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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