LACRIMAL SYSTEM -- DISORDER AND INFX Flashcards
(24 cards)
what is nasal lacrimal duct obstruction (NLDO)?
- It is obstruction of the nasolacrimal duct.
what are the 2 types of NLDO? whate
- Congenital – caused by membranous blockage at the valve of Hasner.
- Acquired (older pts) – caused by involutional stenosis.
symptoms of NLDO?
- Unilateral epiphora (tearing).
- Crusting
- Recurrent conjunctivitis
- No-to-mild redness or tenderness around the puncta.
signs of NLDO?
- Mucous reflex from puncta after compression of the lacrimal sac
- Medial lower eyelid erythema (red)
w/u for NLDO?
- jones tests – to determine whether or not the nasolacrimal duct is blocked
Tx for NLDO?
- congenital NLDO – spontaneously resolves by the child’s 1st bday. If it does not then nasolacrimal duct probing may be needed to clear blockage.
- Acquired NLDO– obstruction may be clear with dilation and irrigation. If not then rx abx/steroid combo. In severe cases, surgery is required (dacryoplasty, dacryocystorhinostomy, silicone intubation).
what is canaliculitis?
- It is inflammation of the canaliculi that can be caused by bacterial, viral, fungal infections.
what bacteria is the most common cause of canaliculitis
actinomyces Israelii (gram +)
symptoms of canaliculitis
- Medial eyelid/puncta tenderness
- epiphora
signs of canaliculitis
- Unilateral epiphora
- Pouting punctum (red, swollen, rolled away from globe punctum)
- Dacryoliths (solid yellow sulfur granules) upon palpation of the lacrimal sac area.
tx for canaliculitis
- Remove concretion obstruction via expression first –> then perform irrigation of the canaliculi w/ abx solution 00> then rx oral antibiotics
- In cases that do not respond to tx, surgery is required – Canaliculotomy – removal of posterior wall of the cacaliculi.
- F/U every 5-7 days
what is
DACRYOCYSTITIS
- It is infection of the lacrimal sac 2/2 to nasolacrimal duct obstruction.
how does one get affected with DACRYOCYSTITIS
- Backflow of bacteria from the nasolacrimal duct into the lacrimal sac due to an obstruction of the lacrimal drainage system (ex. NLDO)
what bacteria are involved in DACRYOCYSTITIS
adult – streptococcus pneumoniae
children – H. influenza
symptoms of DACRYOCYSTITIS
- Pain/tender medial eyelid
- Crusting
- unilateral epiphora
- Possible fever
signs of DACRYOCYSTITIS
- Red, swollen, tender lacrimal sac.
- Possible fever
- mucopurulent discharge upon palpation
tx for DACRYOCYSTITIS
- DONT PROB IN ACUTE INFX – may spread infx more
- Rx oral or IV abx depending on severity
- if conjunctivitis present – rx topical abx
- Dacryocystorhinostomy (DCR) – ONLY once infection has resolved!
- f/u daily
what is DACRYOADENITIS
It is inflammation of the lacrimal gland.
what are the 2 types DACRYOADENITIS
- acute – viral or bacterial infx
- chronic – inflammatory disorder
what are the bacteria and virus involved in DACRYOADENITIS
Bacteria: Staph aureus (most common)
Viral: Mumps / Mononucleosis / Influenza /HZV
what are the inflammatory conditions involved in DACRYOADENITIS
Sarcoidosis
Tuberculosis
Graves disease
Idiopathic orbital inflammation
symptoms for DACRYOADENITIS
- Temporal eyelid swelling (near lacrimal gland)
- Pain
- Tenderness
- Discharge possible
- Warmth
signs of
DACRYOADENITIS
- Classical S-shape ptosis
- Temporal upper eyelid pain, redness, and swelling
ACUTE:
* Fever + Preauricular lymphadenopathy
* Elevated WBC
CHRONIC:
* EOMS restriction
tx for DACRYOADENITIS
acute – oral or IV meds depending on suspected bacterial or viral etiology
chronic – identify and tx underlying inflammatory disorder
