(c) lacrimal apparatus
TRANSCRIPT
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LACRIMAL LACRIMAL APPARATUSAPPARATUS
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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
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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
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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
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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
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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
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Chronic DacryocystitisChronic Dacryocystitis
► InvestigationInvestigation
- Sac syringing- Mucopurulent - Sac syringing- Mucopurulent regurgitation from upper regurgitation from upper
punctumpunctum
- Dacryocystography- Dacryocystography
- MDCG- MDCG
-Dacryoscintigraphy-Dacryoscintigraphy
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Chronic DacryocystitisChronic Dacryocystitis
►ComplicationsComplications
-Acute Dacryocystitis-Acute Dacryocystitis
-Chronic Conjunctivitis-Chronic Conjunctivitis
-Hypopyon Corneal Ulcer -Hypopyon Corneal Ulcer
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Chronic DacryocystitisChronic Dacryocystitis
►Treatment- Always SurgicalTreatment- Always Surgical
DacrycystorhinostomyDacrycystorhinostomy
DacryocystectomyDacryocystectomy
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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
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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
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Acute DacryocystitisAcute Dacryocystitis
►ComplicationsComplications
Lacrimal abscessLacrimal abscess
lacrimal Fistulalacrimal Fistula
Chronic DacryocystitisChronic Dacryocystitis
Orbital CellulitisOrbital Cellulitis
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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
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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
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Congenital Congenital DacryostenosisDacryostenosis
►Differential DiagnosisDifferential Diagnosis
Congenital GlaucomaCongenital Glaucoma
Ophthalmia NeonatorumOphthalmia Neonatorum
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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
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DacryoadenitisDacryoadenitis
► Inflammation of Lacrimal GlandInflammation of Lacrimal Gland►Two types -AcuteTwo types -Acute
ChronicChronic
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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
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DacryoadenitisDacryoadenitis
►TreatmentTreatment
Systemic AntibioticsSystemic Antibiotics
Anti inflammatory DrugsAnti inflammatory Drugs
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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
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LIDSLIDS
►Functions of LidsFunctions of Lids
Protects the globeProtects the globe
Wetting of corneaWetting of cornea
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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
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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
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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
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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
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BlepharitisBlepharitis
► Inflammtion of Lid marginInflammtion of Lid margin►Two Types- Squamous BlepharitisTwo Types- Squamous Blepharitis
Ulcerative BlepharitisUlcerative Blepharitis
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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
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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
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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
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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
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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