Lacrimal System Secretory part Reflex Main lacrimal gland Basic 1.

Accessory lacrimal glands of: - Krause: fornices - Wolfring: Superior & inferior borders of superior & inferior tarsus 2. M.G., Zeiss glands 3. Goblet cells Excretory part: (Lacrimal drainage system) 1. Puncti: 6 mm medial to medial canthus 2. Canaliculi: - Vertical limb: 2 mm - Horizontal limb: 8 mm 3. Lacrimal sac 4. Nasolacrimal duct : inferior meatus, Hasner's valve.

Tear film Superficial oily layer: M.G., Zeiss glands Middle aqueous layer: Main & accessory lacrimal glands Deep mucus layer: Goblet cells of the conjunctiva Functions : - Optical - O2 supply to the cornea - Lubricant - Antibacterial: Lysozyme, betalysin, IgA,G - Mechanical: flushing - Psychic

WATERY EYE - Reflex lacrimation (Hypersecretion) - Epiphora: impaired drainage (Puncti, canaliculi, lacrimal sac, NLDO congenital/acquired) DRY EYE

Causes

WATERY EYE / EPIPHORA : impaired drainage Puncti Canaliculi Congenital NLDO 1. Eversion: ectropion, Rx 1. Occlusion 10-30% of newborn 2. Occlusion: - Congenital Delayed canalization of NLD - Congenital - Acquired: 50-70%: Spontaneous st - Traumatic Trauma, FB canalization in 1 10-12 M - Drug induced - Inflammatory: trachoma

Inflammation of lacrimal sac Acute Dacryocystitis Chronic Dacryocystitis Staphylococci, Pneumococci, Streptococci

DRY EYE 1. aqueous tear production - Deficient secretion of lacrimal glands Congenital aplasia Atrophy: Sjogren's syndrome; dry eye, dry mouth, arthralgia - Obstruction of lacrimal glands ducts: Conjunctival scarring Trauma: Surgical, chemical Inflammation: trachoma 2. Mucin deficiency - Conjunctival scarring. - Vitamin A deficiency. 3. evaporation - Lagophthalmos: ectropion, proptosis. - CL wear

C/P

Epiphora Discharge DDx: - MPC - Congenital glaucoma

Acute inflammation

- Epiphora. - Recurrent & chronic conjunctivitis: Discharge - Regurgitation of pus or mucopus Complications: - Corneal ulcer - PO endophthalmitis

Rx

1. Dilatation 2. Punctoplasty: Snip operation 3. Stents: - Perforated punctual plugs (PPP) - Silastic intubation

1. Removal of FB 2. ConjunctivoDCR

1. Medical - Antibiotics. - Digital compression 6-10 M 2. Probing and syringing - If medical treatment fails - Can be repeated once 3. Silastic intubation (6M) 4. Dacryocystorhinostomy (DCR)

1. Medical: Antibiotics, analgesics 2. Surgical: Incision & drainage

- Nasal pathology - DCR

- Treatment of the cause. - Artificial tears. - Occlusion of puncti: punctal plus.