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BOARDS2: conjuntiva/cornea > Epiphora > Flashcards

Epiphora Flashcards

(46 cards)

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1
Q

Whic of these is most likely associated with NLDO?
A. Rhinitis
B. Schirmer 1 < 5mm
C. Increased lid laxity
D. Negative jones 1
E. Swelling below medial canthus tendon
F. Expression of sulfur granules from canaliculi

A

D. Negative jones 1

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2
Q

What is the treatment for NLDO?

A

DCR

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3
Q

What results in the “wrinkle sign” during nasolacrimal probing

A

Canaliculitis

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4
Q

Signs and symptoms of NLDO

A

Chronic, unilateral tearing with no other signs of ocular infection, irritation, or other abnormality.

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5
Q

Things that cause decreased tear drainage

A

Ectropion
Punctal malposition or stenosis
Problems with lacrimal sac

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6
Q

What tests are done to determine NLDO

A

Jones 1 and 2

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7
Q

DiffDx for epiphora with mild to no associated pain

A 
NLDO
DED
Blepharitis 
Punctal pathology 
Conjunctivitis (allergic and toxic)
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8
Q

DiffDx for epiphora with moderate to severe pain

A

Corneal pathology ( abrasion, RCE, FB, rust ring, etc)
Anterior uveitis
Dacryocystitis
Entropion with trichiasis

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9
Q

Infection or inflammation of the lacrimal sac that commonly occurs due to an obstruction of the nasolacrimal system, leading to bacteria within the tears infecting the lacrimal sac

A

Dacryocystitis

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10
Q

Signs and symptoms of dacryocystitis

A 
Pain 
Epiphora
Crusting
Occasional fever
Prominent edema and tendering of the lacrimal sac BELOW the medial canthal tendon
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11
Q

Swelling above the medial canthal tendon

A

Lacrimal sac tumor

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12
Q

Inflammation and infection of the canaliculi that may be caused by bacterial, fungal or viral pathologies.

A

Canaliculus

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13
Q

Signs and symptoms of canaliculitis

A

Epiphora
Mild tenderness/pain on the nasal portion of the eyelids
A tender, swollen puncta (pouting puncta)
Mucopurulent discharge upon expression of lacrimal sac
Unilateral, smoldering red eye that has been misdiagnosed as “recurrent conjunctivitis” that is resistant to topical ophthalmic Abx treatment

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14
Q

Version of the eyelid margin away from the globe of the eye, resulting in epiphora.

A

Ectropion

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15
Q

Results in ocular irritation that can lead to subsequent reflex bilateral tearing and epiphora

A

DED

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16
Q

Signs and symptoms of DED

A

Bilateral tearing and epiphora
decreased TBUT
Thin lacrimal lake
Corneal and/or conjunctival staining

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17
Q

Allergic conjunctivitis is what kind of HS reaction

A

Type 1

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18
Q

Signs and symptoms of allergic conjunctivitis

A

Epiphora associated with moderate to severe itching, conjunctival chemosis, and papillae

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19
Q

Cause of congenital NLDO

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A

Blocked valve of hasner

  • 20% of newborns have this
  • only 5% are symptomatic
  • persistent epiphora
20
Q

When does opening of the valve of hasner occur

Study These Flashcards
A

Spontaneous opening occurs 1-2 months after birth, and 96% of cases resolve by 1 year of age

21
Q

If valve of hasner does not spontaneously open

Study These Flashcards
A

Digital massage can be performed 2-4x/day. The superior and inferior puncta are occluded with an index finger, followed by a genital downward massage over the lacrimal sac and the NLD. The majority of cases response to the massage technique

22
Q

In babies, if the NLDO does not spontaneously resolve or respond to the digital massage technique by 13 months of age or older,

Study These Flashcards
A

nasolacrimal duct probing is indicated

23
Q

At what age should a baby have nasolacrimal duct probing to open the valve of hasner

Study These Flashcards
A

13 months of age

24
Q

The order of treatment for congential NLDO

Study These Flashcards
A

Wait
Massage
Probe
DCR

25
What is indicated for babies with congential NLDO that do not respond to digital massage or NLD probing
DCR
26
What is common for babies to get if they have congential NLDO
Secondary dacryocystitis | - due to stagnant tears in the lacrimal sac.
27
When should you NOT do NLD probing for a baby with congential NLDO
If active infection is present
28
Most common causes of acquired NLDO
``` Involutional stenosis in older ages Additional -infectious (dacryocystitis) -inflammatory (chronic sinus disease) -neoplastic -mechanical sources ```
29
Most common causes of dacryocystitis
Staph aureus Staph epi Pseudomonas H. Flu in children
30
Most common causes of canaliculitis
``` Actinomyces Israelii (Streptothrix) -yellow sulfur granules on expression ``` Additional - staph aureus - candida albicans - aspergillus - nocardia - herpes simplex - herpes zoster - surgery, trauma, neoplastic disorders
31
Most common causes of ectropion
``` Age related (involutional, due to loss of muscle tone within the orbicularis oculi) Additional - paralytic (facial palsy, etc) -mechanical (eyelid edema, tumor, etc) -cicatricial (scarring) -congenital (rare) ```
32
Jones 1 testing
- Evaluates patency of nasolacrimal system | - NaFL and 5m
33
Positive jones 1
Patent nasolacrimal drainage system | Presence of NaFL in the back of the patient’s throat, or by having the patient blow nose and see NaFL on tissue
34
Negative jones 1
Indicates nasolacrimal system is obstructed | Absence of NaFL on tissue or back of throat after 5m
35
Jones 2 test
Performed after a negative jones 1 | Irrigation of the nasaloacrimal system with saline to determine the location of the blockage
36
How do you know the blockage has been cleared on jones 2
Patient tastes saline, gags, or fluid recovered from nose
37
Reflex of saline from same punctum in jones 2
Obstruction within the canaliculus
38
Reflex of saline from the opposite punctum
Nasolacrimal blockage
39
If the jones 2 test fails to remove the obstruction within the nasolacrimal system
DCR needed
40
DED testing
``` Schirmer 1: <15mm in 5m Schirmer 2: <5mm wetting in 5m TBUT <10s Decreased findings on phenol red thread Lissamine green staining (inferior and at 3 and 9 o’clock) Variable corneal staining with NaFL ```
41
Involutional ectropion testing
Snap back test - should return immediately - the longer the lid takes to return to normal, the greater the lid laxity
42
What is a DCR
Creates an anastomoses between the nasal cavity and the lacrimal sac, allowing tears to drain around the obstruction in the NLD
43
Main treatments for DED
AT Qday-QID PFAT 4-8x day Lubricating ointment at night Restasis
44
Treatment for involutional ectropion
Surgically | Due to horixaontlal I’d laxity, which can be corrected with a lateral tarsal strip procedure
45
Treatment for dacryocystitis
Augmentin 500mg PO TID x 10 days | -if allergic to PCN: bactrim 1 double strength tablet PO BID x 10 days
46
Treatment for canaliculitis
Canalicular irrigation with PCN G 100,00 U/mL | Systemic abx: PCN V 500mg PO QID x 7 days

BOARDS2: conjuntiva/cornea (7 decks)

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