THE LACRIMAL SYSTEM

THE LACRIMAL THE LACRIMAL SYSTEMSYSTEM

Anatomy and physiologyAnatomy and physiologyAnatomy and physiologyLacrimal glandLacrimal glandgland of the third eyelidgland of the third eyelidaccessorial lacrimal glandsaccessorial lacrimal glandspreocular tear film preocular tear film

Lacrimal punctasLacrimal punctascanaliculicanaliculilacrimal saclacrimal sacnasolacrimal ductnasolacrimal duct

dolicephalic

brachicephalic

The praeocular tear film(PTF)The praeocular tear film(PTF)The praeocular tear film(PTF)Covers the cornea and conj. Covers the cornea and conj. -- prevents the eye from prevents the eye from the dessiccationthe dessiccationallows transport of oxigen and nutritives to the corneaallows transport of oxigen and nutritives to the corneaby lubrication of the eye surface, helps the movement by lubrication of the eye surface, helps the movement of the lidsof the lidseliminates the surfaceeliminates the surface--irregularities of the cornea irregularities of the cornea --maximal refractive powermaximal refractive powerwashing out of the foreign bodies from the eye surfacewashing out of the foreign bodies from the eye surfaceaccumulates in the ventral fornixaccumulates in the ventral fornix

DISTURBANCES of LACRIMAL FUNCTION

DISTURBANCES of LACRIMAL FUNCTION

I. FAILURE IN THE DRAINAGE OF THE TEARS

epiphoraepiphora

II. FAILURE TO PRODUCE NORMAL PTF

keratoconjunctivitis keratoconjunctivitis siccasicca

I. FAILURE IN THE DRAINAGE OF THE TEARS

I. FAILURE IN THE DRAINAGE I. FAILURE IN THE DRAINAGE OF THE TEARSOF THE TEARS

Anomaly of the lacrimal punctas Anomaly of the lacrimal punctas and canaliculiand canaliculiDacryocystitisDacryocystitisTear staining syndromeTear staining syndrome......

epiphoraepiphora

1, ANOMALY OF THE LACRIMAL PUNCTAS AND CANALICULI

1, ANOMALY OF THE LACRIMAL 1, ANOMALY OF THE LACRIMAL PUNCTAS AND CANALICULIPUNCTAS AND CANALICULI

EtiologyEtiologyatresia, imperforatio, ectopyatresia, imperforatio, ectopy

developmental abnormlitiesdevelopmental abnormlities

obstructionobstructioninflammatory, foreign bodiesinflammatory, foreign bodies

SignsSignsepiphoraepiphoralack of the punctumlack of the punctum

TreatmentTreatmentflushing, catheterisationflushing, catheterisationsurgerysurgery

Surgical repair of imperforated punctum

II. FAILURE TO PRODUCE NORMAL PTF

II. FAILURE TO PRODUCE NORMAL PTF

Failure in the secretion of the PTFFailure in the secretion of the PTFcontamination of foreign corpusculi with the eye contamination of foreign corpusculi with the eye surfacesurface

dessiccation of the eye surface, permanent, dessiccation of the eye surface, permanent, subsequent inflammationsubsequent inflammation = = keratoconjunctivitis keratoconjunctivitis

siccasicca

Pathomechanism of KCS

Pathomechanism Pathomechanism of KCSof KCS

Change in the volume Change in the volume of the PTFof the PTF

frequentfrequent

Change in the quality of Change in the quality of the PTFthe PTF

rarerare

Keratoconjunctivitis sicca (KCS)Keratoconjunctivitis sicca (KCS)any breed of dogs (horse)any breed of dogs (horse)breed predisposition:breed predisposition: spaniel, pekingese, poodle, spaniel, pekingese, poodle, bulldog, yorkshirebulldog, yorkshire

ETIOLOGYETIOLOGY

unknown or known causes changes in the unknown or known causes changes in the

lacrimal gland and/or in the gland of the third lacrimal gland and/or in the gland of the third

eyelid deficiency in the tear productioneyelid deficiency in the tear production

IdiopathicIdiopathic

AtoimmunAtoimmunKCS without systemic diseaseKCS with systemic disease ( polyarthritis, colitis, KCS with systemic disease ( polyarthritis, colitis, diabetes mellitus, hypothyreosis): diabetes mellitus, hypothyreosis): immuncomplexes in the blood destroy the tear glandsimmuncomplexes in the blood destroy the tear glands

Chronic blepharoconjunctivitisChronic blepharoconjunctivitisscar formation at the site of the openings of the scar formation at the site of the openings of the lacrimal glandlacrimal gland

Drug induced; intoxicationsDrug induced; intoxicationslong term therapy of sulphonamidslong term therapy of sulphonamidsafter local or general anaesthesiaafter local or general anaesthesiaexotoxinsexotoxins

Surgically inducedSurgically inducedafter removal of the prolapsed third eyelid gland (or after removal of the prolapsed third eyelid gland (or entire third eyelid)entire third eyelid)

TraumaTraumawhich affects the tear glands directly or via there nerve which affects the tear glands directly or via there nerve supplysupply

Canine distemperCanine distemperthe virus definitively lacrimotoxic to the lacrimal gland the virus definitively lacrimotoxic to the lacrimal gland and to the gland of the third eyelidand to the gland of the third eyelid

CongenitalCongenitalmops, yorkshire terriermops, yorkshire terrier

SIGNSSIGNS

uniuni-- or bilateralor bilateral

intermittent: in summer, when evaporation intermittent: in summer, when evaporation of the tears is more intensiveof the tears is more intensive

acute or chronicacute or chronic

Signs of acute KCS (dacryoadenitis)

Signs of acute KCS Signs of acute KCS (dacryoadenitis)(dacryoadenitis)

pain, blepharospasm, pain, blepharospasm, prolaps of the nictitansprolaps of the nictitansconjunctival hyperaemyconjunctival hyperaemylittle, mucopurulent little, mucopurulent dischargedischargedry, lusterless corneadry, lusterless corneacorneal ulcerationcorneal ulcerationvision is impaired on the vision is impaired on the affected eyeaffected eye

Signs of chronic KCS (dacryoadenopathy)

Signs of chronic KCS Signs of chronic KCS (dacryoadenopathy)(dacryoadenopathy)hyperemic, velvethyperemic, velvet--like conj.like conj.profuse, mucopurulent profuse, mucopurulent discharge, strongly adheres discharge, strongly adheres to the corneato the corneadried up exsudate on the dried up exsudate on the perioculaperioculadry, opaque corneadry, opaque corneacorneal vascularisation, corneal vascularisation, pigmentationpigmentationkeratinisation in the cornea keratinisation in the cornea (and conj.)(and conj.)dry, ipsilateral nostrildry, ipsilateral nostrilchronic staphylococcal chronic staphylococcal infectioninfection

DIAGNOSISDIAGNOSISchronic KCSchronic KCS: by clinical signs: by clinical signsearly and subclinical forms of early and subclinical forms of KCSKCS: Schirmer tear test; Rose : Schirmer tear test; Rose bengal stainingbengal stainingexaminations for systemic examinations for systemic diseasesdiseases

TREATMENTTREATMENTcan not be cured!can not be cured!

mainly medical mainly medical

occasionaly surgicaloccasionaly surgical

long term therapylong term therapy

Medical therapyMedical therapyMedical therapyTear replacementTear replacement

artificial tears artificial tears

Controlling of the secondary infection and Controlling of the secondary infection and inflammationinflammation

topical antibiotics, subconj. steroidtopical antibiotics, subconj. steroid

Removal of excessive dischargeRemoval of excessive dischargetopical eye washes topical eye washes

Inhibition of immune mechanisms and Inhibition of immune mechanisms and stimulation of existing secretionstimulation of existing secretion

cyclosporine, tacrolimus topicallycyclosporine, tacrolimus topically

commercial formula of cyclosporine: commercial formula of cyclosporine: Optimmune Eye Ointment AUVOptimmune Eye Ointment AUV (0,2% (0,2% cyclosporin)cyclosporin)

The initial length of the medical th. is 3 monthsThe initial length of the medical th. is 3 months

Surgical th. of KCSSurgical th. of KCSIndicationIndication

No resultNo resultThe regular, long term th. is impossibleThe regular, long term th. is impossible

Parotideal duct transpostionParotideal duct transpostion

Parotideal duct transpostionParotideal duct transpostionParotideal duct transpostion