Pleomorphic adenoma
Middle aged patients.
Benign but has malignant potential

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13
Q

What is the histopathology of pleomorphic adenomas, and list its clinical features?

A

epithelial and mesenchymal components

Painless, progressive enlargement of the upper eyelid with inferonasal dystopia.

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14
Q

What investigations are appropriate for lacrimal tumours?

A

CT scan

Biopsy

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15
Q

What is a rare malignant tumour of the lacrimal gland/

A

Lacrimal gland carcinoma

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16
Q

What are the features of a lacrimal gland carcinoma?

A

Rapidly growing, optic disc swelling, inferonasal dystopia, choroidal folds and perineural invasion.

17
Q

Histologically, what might be seen in a lacrimal gland carcinoma?

A

Cribriform (swiss cheese) growth pattern

18
Q

How is a lacrimal gland carcinoma managed?

A

Surgical removal of the globe and surrounding tissue following biopsy.
Radiotherapy
Radical orbitectomy

19
Q

What is sjogrens syndrome?

A

An autoimmune condition in which the salivary and lacrimal glands become infiltrated with lymphocytes and the acini are progressively destroyed.

20
Q

What antibodies are found in Sjogren’s?

A

Anti-Ro and Anti-La

21
Q

What investigations are appropriate for Sjogren’s?

A

Antibodies
Schirmer test
Test tear film breakup time
Ocular staining

22
Q

What triad features are found in Sjogren’s?

A

Xerostomia
Keratoconjunctivitis sicca
Parotid gland enlargement

23
Q

List some other features of Sjogren’s:

A

Posterior blepharitis
Corneal punctate epithelial erosions
Strands of filaments of mucus and debris which stain with rose bengal

24
Q

How is Sjogren’s managed?

A
  • Ocular lubricants and artificial tears
  • Topical corticosteroids and/or pilocarpine orally
  • Punctal occlusion or low water content bandage contact lenses
25
Q

What causes xerophthalmia?

A

Severe Vit A deficiency

26
Q

What are the features of xerophthalmia?

A
Nyctalopia 
Xerosis
Bitot's spots
Punctate corneal epithelial erosions
Keratomalacia
27
Q

How is xerophthalmia managed?

A

Vitamin A supplement and topical lubrication

28
Q

Define nyctalopia:

A

Inability to see in dim light