The nasolacrimal drainage system serves as a conduit for tear flow from the external eye to the nasal cavity Tears drain into the upper and lower puncta upper and lower canaliculi common ID: 929516
Download Presentation The PPT/PDF document "LACRIMAL DRAINAGE SYSTEM" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
LACRIMAL DRAINAGE SYSTEM
Slide2The nasolacrimal drainage system serves as a conduit for tear flow from the external eye to the nasal cavity.Tears drain into the upper and lower
puncta
upper and lower canaliculi common canaliculus lacrimal sac lower canaliculus noseTear drainage is active processEach blink will pumps tears through the system
ANATOMY
Slide3Slide4ABNORMALITIES OF LACRIMAL SYSTEM
Abnormalities are found is
Tear composition
Drainage of tear
Slide5ABNORMALITIES IN COMPOSITION
AQUEOUS INSUFFICIENCY (DRY EYES)Deficiency of lacrimal secretion resulting in Keratoconjunctivitis sicca (KCS).If associated with dry mouth or mucous membrane = Sjogren’s SyndromeSymptomsGrittiness, burning, and photophobia
Lids heaviness and ocular fatigue. May worse in eveningVisual acuity may be reducedSignsSmall dots of fluorescence over exposed corneal & conjunctival surface.Tags of abnormal mucus may attach to cornea causing pain. (filamentary keratitis)TreatmentSupplementation of tears (artificial tear)
Humid environment around the eyes using shielded spectacles
Occlude the
puncta
with plug or surgery to conserve the tears
Slide6Slide7Slide8INADEQUATE MUCUS PRODUCTION
STEVENS-JOHNSON’S SYNDROMEAcute episodes inflammation causing macular target lesion on skin and discharging lesion on the eye, mouth and vulva.Causes conjunctival shrinkage with adhesion forming between the globe, aqueous and mucin deficiency. Similar symptoms to those seen in aqueous deficiency. XEROPHTHALMIAVit A Deficiency, causing childhood blindness on a worldwide scale.
Goblets cells are lost from the conjunctiva and ocular surface become keratinized.Aqueous deficiency causing dry eyes can lead to corneal ulceration and lastly blindnessBitot’s spot : clumps of keratin debris build up inside conjunctiva preceedes ulcerationPrevented by early treatment with vitamin A OTHER CAUSESChemical burns of the eyes by alkalis.
Trachoma causes by Chlamydial infection roughening the inner surface of the eyelid.
Slide9Slide10Slide11Slide12Slide13MALPOSITION OF EYELID MARGIN
Ectropion
or insufficient closure of eyes (7th nerve palsy or proptosis in dysthyroid eyes) preocular tear film cannot form adequeately dry eyes
TreatmentCorrection of lid deformity by LATERAL TARSHORRHAPHYIf temporary, use artificial tears and lubricantOr induced temporary ptosis by local injection of botulinum toxin
Slide14Slide15DISORDERS OF TEAR DRAINAGE
Tear production exceed the capacity of drainage system. It may caused by :
Irritation of ocular surface, e.g. by foreign bodyOcclusion of any part of drainage system.
OBSTRUCTION OF TEAR DRAINAGE
Nasolacrimal duct is common site for tear drainage system to get blocked.
Usually block by infection or direct trauma.
In
peadiatric
age, congenital obstruction of the duct is common at the distal end
watering eye
T
he sac may become infected accumulate as
mucocele
or causing
dacrocystitis
.
Conjunctiva is not inflamed.
Most obstruction resolved spontaneously in first year of life.
If
epiphora
persist, patency is achieved by passing probe via the
punctum
to open the obstruction.
Slide16SYMPTOMSWatering eyes associated with stickiness
Eye is white.
Symptoms may get worse during windy or cold weather SIGNSStenosed punctum may apparent on slit lamp examinationObstruction may diagnosed by syringing the nasolacrimal system with saline the system is patent if the patient taste the saline as it reached the pharynx.Injecting radio-opaque dye to confirmed the exact location into the nasolacrimal system. Then, X-rays is used to follow the passage of the dye until we find the blockage.
TREATMENTTreat the underlying cause such Blepharitis etc.SURGERY : Dacryocystorrhinostomy (DCR), connecting the mucosal surface of lacrimal sac to the nasal mucosa by removing the intervening bone.
Slide17Slide18Slide19Slide20Slide21INFECTION OF THE NASOLACRIMAL SYSTEM
DARCOCYSTITIS
Infection of the sac cause by obstruction of the drainage system.Organism involved usually Staphylococcus.Symptoms Painful swelling on medial side.Enlarged and infected sac.Could resulting in formation of mucoceleTreatmentSystemic antibioticDCR may be necessary to prevent recurrence.
Slide22Slide23