1 / 19

Tearing Due to Block Drainage System

Tearing Due to Block Drainage System. Kimberly Cockerham, MD, FACS Plastics-Orbit-Adult Strabismus Zeiter Eye Medical Group, Inc. Systematic Approach to Tearing. Dry Wet Other Ocular Surface Eyelid Orbit. The “Wet” Eye. Tear Lake High Delayed Dye Disappearance.

ashtyn
Télécharger la présentation

Tearing Due to Block Drainage System

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Tearing Due to Block Drainage System Kimberly Cockerham, MD, FACS Plastics-Orbit-Adult Strabismus Zeiter Eye Medical Group, Inc.

  2. Systematic Approach to Tearing • Dry • Wet • Other • Ocular Surface • Eyelid • Orbit

  3. The “Wet” Eye Tear Lake High Delayed Dye Disappearance

  4. 2% Fluorescein in each eye • Abnormal test if: • Asymmetric • Persistent dye at: • 5 min in young • 15 min in elderly

  5. Anatomy Puncta Canaliculus Lacrimal sac Lacrimal duct

  6. Evaluation of the Wet Eye • If there is delayed dye disappearance: • Inspect the puncta • Push on lacrimal sac • Probe the canaliculi • Irrigate the nasolacrimal system

  7. Punctal Stenosis • Inflammation • Topical drops • Exposure RX = punctopexy

  8. Punctal Infiltration RX = Excision and Reconstruction

  9. Canalicular Abnormality • Infection (canaliculitis) • Trauma • Chemotherapy • Topical medications (glaucoma drops)

  10. Canaliculitis Actinomyces: three snip followed by topical Pen G

  11. Nasolacrimal Duct Obstruction • Infection • Inflammation • Wegner’s • Sarcoidosis • Steven’s Johnson • Herpes • Intranasal abnormality Dacryocystitis

  12. Lacrimal Sac Mass • Inflammation • Sarcoidosis • Non-specific inflammation • Neoplasia • Squamous cell carcinoma • Lymphoma

  13. Evaluation of the Wet Eye • Irrigation • Flows freely to mouth or nose • System not structurally blocked • Functional block still possible • Jones I • No irrigation • Is Fluorescein detected in nose ? • Jones II • Irrigate after Jones I • Is Fluorescein detected in nose ?

  14. The Role of Imaging

  15. Proximal Canalicular Stenosis Endoscopic View: Canalicular Stenosis, RX = KTP laser

  16. Extensive Stenosis RX = Jones Tube

  17. Dacryocystorhinostomy (DCR)

  18. Dry:Tear Lake Low Normal Dye DisappearanceOther: Tear Lake Often NormalDye Disappearance Often NormalListen and Look for CluesWet:Tear Lake High Delayed Dye Disappearance A Systematic Approach to Tearing

  19. Questions….Concerns ? Kimberly Cockerham, MD, FACS Plastics – Orbit – Adult Strabismus ZeiterEye Medical Group, Inc.

More Related