LACRIMAL LACRIMAL APPARATUSAPPARATUS

Lacrimal ApparatusLacrimal Apparatus

►Secretary portion : Lacrimal GlandSecretary portion : Lacrimal Gland►Lacrimal Passage: Puncta]Lacrimal Passage: Puncta]

CannaliculiCannaliculi

Lacrimal SacLacrimal Sac

Naso Lacrimal DuctNaso Lacrimal Duct

Lacrimal ApparatusLacrimal Apparatus

Functions of TearFunctions of Tear►Washing away of Foreign BodiesWashing away of Foreign Bodies►keeps Cornea Moistkeeps Cornea Moist►Bacteriostatic Action : Lyzozyme Bacteriostatic Action : Lyzozyme

enzymeenzyme

Lacrimal ApparatusLacrimal Apparatus

►Lacrimation – Increased Secretion of tearLacrimation – Increased Secretion of tearPsychogenicPsychogenicIrritation of EyeIrritation of EyeOcular InflammationOcular Inflammation

►Epipora- Overflowing of tears due to Epipora- Overflowing of tears due to obstruction in lacrimal passageobstruction in lacrimal passageEctropion, Occlusion of punctaEctropion, Occlusion of punctaObstruction of NLDObstruction of NLD

Chronic DacryocystitisChronic Dacryocystitis

►Chronic inflammation of Lacrimal SacChronic inflammation of Lacrimal Sac►Exciting Factor- NLD ObstructionExciting Factor- NLD Obstruction►Aetiology- Spread of Infection from Aetiology- Spread of Infection from

nosenose

- Nasal Polyp/ DNS- Nasal Polyp/ DNS

- Fracture Maxilla- Fracture Maxilla►Organisms- Staph, Strepto, PneumoOrganisms- Staph, Strepto, Pneumo

Chronic DacryocystitisChronic Dacryocystitis

►Symptoms – Watering of the eyeSymptoms – Watering of the eye►Signs- Swelling at the region of sacSigns- Swelling at the region of sac

Regurgitation of mucopus on Regurgitation of mucopus on pressure pressure over sac over sac

Congestion in caruncle regionCongestion in caruncle region

Chronic DacryocystitisChronic Dacryocystitis

► InvestigationInvestigation

- Sac syringing- Mucopurulent - Sac syringing- Mucopurulent regurgitation from upper regurgitation from upper

punctumpunctum

- Dacryocystography- Dacryocystography

- MDCG- MDCG

-Dacryoscintigraphy-Dacryoscintigraphy

Chronic DacryocystitisChronic Dacryocystitis

►ComplicationsComplications

-Acute Dacryocystitis-Acute Dacryocystitis

-Chronic Conjunctivitis-Chronic Conjunctivitis

-Hypopyon Corneal Ulcer -Hypopyon Corneal Ulcer

Chronic DacryocystitisChronic Dacryocystitis

►Treatment- Always SurgicalTreatment- Always Surgical

DacrycystorhinostomyDacrycystorhinostomy

DacryocystectomyDacryocystectomy

Acute DacryocystitisAcute Dacryocystitis

►Suppurative Inflammation of Lacrimal Suppurative Inflammation of Lacrimal Sac and pericystic tissueSac and pericystic tissue

►Aetiology- Chronic DacryocystitisAetiology- Chronic Dacryocystitis

Penetrating Injury of Penetrating Injury of Lacrimal Lacrimal Sac Sac

Acute DacryocystitisAcute Dacryocystitis

►Clinical FeaturesClinical Features

- Tender swelling in the region of sac- Tender swelling in the region of sac

- Skin over swelling is red- Skin over swelling is red

- Systemic features like Fever- Systemic features like Fever

Acute DacryocystitisAcute Dacryocystitis

►ComplicationsComplications

Lacrimal abscessLacrimal abscess

lacrimal Fistulalacrimal Fistula

Chronic DacryocystitisChronic Dacryocystitis

Orbital CellulitisOrbital Cellulitis

Acute DacryocystitisAcute Dacryocystitis

►TreatmentTreatment

Systemic AntibioticsSystemic Antibiotics

Anti inflammatory DrugsAnti inflammatory Drugs

Hot CompressesHot Compresses

If pus points- I & DIf pus points- I & D

Once inflammation subsides DCR Once inflammation subsides DCR after after four weeks intervalfour weeks interval

Congenital Congenital DacryostenosisDacryostenosis

► Also known as congenital DacryocystitisAlso known as congenital Dacryocystitis► Aetiology – non canalization of naso Aetiology – non canalization of naso

lacrimal duct lacrimal duct

► Clinical features- WateringClinical features- Watering-Matting of Eye lashes-Matting of Eye lashes

-Regurgitation on -Regurgitation on pressure pressure over sacover sac

Congenital Congenital DacryostenosisDacryostenosis

►Differential DiagnosisDifferential Diagnosis

Congenital GlaucomaCongenital Glaucoma

Ophthalmia NeonatorumOphthalmia Neonatorum

Congenital Congenital DacryostenosisDacryostenosis

►TreatmentTreatment

Sac MassageSac Massage

Topical antibioticsTopical antibiotics

Probing -If No relief in 2-3 monthsProbing -If No relief in 2-3 monthsDCR - If Repeated probing DCR - If Repeated probing

failsfails

DacryoadenitisDacryoadenitis

► Inflammation of Lacrimal GlandInflammation of Lacrimal Gland►Two types -AcuteTwo types -Acute

ChronicChronic

DacryoadenitisDacryoadenitis

►Common in childrenCommon in children►Following viral infections – Mumps Following viral infections – Mumps

Measles and Infectious mononucleosisMeasles and Infectious mononucleosis►Clinical Features – Clinical Features –

Swelling of Lateral part of lid – Swelling of Lateral part of lid – S shaped ptosisS shaped ptosisdiplopiadiplopia

►May form an abscessMay form an abscess

DacryoadenitisDacryoadenitis

►TreatmentTreatment

Systemic AntibioticsSystemic Antibiotics

Anti inflammatory DrugsAnti inflammatory Drugs

Chronic DacryoadenitisChronic Dacryoadenitis

►Usually blilateralUsually blilateral►Aetiology – Granulomatous InfectionAetiology – Granulomatous Infection

TuberculosisTuberculosis

SarcoidosisSarcoidosis►Treatment – Anti infalmmatory DrugsTreatment – Anti infalmmatory Drugs

Treatment of causeTreatment of cause

Complication – Dry EyeComplication – Dry Eye

LIDSLIDS

►Functions of LidsFunctions of Lids

Protects the globeProtects the globe

Wetting of corneaWetting of cornea

LIDSLIDS

►Anatomy-Anatomy-►Four Layers- SkinFour Layers- Skin

Muscular LayerMuscular Layer

TarsusTarsus

ConjunctivitisConjunctivitis►Skin is thin, devoid of subcutaneous Skin is thin, devoid of subcutaneous

fatfat

non hair bearingnon hair bearing

LIDSLIDS

►Hair at eyelid margin are highly modified Hair at eyelid margin are highly modified and arranged in 2-3 rows called as ciliaand arranged in 2-3 rows called as cilia

►Glands- Sweat Galnds- Molls GlandGlands- Sweat Galnds- Molls Gland

Sebacious gland- Zeis GlandSebacious gland- Zeis Gland

Meibomian Glands – Highly modified Meibomian Glands – Highly modified sebacious glands embedded in Tarsal sebacious glands embedded in Tarsal plate -30-40 in upper lidplate -30-40 in upper lid

15 – 20 in lower lid15 – 20 in lower lid

Hordeolum Externum Hordeolum Externum

►Suppurative inflammation of Molls/ Zeis Suppurative inflammation of Molls/ Zeis Gland Gland

►Commonly called as styeCommonly called as stye►Painful tender swelling at lid MarginPainful tender swelling at lid Margin►Pus points at root of ciliaPus points at root of cilia►Treatment- Hot compressesTreatment- Hot compresses

NSAIDs & Systemic AntibioticsNSAIDs & Systemic Antibiotics Epilation of affected ciliaEpilation of affected cilia

Hordeolum InternumHordeolum Internum

► Suppurative inflammation of Meibomian GlandsSuppurative inflammation of Meibomian Glands► Painful tender swelling at lid MarginPainful tender swelling at lid Margin►More Painful because of tough Tarsal plateMore Painful because of tough Tarsal plate► Pus points on conjunctival surfacePus points on conjunctival surface► Treatment- Hot compressesTreatment- Hot compresses

NSAIDs & Systemic AntibioticsNSAIDs & Systemic Antibiotics

Topical AntibioticsTopical Antibiotics

Incision & DrainageIncision & Drainage

BlepharitisBlepharitis

► Inflammtion of Lid marginInflammtion of Lid margin►Two Types- Squamous BlepharitisTwo Types- Squamous Blepharitis

Ulcerative BlepharitisUlcerative Blepharitis

Squamous BlepharitisSquamous Blepharitis

►Usually associated with seborrhoeaUsually associated with seborrhoea►Excess Liids are converted to fatty Excess Liids are converted to fatty

acids at lid margin which gives rise to acids at lid margin which gives rise to inflanmmationinflanmmation

Squamous BlepharitisSquamous Blepharitis

►Clinical FeaturesClinical Features► Itching and burning of eyelidsItching and burning of eyelids►White scale seen at lash lineWhite scale seen at lash line►Scle can be easily removed Scle can be easily removed ►Underlying skin healthyUnderlying skin healthy►Treatment – Lid HygieneTreatment – Lid Hygiene

Bland ointBland ointTreatment of SeborrhoeaTreatment of Seborrhoea

Ulcerative BlepharitisUlcerative Blepharitis

►Chronic Infection of lid margin by Chronic Infection of lid margin by StapylococciStapylococci

►Clinical Features- Swelling of Lid MarginClinical Features- Swelling of Lid Margin

-Prominent vessels at lid margin-Prominent vessels at lid margin

-Yellowish crusts at lash line-Yellowish crusts at lash line

-Difficult to remove-Difficult to remove

-On removal of crusts -On removal of crusts underlying underlying skin show ulcersskin show ulcers

Ulcerative BlepharitisUlcerative Blepharitis

►ComplicationsComplications

Madarosis, Trichiasis, entropion,Madarosis, Trichiasis, entropion,

ectropionectropion

-Chronic Conjunctivitis-Chronic Conjunctivitis

-Marginal Keratitis-Marginal Keratitis

-Punctate epithelial Keratitis-Punctate epithelial Keratitis

Ulcerative BlepharitisUlcerative Blepharitis

►TreatmentTreatment-Removal crust using baby shampoo / -Removal crust using baby shampoo /

2% Sodium Bicarbonate solution2% Sodium Bicarbonate solution-Application of Antibiotic ointment to -Application of Antibiotic ointment to lid marginlid margin-Topical antibiotic drops-Topical antibiotic drops

-If recurrent – A course of systemic -If recurrent – A course of systemic antibioticsantibiotics