Lacrimal Drainage System

Question 1

Describe loc. of lacrimal sac, lac. gland, & where nasolacrimal duct opens into + puncta

Answer 1

lac. gland: lacrimal fossa in frontal bone
lac. sac: maxillary bone & lacrimal fossa
nasolacrimal duct opens into valve of Hasner
puncta: post. edge of lid margin

Question 2

Describe what forms the tear film

Answer 2

1. lipid layer: meibomian glands (-> stability & prevents evaporation)
2. aqueous layer: lacrimal gland, krause & Wolfring (acessory lac. glands) , cleanse surfac, provides smooth optic surface
3. muccin: goblet cells (smooth surface)

Question 3

Which examination methods are used in tear production and tear excretion?

Answer 3

Tear production
- Schirmer test (amount)
- Tear break-up time (stability)
- Fluorescein dye (konjunctival and corneal findings)
- Impression cytology

Tear excretion
- Fluorescein dye test (injected, known as jones test)
- Lacrimal lavage
- Dacryocystography
- Dacryosintigraphy

Question 4

Difference btw hypersecretion and epiphoria

Answer 4

hypersecretion d/t ocular inflammation or surface disease

epiphoria: defective drainage d/t comprimise of lacrimal drainage system (exacerbated by cold and windy atmosphere, least in a warm dry room)

Question 5

Which lacrimal gland tumor is the most common? + which worst px?

Answer 5

pleomorphic adenoma (most common, benign)
adenoic cystic ca (worst px)

Question 6

What is keratoconjunctivitis sicca associated with?

Answer 6

-insufficient wetting of cornea & conjunctiva
- 40-50 y.o. women (menopause), environm.
- romatoid disease (sjorgen’s disease, RA)
- A vit. def., medication (OC, retinoids)

Question 7

Symptoms and Tx of KCS

Answer 7

symptoms:
-Burning, redness, tearing, foreign body sensation
- Symptoms and signs are incomperable
- Schirmer <10 mm, FBUT <10 sec

Tx:
. Artificial tear drops
- Punctal plugs
- Evaluate medication hx, enviromental conditions
- Good px, no certain th

Question 8

What is dacrocystitis; ddx; symptoms; tx?

Answer 8

Dacrocystitis ➜ Lakrimal sak’ın enfeksiyonudur. Staf ve Strepler suçludur. Akut fazda tanısal test yoktur. Sıcak uygulama ve oral Ax. Kurcalanmamalıdır, sıkılmamaılıdır. Çocuklarda hastaneye yatış gerektirir, erkişkinlerde genelde gerektirmez. Ateş yapmaz,
çok ağrılıdır, tedavi sistemiktir. Kronikse dakriosistorinostomi ile kese burna ağızlaştırılır.

Ayırıcı Tanısı
➢ Primer punctal stenosis
➢ Secondary punctal stenosis
➢ Canalicular obstruction
➢ Nasolacrimal duct obstruction
➢ Dacrolithiasis
➢ Kronik dakrosistit
➢ Akut dakroadenit
√ Lakrimal gland enfeksiyonu (mumps, EBV), rüptüre dermoid kisti, malignant lakrimal gland tümörü (karsinom)
➢ Kronik dakroadenit
➢ Kanallikulit
➢ Lakrimal sac tümörü

• Semptomları
  ➢ Lakrimal sac’in enfeksiyonudur. Stafilokokkal/streptokokkal olabilir
  ➢ Akut gelişir, 50-60 yaşlarında daha çok
  ➢ Ağrı, diffüz swelling, redness, epiphora, abse, fistül
  ➢ Çoğunlukla nazolakrimal duct’ın obstrüksiyonuna sekonder gelişir.
• Tedavisi
  ➢ Hot pads
  ➢ Per oral antibiotics

chronic is painless (caused by mucocele): tx with DCR

Question 9

Nasolacrimal Duct Obstrüksiyonu; bebek doğduğunda medial canthus inferiorunda
mavi kabarıklık varmış. Sonradan şişmiş, preseptal selülit olmuş; Dx, complications, tx, İlk başlarda çapaklanıyorken tedavisi neydi?, Çocuk 2 yaşına geldi, göz sulanması devam ediyor. Ne yaparsın?

Answer 9

Tanın nedir?
➢ Nasolacrimal duct obstrüksiyonu?

Komplikasyonları nedir?
➢ Orbital selülit
➢ Apse
➢ Kavernöz sinüs tutulumu
➢ Menenjit

Tedavisi
➢ Drainage
İlk başlarda çapaklanıyorken tedavisi neydi?
➢ Masaj yap
➢ aX Damla
➢ Göz hijyenine dikkat

Çocuk 2 yaşına geldi, göz sulanması devam ediyor. Ne yaparsın?
➢ Probing of the lacrimal duct under general anesthesia (done here, but delayed until 12-18 moths)
➢ İki başarısız probing sonrası: temporary intubation with fine silastatic tubes w
or w/o baloon dilataton of the nasolacrimal duct may effect a cure
➢ En son ihtimal DCR=dacrocystorhinostomy (btw. ages of 3 & 4)

Question 10

What to do in congenital dacryocele?+ what is it?

Answer 10

it is:
collection of amniotic fluid or mucus in lacrimal sac caused by imperforate hasner valve

bluish cystic swelling at or below the medial canthal area

a tense lacrimal sac initially filled with mucus and secondarily infected

tx: conservative but probing should not be delayed

Question 11

How is dacryolithiasis treated?

Answer 11

DCR (dacrocystorhinostomy)