Term
| What is congenital dacroyocele? |
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Definition
A collection of amnionic fluid within an obstructed lacrimal sac.
Appears firm. |
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Term
| Congenital nasolacrimal duct obstruction results from? Is it common? When does it occur? |
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Definition
Results from nasolacrimal duct failure to close completely (canalize), during gestation.
Common. - in 2-4% patients. |
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Term
| What is the most common cause of tearing in childhood? |
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Definition
| congenital nasolacrimal duct obstruction |
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Term
| What are some signs of congenital nasolacrimal duct obstruction? |
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Definition
| tearing, discharge, crusting, mucus reflux from the punctum with compression to the lacrimal sac. |
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Term
| How do you manage conjenital naso.duct obs. |
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Definition
Warm compresses,
topical antibiotic ointment (erythromycin), for 1 week if mucopurulent discharge.
Massage |
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Term
Does CNDO cure by itself?
Do you have to probe? When do you consider probing. |
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Definition
Over 90% of the nasolacrimal obstruction will resolve spontaneously or with massage.
Probing is usually between 6 and 13 months. If probing is not sucessful, surgery. |
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Term
| Congenital glaucoma - how do you diagnose? |
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Definition
Measure the iris with HVID (horizontal visible iris diameter). Normal baby's is 9-10. Glaucoma baby, its 11-12 (about the size of an adults'!)
Baby tearing and sensitive to light |
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Term
Acquired nasolacrimal duct obstruction
Etiology, findings, and how to diagnose? |
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Definition
Chronic sinus disease, age-related stenosis, naso/orbital trauma.
Tearing, discharge, crusting, recurrent conj.
Diagnose with the Jones test. |
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Term
| Acquired nasolacrimal duct obstruction - management |
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Definition
warm compress, topical antibiotic-steroid if partial obstruction.
Dilation/irrigation, and or probing.
if not successful, management is usually surgical
- Silicone intubation
- Dacrycystohinostomy (DCR) to make an anastomosis between the lacrimal sac and nasal cavity.
Dilation/irrigation and/or probing
if not sucessful, sugery (either silicone intubation, or Dacryocysorhinostomy DCR (anastomosis between lacrimal sac and nasal cavity). |
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Term
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Definition
| infection of the lacrimal sac. Nasolacrimal duct obstruction, which leads to stagnant tears in the lacrimal sac which then become infected |
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Term
| What causes nasolacrimal duct obstructioN? |
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Definition
Long and narrow nasolacrimal ducts,
Lacrimal sac diverticulum (extra folds - kind of like intestines)
Trauma,
dacryoliths
inflammatory sinus and nasal problems. |
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Term
| What kind of bacteria is causeing acute dacryocystitis? |
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Definition
| Staphylococci (#1 flora), streptococci, or E.coli, Pseudomonas, other gram negatives. |
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Term
| What are your findings with acute dacrycystitis? |
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Definition
Tenderness, erythema, and swelling over nasal portion of lower eyelid
Epiphora
Purulent punctal discharge particularly if pressure is applied to the lacrimal sac
Fever and malaise may occur |
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Term
| What are complications of dacryocystitis? |
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Definition
Preseptal cellulitis
Conjunctivitis
Cutaneous fistulas may form from the lacrimal sac
Less common, orbital cellulitis and sepsis |
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Term
| How do you manage acute dacrycystitis? |
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Definition
Warm compress tid
Systemic antibiotic
- Oral Augmentin(amoxicillin/clavulante)
IV Unasyn (amoxicillin/sulbactam)
Topical antibiotic ointment (erythromycin) if conjunctivitis exists
Aspirate lacrimal sac contents with 19 gauge needle for culture and susceptibility testing |
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Term
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Definition
If pointing abscess, consider incision and drainage
After infection resolved, lacrimal system dilation/irrigation and/or probing to relieve the obstruction
Nasal exam, possible CT scan
Consider dacryocystorhinostomy (DCR) with silicon tubing to correct the nasolacrimal duct obstruction and prevent future dacryocystitis |
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Term
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Definition
Enlarged lacrimal sac without signs of acute inflammation
Can be from
- Chronic infection
- Chronic inflammation/granuloma
- Tumor (cancer)
Culture to determine antibiotic therapy; then dacryocystorhinostomy
If not infectious, biopsy and appropriate treatment |
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Term
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Definition
Inflammation of the lacrimal gland. SINUSOIDAL S SHAPED LID!
Palpebral lobe affected more frequently than orbital
Most cases associated with systemic infection |
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Term
| What can cause acute Dacryoadenitis? |
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Definition
Viral infection
Mumps
Epstein-Barr virus
Herpes zoster
Bacterial infection
Staphylococci
Neisseria gonorrhoeae |
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Term
| What are some clinical features of Acute Dacryoadenitis? |
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Definition
Temporal upper eyelid inflammation (swelling, redness, warmth, tender, S-shaped deformity)
Tearing
Discharge
Fever
Proptosis if orbital lobe involved |
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Term
| How should we test to see if pt has acute dacryo? |
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Definition
Culture and Gram staining of discharge
CBC
Blood culture
Consider orbital CT scan |
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Term
| Whats a good way to see if a person has acute dcaryoadentitis? |
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Definition
| elevating the upper lid while having the patient looking down. You can see the swollen palpebral lobe of the lac gland. |
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Term
| How do we manage acute dacryoad? |
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Definition
Treat the underlying infection or inflammation
Mumps/Epstein-Barr virus - warm compresses
Herpes simplex/zoster virus - systemic acyclovir or famciclovir
Staphylococci and streptococci - systemic antibiotic eg Augmentin
Neisseria gonorrhoeae - systemic antibiotic eg ceftriaxone – (((2nd gen ceph – gram +- action.)))
Mycobacterium species TB - surgical excision + systemic antibiotics eg isoniazid and rifampin
Treponema pallidum (causes syphilis) - systemic antibiotic eg penicillin G |
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Term
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Definition
Chronic inflammation (and enlargement) of the lacrimal gland
This is more common than acute, Globe displacement, Restricted ocular motility
Etiology
- Sarcoidosis
- Thyroid ophthalmopathy
- Sjogren’s syndrome
- Tumors |
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Term
| Chronic Dacryoadenitis - Sarcoid |
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Definition
| Lacrimal gland sarcoidosis (granulomatous inflammation) |
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Term
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Definition
Autoimmune disease
Triad: dry eye, dry mouth, arthritis
Lacrimal gland infiltrated with lymphocytes (and therefore may be enlarged) |
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Term
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Definition
Enlargement of lacrimal fossa with displacement of the globe and no inflammatory signs
use CT scan |
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Term
| What population do we see Dacryoadenitis - Dermoid Cyst |
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Definition
it is a cystic lesion seen in preschool children. it is a superotemporal mass that is mobile and nontender
It is Well circumscribed on CT with rare bony remodeling
Surgical excision |
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Term
| What is Canaliculitis? Etiology (what causes it?) |
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Definition
Infection of the canaliculus (duct between the punctum and the lacrimal sac)
Etiology
Actinomyces Israelii (filamentous gram + rod)
Candida albicans (single cell yeast)
Aspergillus (filamentous fungus)
Nocardia asteroides (filamentous rod)
Herpes simplex/zoster (viruses) |
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Term
| What are some signs that you see with canaliculitis? |
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Definition
| erythema and swelling of punctum and adjacent tissues (conjuctivitis around the medial canthus) |
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Term
| Where do we see sulfur granulus? |
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Definition
in canaliculitis.
Removal:
-Canalicular concretion (sulfur) removal either by manual expression through the punctum or by scraping the canaliculus |
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Term
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Definition
Warm compresses
Culture
Remove concretions
Appropriate systemic and topical antibiotics |
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Term
| What test can you use to determien patency of drainage system? |
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Definition
| Jones test. Apply fluraceine in eye. Check nasal pasageway and shine cobolt blue. And see if you have fluroscine. |
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