DISEASES OF THE LACRIMAL SYSTEM Dr Ayesha S

DISEASES OF THE LACRIMAL SYSTEM Dr. Ayesha S. Abdullah 07. 10. 2017

Learning Outcomes By the end of this class the students would be able to � Outline the clinical evaluation protocol for a patient presenting with epiphora � Differentiate between the various common conditions leading to watery eyes in children and adults � Diagnose a case of acute and chronic dacrocystitis, recommend management plan for such a patient and list possible complications

Watery Eyes- Differential Diagnosis Increased productionlacrimation Lids Conjunctiva Decreased Drainage Trauma Entropion Dry eyes Trichiasis Conjunctivitis Blepharitis Cong. Glaucoma Large eyes. Buophthalmos, hazy cornea Allergic-Itchy, seasonal, papillae Bacterial-purulent discharge, papillae Viral – watery discharge, follicles, LN Pump Failure Malposition Ectropion Facial Palsy Lacrimal Obstruction/ Blockage

Lacrimal Obstruction/ Blockage Congenital- Punctal Obst atresia/ Stenosis Acquired. Stenosis, scarring Lacrimal Sac Obst Granulomas Tumours- Primary & secondary Lymphoma Nasolacrimal Duct Obst Congenital Traumatic Nasal Pathology- Inflammation/ polyps Tumours Post-irradiation fibrosis Canalicular Obst. Fibrosis (infections; HSV, Actinomyces, 5 - FU) Chronic Dacrocystitis

Blockage �Punctal examination �Regurge test �Lacirmal Sac Wash

Blockage- Lac sac wash

Organize The Photographs In Correct Sequence A C B D

Lacrimal Massage

Chronic Dacrocystitis � Chronic inflammation secondary to NLD blockage � Symptoms � Long history of epiphora and intermittent eye discharge � Painless swelling along the side of the nose at the medial canthus. � Signs � Mucocoele � Regurge test is positive � Irrigation of the sac reveals the site of obstruction at NLD � DCR is the treatment Conventional Open technique Endoscopic DCR

Positive regurge

CDC

Complications

Complications

DCR

Acute Dacrocystitis � Symptoms � Acute or subacute onset of pain in the medical canthal area along the side of the nose with swelling and redness � Past history of watery eyes/ discharge � If the infection is severe the person may present with pre-septal cellulitis � Signs � Tender, red, hot swelling at the medial canthal area � Regurgre test should not be attempted

Acute Dacrocystitis �Treatment �NO PROBING & IRRIGATION �Antobiotics �NSAIDs �Warm compresses �DCR after the acute episode settles �An abscess may require drainage

DACROADENITIS