tearing: hyperlacrimation, epiphora. dry eye: tear break-up time, schirmer test
TRANSCRIPT
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Tearing: hyperlacrimation, epiphoraTearing: hyperlacrimation, epiphora
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Dry eye: tear break-up time, Dry eye: tear break-up time, Schirmer testSchirmer test
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Epiphora:Epiphora:-malpositioning-malpositioning-obst. -obst.
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INFECTIONS OF LACRIMAL PASSAGES
1. Congenital nasolacrimal duct(NLD)obstruction
2. Congenital dacryocele
3. Chronic canaliculitis
4. Dacryocystitis• Acute• Chronic
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Congenital nasolacrimal duct obstruction• Caused by delayed canalization near valve of Hasner,Common• On pressure reflux of purulent material from punctum
Infrequently acute dacryocystitis Epiphora and matting
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Treatment of congenital nasolacrimal duct obstruction
• one third: bilateral•Role out congenital glaucoma•Massage of nasolacrimal duct:10strokes 4 times a day• antibiotic drops 4 times daily: if..discharge• Improvement by age 12 months in 95% of cases
• If no improvement - probe at 12 months• Results - 90% cure by first probing • 6% by repeated probing
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Congenital dacryocele
• Bluish cystic swelling at or below medial canthaltendon• May become secondarily infected
• Do not mistake for encephalocele - pulsatile swelling above medial canthal tendon
Distension of lacrimal sac by trapped amniotic fluid (amniontocele)caused by imperforate valve of Hasner
• Initially massage
• Probing if massage fails
Treatment
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Acute dacryocystitis
• May develop into abscess•Intraosseous obstruction
• Systemic antibiotics and warm compresses• DCR after acute infection is controlled
Usually secondary to nasolacrimal duct obstruction and tear stasis
• Tender canthal swelling • Mild preseptal cellulitis
Treatment
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Chronic dacryocystitisEpiphora and chronic or recurrent unilateral conjunctivitis
Expressed mucopurulent material Painless swelling at inner canthus
Treatment - DCR
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Dacryocystorhinostomy