Disorders of Lacrimal Apparatus and Glands of the Eye MCQs

The lacrimal gland is split into two lobes by the lateral extent of the levator aponeurosis. Reference : kurana 4/e, p. 35

Congenital dacryocystitis is the inflammation of the lacrimal sac in a newborn, most commonly due to delayed/incomplete canalization of the nasolacrimal duct (NLD), most often at the lower end of NLD and near valve of Hasner - occlusion is membranous. Presents with epiphora, swelling and purulent discharge at inner canthus. Treatment Massage over lacrimal sac with topical antibiotics -initial treatment of choice for 1 year. Syringing is attempted usually by 9-12 months of age. Most of us do it after 1 year only Probing of NLD should be undertaken after 12 months of age, as spontaneous resolution is likely to occur by 12 months. Dacryocystorhinostomy after 4 years of age. Reference: Parson's 21/e p. 464, 466

Congenital dacryocystitis is the inflammation of the lacrimal sac in a newborn, most commonly due to delayed/incomplete canalization of the nasolacrimal duct (NLD), most often at the lower and near valve of Hasner -occlusion is membranous. Presents with epiphora, swelling and purulent discharge at inner canthus. Treatment Criggler Massage over lacrimal sac with topical antibiotics -initial treatment of choice. Syringing is attempted usually by 9-12 months of age Probing of NLD should be undertaken after 12 months of age, as spontaneous resolution is likely to occur by 12 months. Dacryocystorhinostomy after 4 years of age. Reference: Parson's 21/e p. 464, 466

The upper lacrimal punctum lies 0.5mm medial to the lower punctum. Upper punctum is directed downwards and backwards while the lower punctum is directed upwards and backwards. Reference: Khurana Anatomy, 2/e, P. 368

Causes of epiphora (overflow of tears at the eyelid margin) include - Hypersecretion secondary to anterior segment disease such as dry eye ('paradoxical watering') or inflammation. Defective drainage due to a compromised lacrimal drainage system; this may be caused by: Malposition of the lacrimal puncta. Obstruction at any point along the drainage system, from the punctal region to the valve of Hasner. Ex: Nasolacrimal duct block Lacrimal pump failure , which may occur secondarily to lower lid laxity or weakness of the orbicularis muscle. Ex: Facial nerve palsy Reference: Parson's 20/e, p.449

Contraindications to probing and irrigation include - Acute dacryocystitis Acute canaliculitis In the setting of active infection , probing and irrigation are most likely to cause trauma because the lacrimal sac wall is inflated and friable, it also can cause unnecessary pain and anxiety for the patient. Reference: Parson 20/e, P. 478-479

Gram-positive organisms are most common in dacryocystitis. Consider gram-negative organisms in patients with diabetes mellitus, immunocompromised patients, or nursing home residents if there is no response to initial treatment. Fungal infection would be a rare cause of dacryocystitis. Reference: Kanski 8th edition/73

A patient with obvious dacryocystitis should not be probed. Probing would be painful and not provide additional information. Antibiotics will help inflammation subside prior to dacryocystorhinostomy. Massage may have some role in chronic dacryocystitis. Reference: Kanski 8th edition/75