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Duke Elder exam > Lacrimal system > Flashcards

Lacrimal system Flashcards

(67 cards)

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1
Q

3 layers of the tear film

A

lipid (superficial)
aqueous
mucous (deep)

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2
Q

source of lipid, aqueous and mucus tear films

A 
lipid = meibomian glands
aqueous = lacrimal gland 
mucuous = conjunctival goblet cells
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3
Q

function of lipid tear film

A

prevent acqueous layer evaporation

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4
Q

function of aqueous tear film

A

antibacterial activity, washing out debris and suppying cornea with nutrients

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5
Q

function of mucous tear film

A

aids in spreading tears and stabilising tear film

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6
Q

thickness of lipid, aqueous and mucous tear film

A 
lipid = 0.1 um 
aqueous = 7.0 um 
mucus = 0.2 um
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7
Q

pathway of the lacrimal system

A

lacrimal gland - puncta - canaliculi - lacrimal sac - nasolacrimal duct - inferior nasal meatus

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8
Q

structure of lacrimal gland

A

tubule-alveolar gland with acini and ducts - 2 parts:

  • orbital (in frontal bone)
  • palpebral (superiorlaterally in eyelids inferior to levator palpebrae muscle)
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9
Q

function of lacrimal gland

A

forms aqueous layer of tear film

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10
Q

blood supply to lacrimal gland

A

lacrimal artery - branch of ophthalmic artery

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11
Q

sensory nerve supply to lacrimal gland

A

lacrimal nerve (CNVI)

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12
Q

parasympathetic secretomotor nerve supply to lacrimal gland

A

CNVII - pathway = preganglionic parasympathetic fibres originate from superior salivatory nucleus in the pons and travel with greater petrosal nerve (branch of CNVII) to synapse at pterygopalatine junction - postganglionic fibres then joins the lacrimal branch of CNV1 to supply lacrimal gland

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13
Q

afferent and efferent nerves for lacrimal reflex

A 
afferent = CNVI
efferent = CNVII
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14
Q

what do the accessory lacrimal glands do

A

sustain the basal secretory level of the aqueous layer of the tear film

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15
Q

2 types of accessory lacrimal glands

A

Krause glands - adjacent to conjunctival fornix, more numerous in upper eyelid

Wolfring glands - in upper border of tarsal plate, larger than Krause glands

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16
Q

what are puncta

A

small round opening located medially at the posterior edge of the upper and lower lid margins at the junction of the lid’s ciliated and non-ciliated parts

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17
Q

what are the superior and inferior canaliculi comprised of

A 
vertical part (ampulla - 2mm long) 
horizontal part (8mm long)
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18
Q

where do the superior and inferior canaliculi join together

A

common canaliculus

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19
Q

what does the junction of the lacrimal sac and common canaliculus contain

A

Rosenmuller valve - importnat in preventing tear reflux

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20
Q

where is the lacrimal sac located

A

lacrimal fossa - formed by lacrimal bone and frontal process of the maxilla

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21
Q

what is the nasolacrimal duct

A

continuation of the lacrimal sac, opens into the inferior meatus in the nose

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22
Q

what does the opening of the nasolacrimal duct contain

A

fold of mucus - valve of Hasner - prevents air entering the nasolacrimal system during nose blowing

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23
Q

main PC of acquired lacrimal duct obstruction

A

epiphora (excessive watering of eye)

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24
Q

2 causes of acquired lacrimal obstruction

A 
punctal stenosis (idiopathic or chronic blepharitis) 
nasolacrimal obstruction (idiopathic, trauma, surgery or tumours)
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25
treatment for punctal stenosis
punctoplasty
26
treatment for nasolacrimal obstruction
dacryocystorhinostomy (anastomosis of lacrimal sac with mucosa of middle meatus)
27
where is congenital nasolacrimal duct obstruction usually located
at valve of Hasner
28
2 features of congenital nasolacrimal duct obstruction
epiphora | mucopurulent discharge on pressure over lacrimal sac
29
first, second and third line treatments for congenital nasolacrimal duct obstruction
first = observation and massaging of the lacrimal sac for the first 12 months of life second = nasolacrimal duct probing third = nasolacrimal duct stent insertion, balloon dilatation or dacryocystorhinostomy
30
what is canaliculitis
infection of canaliculi - most commonly due to Actinomyces israelii
31
3 features of canaliculitis
epiphora red eye discharge on pressure over the canaliculus
32
management of canaliuclitis
topical Abx
33
what is dacryoadenitis
idiopathic lacrimal gland inflammation
34
main risk factor for dacryoadenitis
tear stasis, secondary causes include viral infections e.g. mumps
35
potential cause of bilateral dacryoadenitis
sarcoidosis
36
potential cause of persistence/presence of paraesthesia with dacryoadenitis
carcinoma
37
4 features of dacryoadenitis
painful/tender/red/swollen lacrimal gland (superolateral upper eyelid) disturbed tear production s-shaped ptosis of upper eyelid downward and inward displacement of the globa
38
what is dacryocystitis
infection of lacrimal sac due to obstruction in nasolacrimal duct
39
4 bacteria causing bacryocystitis
s. aureus s. epidermidis (adults) s. pneumoniae h. influenzae (children)
40
features of acute dacryocystitis
erythematous tender swelling over lacrimal sac with associated epiphora
41
management of acute dacryocystitis
warm compresses, systemic abx and dacryocystorhinostomy after the acute phase has completely resolved
42
features of chronic dacryocystitis
epiphora and recurrent unilateral conjunctivitis
43
management of chronic dacryocystitis
dacryocystorhinostomy
44
most common lacrimal gland tumour
pleomorphic adenoma of lacrimal gland (benign but can transform to malignant)
45
featrures of pleomorphic adenoma of lacrimal gland
progressive painless enlargement of upper eyelid with inferonasal dystopia
46
investigation and treatment of pleomorphic adenoma of lacrimal gland
CT | surgery
47
main type of lacrimal gland carcinoma
adenoid cystic carcinoma
48
histopathology of adenoid cystic carcinoma
cribriform ('Swiss cheese') growth pattern
49
2 other types of lacrimal gland carcinoma
pleomorphic adenocarinoma | mucoepidermoid carcinoma
50
5 features of lacrimal gland carcinoma
``` rapidly growing and painful lacrimal gland mass inferonasal dystopia optic disc swelling choroidal folds perineural invasion? ```
51
what is perineural invasion
spreading of a cancer around a nerve - causing a neurological deficit
52
4 ways to manage lacrimal gland carcinoma
biopsy orbital exenteration (surgical removal of globe and surrounding tissue) radical orbitectomy radiotherapy
53
what is Sjogren syndrome
autoimmune condition - salivary and lacrimal glands become infiltrated with lymphocytes and acini are progressively destroyed
54
triad of features of Sjogren syndrome
xerostomia keratoconjunctivitis sicca parotid gland enlargement
55
other condition commonly present with Sjogren syndrome
posterior blepharitis
56
type of erosions in Sjogren syndrome
corneal punctate epithelial erosions (stains with fluorescein)
57
4 investigations for Sjogren syndrome
anti-Ro and anti-La antibodies reduced tear film breakup time Schirmer test ocular staining
58
what does the schirmer test do
determines whether the eye produces enough tears to keep it moist
59
what does ocular staining show in Sjogren syndrome
interpalpebral staining of cornea and conjunctiva, rather than a superior or inferior stain pattern (seen in superior limbic keratoconjunctivitis or exposure keratopathy respectively)
60
first line treatment of Sjogren syndrome
ocular lubricants and artificial tears - including hypromellose (lowest viscosity) carbomer and paraffins (highest viscosity)
61
second line treatment of Sjogren syndrome
topical corticosteroids and/or oral pilocarpine (increases lacriaml gland secretion)
62
third line treatment of Sjogren syndrome
punctal occlusion or low-water content bandage contact lenses (e.g. silicone hydrogel)
63
what is xerophthalmia caused by
severe vitamin A deficiency
64
5 features of xerophthalmia
``` nyctalopia xerosis Bitot's spots punctate corneal epithelial erosions keratomalacia in severe cases ```
65
what is xerosis
severe conjunctival dryness and keratinization
66
what are Bitot's spots
triangular keratinized build up on the conjunctiva
67
management of xerophthalmia
vit A supplementation and topical lubrication

Duke Elder exam (5 decks)

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