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48 Cards in this Set
- Front
- Back
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List the lacrimal drainage system in order.
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Puncta -> canaliculi -> common canaliculus --> lacrimal sac --> NLD --> valve of Hasner into the internal meatus
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describe the dye disappearance test
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place NaFl in the conjunctiva of both eyes and if after 3 mins it still remains then there is inadequate drainage
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what is a hard stop in D&I and what does it signify?
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you've reached the bone
tells you that the system is patent or that there is a total obstruction |
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what is a soft stop in D&I and what does it signify?
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you have reached the lateral end of the lacrimal sac but you did not enter it
signifies that there is either a lower canalicular obstruction or obstruction of the common canaliculus |
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what happens to saline if there is a total NLD obstruction?
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it doesnt reach the nose and is therefore regurgitated through the upper punctum
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what happens to saline if there is a lower canalicular obstruction?
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reflux through lower punctum
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what happens to saline if there is a common canaliculuar obstruction?
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reflux through upper punctum
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What does the Jones 1 test tell you?
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differentiated btw a partial obstruction vs a primary hypersecretion problem
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what is a positive jones1 finding and what does it indicate?
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NaFl recovered from nose thus NLD is patent and there is no onbstruction therefore there is a hypersecretion issue
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what is a negative jones 1 finding and what does it indicate?
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NaFl was not recovered from nose hus there is either a partial obstruction or lacrimal pump failure
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when do you perform a jones 2 test?
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after a negative jones 1 finding
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what does the jones 2 test tell you?
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tells location of obstruction based on if the dye from jones 1 enters the lacrimal sac
wash out the NaFl and irrigate with saline |
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what is a positive jones 2 test and what does it indicate?
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NaFl stained saline from nose - indicateds partial obstruction of NLD, upper lacrimal system is patent
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what is a negative jones 2 test and what does it indicate?
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no NaFl stained saline recovered from nose - NaFl did not enter lacrimal sac therefore there is a partial obrstruction of puncta, canaliculi, or common canaliculus
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TBUT
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tells if there is an evaporative issue
<10 secs abnormal |
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schirmer
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tells about aqueous tear production
1 < 6mm abnormal 2 < 10 mm abnormal after 5 min |
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schirmer 1
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with anesthetic
measures BASAL secretion <6mm in 5 min abnormal |
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schirmer 2
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without anesthetic
measures BASAL & REFLEX secretion <10 mm in 5 min abnormal |
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phenol red thread test
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<6mm in 15 secs abnormal
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infection of canaliculi caused by bacteria, virus, or fungus
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canaliculitis
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clinical picture of canaliculitis
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unilateral red eye
epiphora tenderness/pain on nasal portion of lid chronic discharge pouting punctum hyperemia and edema stones seen during probing |
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inflammation of lacrimal gland
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dacryoadenitis
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what are some of the causes of dacryoadenitis?
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trauma
orbital pseudotumor sarcoid dermoid lymphoid syphillis TB leukemia lacrimal gland cyct benign epi tumor malignant epi tumor adenoid cystic carcinoma |
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clinical picture of dacryoadenitis
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swollen temporal 1/3 of upper lid causing an S curve to upper lid - ptosis
unilateral local pain conjunctivitis discharge proptosis |
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diagnostic sign of dacryoadenitis
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s shaped curve of upper temporal lid due to swelling
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management of dacryoadenitis
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neuroimaging
biopsy systemic steroids systemic AB tylenol & ice for viral cases systemic WU |
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infection or inflammation of the lacrimal sac due to an obstruction in the lacrimal system
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dacryocystitis
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clinical picture of dacryocystitis
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pain, epiphora
diffuse inflammation and chronic conjunctivitis or preseptal cellulitis infllammation & redness at medial canthus |
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what should be ruled out in dacryocystitis?
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mucocele
prespetal orbital cellulitis if pus filled sac seen |
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what should not be done in dacryocystitis?
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D & I
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Tx of dacryocystitis
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hot compresses
topical broad spectrum AB oral AB comanage if peds chronic - lid massage and hot packs |
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acquired obstructions
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idiopathic
seen in the elderly |
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incomplete opening of Hasner's membrane
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congenital NLD
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treatment for congenital NLD
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most resolve within 12 months - perform massage to rupture Hasner's membrane 5X BID
after 13 months do D & I |
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signs and symptoms of congenital NLD
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infant
epiphora mucopurulent discharge |
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what should be ruled out in congenital NLD
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congenital glc --> epiphora
neonatal conjunctivitis --> discharge |
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what is the purpose of massages in NLD in infants?
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rupture the valve of Hasner
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lipid deficient dry eyes are due to
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chronic blepharitis, MGD
evaporative |
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aqueous deficient dry eyes are due to
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age, Sjogren's
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K Sicca is
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aqueous deficient DES
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gritty FBS with increasing severity as the day progressess; debris in tear film, reduced TBUT, staining
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K sicca
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mucin deficient DES is due to
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goblet cell dysfunction because of hypovitaminosis A, conj insult, or disease
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ocular cicatricial pemphigoid causes deficiency in what layer of tear film?
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mucin layer - goblet cell destruction
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inflammation of conj leading to shrinkage and sacring
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ocular cicatricial pemphigid
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etiology of ocular cicatricial pemphigoid
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autoimmune
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who gets OCP
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elderly
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what does the progressive scarring of the conj in OCP lead to?
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trichiasis
entropion lagopthalmos exposure keratopathy neo ulceration |
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treatment of OCP
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lubrication
nighly lubrication ung surgery topical vitamin A immunosuppressive therapy |
