أسئلة المحاضرة الثالثة رمد (قبل التعديل)
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Questions and Answers

Which arteries supply blood to the lacrimal gland?

  • Carotid artery and the facial artery
  • Lacrimal branch of the ophthalmic artery and the infraorbital branch of the facial artery
  • Lacrimal branch of the ophthalmic artery and the infraorbital branch of the maxillary artery (correct)
  • Ophthalmic artery and the ophthalmic branch of the maxillary artery

    • What is the role of Hasner's Valve in the lacrimal system?

  • To prevent backflow of tears from the nasolacrimal duct (correct)
  • To facilitate tear drainage into the lacrimal sac
  • To regulate the secretion of the outer lipid layer
  • To assist in the contraction of the orbicularis muscle

    • Which glands are primarily responsible for the production of the outer lipid layer of the tear film?

  • Glands of Krause
  • Sebaceous Zeis glands
  • Meibomian glands (correct)
  • Conjunctival goblet cells

    • How many lacrimal puncta are present in the human eye?

    <p>Two in each eyelid (D)</p> Signup and view all the answers

    Which structure connects the lacrimal sac to the inferior meatus of the nose?

    <p>Nasolacrimal duct (B)</p> Signup and view all the answers

    What is the approximate length of the nasolacrimal duct?

    <p>2 cm (D)</p> Signup and view all the answers

    Where are the Glands of Wolfring primarily located?

    <p>In the conjunctival stroma near the fornices (C)</p> Signup and view all the answers

    What function does the Horner's muscle serve in the lacrimal apparatus?

    <p>It contracts to create negative pressure for tear suction (C)</p> Signup and view all the answers

    What is the definitive end stage solution when all procedures to obtain a patent canaliculus have failed?

    <p>Conjunctivo-dacryocysto-rhinostomy (B)</p> Signup and view all the answers

    Which of the following agents is NOT a common causative factor for acute suppurative inflammation of the lacrimal sac?

    <p>Tuberculosis (C)</p> Signup and view all the answers

    What is the typical symptom experienced in cases of chronic dacryocystitis?

    <p>Watery eye (A)</p> Signup and view all the answers

    Which of the following is a complication associated with acute dacryocystitis?

    <p>Pyocele (C)</p> Signup and view all the answers

    What is the primary focus of the treatment following the subsidence of an acute attack of dacryocystitis?

    <p>Dacryocystorhinostomy (D)</p> Signup and view all the answers

    In chronic dacryocystitis, what is the result of applying pressure to the swelling of the lacrimal sac?

    <p>Regurgitation of mucous or pus (C)</p> Signup and view all the answers

    Which of the following symptoms is NOT typically associated with acute dacryocystitis?

    <p>Discharge from the eye (B)</p> Signup and view all the answers

    What is the key investigation method for chronic dacryocystitis?

    <p>Culture &amp; sensitivity of the regurgitated discharge (B)</p> Signup and view all the answers

    What is the primary purpose of creating a surgical opening between the lacrimal sac and the nasal mucosa?

    <p>To improve tear drainage by bypassing an obstructed duct. (B)</p> Signup and view all the answers

    In which scenario would dacryocystectomy be the preferred treatment?

    <p>When DCR cannot be performed due to severe fibrosis. (C)</p> Signup and view all the answers

    What are some of the contraindications for performing DCR?

    <p>Atrophic rhinitis and polypi. (A), Tumors of the lacrimal sac. (B)</p> Signup and view all the answers

    What is the most likely symptom indicating naso-lacrimal duct obstruction in newborns?

    <p>Continuous watering of the eyes. (D)</p> Signup and view all the answers

    What is the recommended first-line conservative treatment for naso-lacrimal duct obstruction in newborns?

    <p>Lacrimal sac massage by the mother. (D)</p> Signup and view all the answers

    What additional care should follow the lacrimal sac massage in the treatment of naso-lacrimal duct obstruction?

    <p>Frequent use of antibiotic eye drops. (A)</p> Signup and view all the answers

    In diagnosing congenital glaucoma in newborns, which key sign differentiates it from naso-lacrimal duct obstruction?

    <p>Elevated intraocular pressure (IOP). (B)</p> Signup and view all the answers

    What should be avoided during probing of the naso-lacrimal duct to prevent complications?

    <p>Injury to the walls of the duct. (A)</p> Signup and view all the answers

    What is the function of lysozymes found in the aqueous layer of the eye?

    <p>They act as an antibacterial agent. (D)</p> Signup and view all the answers

    Which condition is characterized by a cystic swelling in the upper fornix due to retention of lacrimal secretion?

    <p>Lacrimal gland enlargement (D)</p> Signup and view all the answers

    What is the primary symptom of punctal obstruction?

    <p>Epiphora (D)</p> Signup and view all the answers

    Which of the following is NOT a potential cause of canalicular obstruction?

    <p>Allergic conjunctivitis (C)</p> Signup and view all the answers

    What does the term 'epiphora' specifically refer to?

    <p>Excessive tear production and overflow (B)</p> Signup and view all the answers

    In cases of ectropion, which treatment is recommended regardless of the cause?

    <p>Repair of the eyelid (A)</p> Signup and view all the answers

    What is one of the major complications associated with acute inflammation of the lacrimal gland?

    <p>Mumps (C)</p> Signup and view all the answers

    Which procedure involves using punctal dilators to treat punctal obstruction?

    <p>Punctoplasty (C)</p> Signup and view all the answers

    What is a common cause of evaporative dry eye?

    <p>Meibomian gland dysfunction (C)</p> Signup and view all the answers

    In probing of the nasolacrimal duct (NLD) for infantile dacryocystitis, what is the initial step conducted?

    <p>Use of a Nettleship’s dilator (A)</p> Signup and view all the answers

    Which condition is associated with suboptimal tear secretion leading to aqueous deficient dry eye?

    <p>Keratoconjunctivitis sicca (D)</p> Signup and view all the answers

    What procedure might be indicated if probing of the NLD fails to resolve infantile dacryocystitis after certain attempts?

    <p>Dacryocystorhinostomy (DCR) (C)</p> Signup and view all the answers

    Which of the following methods is NOT used to assess tear film stability?

    <p>Punctate epithelial erosion (D)</p> Signup and view all the answers

    What is the recommended duration for keeping a silicone tube in the nasolacrimal duct during treatment?

    <p>6-12 months (A)</p> Signup and view all the answers

    Which of the following is a potential cause of conjunctival scarring?

    <p>Chemical burns (D)</p> Signup and view all the answers

    What characteristic is associated with Sjogren's syndrome in relation to dry eye conditions?

    <p>Association with arthritis and dry mouth (B)</p> Signup and view all the answers

    Which syndrome is characterized by atrophy and fibrosis of lacrimal and salivary glands?

    <p>Sjögren’s syndrome (A)</p> Signup and view all the answers

    Epiphora, or excessive watering of the eyes, can occur in which of the following conditions?

    <p>Trachoma (A), Chronic dacryocystitis (D)</p> Signup and view all the answers

    What is the most common type of tumor found in the lacrimal gland?

    <p>Mixed tumour (C)</p> Signup and view all the answers

    Tear production in newborns typically begins after how many weeks?

    <p>3 weeks (A)</p> Signup and view all the answers

    Where does the nasolacrimal duct open into the nasal cavity?

    <p>Inferior meatus (A)</p> Signup and view all the answers

    Which procedure is often indicated for acquired obstruction of the nasolacrimal duct?

    <p>Dacryocystorhinostomy (B)</p> Signup and view all the answers

    What is a common cause of obstructive epiphora in children?

    <p>Punctual atresia (C)</p> Signup and view all the answers

    Which of the following is a treatment option for congenital epiphora?

    <p>Hydrostatic massage (B)</p> Signup and view all the answers

    What is the primary location of the glands of Krause in the lacrimal apparatus?

    <p>Within the conjunctival stroma near the fornices (B)</p> Signup and view all the answers

    Which structure is responsible for creating negative pressure in the lacrimal sac during eyelid closure?

    <p>Horner's muscle (A)</p> Signup and view all the answers

    Which layer of the tear film is primarily responsible for preventing rapid evaporation of tears?

    <p>Outer lipid layer (A)</p> Signup and view all the answers

    What is the approximate length of the lacrimal sac?

    <p>15 mm (B)</p> Signup and view all the answers

    Which of the following glands has a limited number situated near the upper border of the tarsal plate?

    <p>Glands of Wolfring (A)</p> Signup and view all the answers

    How many lacrimal ducts connect the lacrimal sac to the inferior meatus of the nose?

    <p>One (A)</p> Signup and view all the answers

    What is the causative agent most commonly associated with chronic dacryocystitis?

    <p>Pneumococci (A)</p> Signup and view all the answers

    Which anatomical feature is responsible for the opening of the nasolacrimal duct?

    <p>Hasner’s Valve (D)</p> Signup and view all the answers

    Which symptom is NOT typically associated with acute dacryocystitis?

    <p>Watery eye (C)</p> Signup and view all the answers

    What does the term 'pyocele' refer to in the context of lacrimal disorders?

    <p>Obstruction leading to fluid accumulation in canaliculi (D)</p> Signup and view all the answers

    What is the primary arterial supply to the lacrimal gland?

    <p>Lacrimal branch of ophthalmic artery (D)</p> Signup and view all the answers

    Which of the following treatments is indicated for acute dacryocystitis during the initial phase?

    <p>Systemic antibiotics (A)</p> Signup and view all the answers

    What is a possible complication of chronic dacryocystitis?

    <p>Orbital cellulitis (A)</p> Signup and view all the answers

    What does a positive regurgitation test indicate during the examination of the lacrimal sac?

    <p>Naso-lacrimal duct obstruction (D)</p> Signup and view all the answers

    What is the primary reason for conducting a dacryocystorhinostomy?

    <p>To relieve naso-lacrimal duct obstruction (D)</p> Signup and view all the answers

    Which of the following is considered a rare causative agent for dacryocystitis?

    <p>Tuberculosis (B)</p> Signup and view all the answers

    What is the primary function of lysozymes found in the middle aqueous layer of tear film?

    <p>To act as an antibacterial agent (B)</p> Signup and view all the answers

    Which condition is primarily associated with cystic swelling in the upper fornix due to accumulation of lacrimal secretion?

    <p>Canaliculitis (C)</p> Signup and view all the answers

    What is the main symptom associated with punctal obstruction?

    <p>Epiphora (B)</p> Signup and view all the answers

    Which treatment is indicated for punctal obstruction using a surgical approach?

    <p>Three snip punctoplasty (D)</p> Signup and view all the answers

    What anatomical structures contribute to the formation of the inner mucinous layer of the tear film?

    <p>Crypts of Henle and Glands of Manz (D)</p> Signup and view all the answers

    Which of the following conditions primarily causes acute inflammation of the lacrimal gland?

    <p>Viral mumps infections (C)</p> Signup and view all the answers

    What is commonly seen as a characteristic sign in cases of lacrimal gland swelling?

    <p>S-shaped deformity of the lid (B)</p> Signup and view all the answers

    Which treatment option is typically used for acquired canalicular obstruction?

    <p>Silicon intubation (B)</p> Signup and view all the answers

    What is the primary indication for dacryocystectomy?

    <p>When DCR cannot be performed (D)</p> Signup and view all the answers

    Which symptom is commonly associated with naso-lacrimal duct obstruction in newborns?

    <p>Persistent epiphora (D)</p> Signup and view all the answers

    What is the main purpose of probing the nasolacrimal duct in infants?

    <p>To re-canalize the nasolacrimal duct (A)</p> Signup and view all the answers

    Which is a contraindication for performing DCR?

    <p>Atrophic rhinitis (C)</p> Signup and view all the answers

    What should be avoided while probing the naso-lacrimal duct to prevent complications?

    <p>Applying excessive force (D)</p> Signup and view all the answers

    What additional care should be taken after performing lacrimal sac massage in newborns?

    <p>Frequent application of anti-biotic drops (A)</p> Signup and view all the answers

    What condition could lead to congenital naso-lacrimal duct obstruction in newborns?

    <p>Incomplete canalization of the duct (C)</p> Signup and view all the answers

    What is a common outcome if probing of the nasolacrimal duct fails after repeated attempts?

    <p>Need for dacryocystectomy (D)</p> Signup and view all the answers

    Which syndrome is associated with atrophy and fibrosis of lacrimal and salivary glands?

    <p>Sjögren’s syndrome (B)</p> Signup and view all the answers

    Epiphora can occur due to which of the following conditions?

    <p>Chronic dacryocystitis (B)</p> Signup and view all the answers

    What is the most common tumor found in the lacrimal gland?

    <p>Mixed tumor (C)</p> Signup and view all the answers

    Tears begin to be produced in newborns after how many weeks?

    <p>3 weeks (A)</p> Signup and view all the answers

    The nasolacrimal duct opens into the nasal cavity at which location?

    <p>Inferior meatus (A)</p> Signup and view all the answers

    Which treatment is NOT commonly effective for congenital epiphora?

    <p>Daratric probe (D)</p> Signup and view all the answers

    In cases of ectropion, what is a common recommended treatment?

    <p>Surgical correction (D)</p> Signup and view all the answers

    What type of obstruction can result from congenital conditions such as punctual atresia?

    <p>Obstructive epiphora (A)</p> Signup and view all the answers

    What is the primary purpose of a silicone tube during the treatment of nasolacrimal duct obstruction?

    <p>To maintain patency in the nasolacrimal duct (D)</p> Signup and view all the answers

    What is the specific measurement used to assess deficient tear production during diagnosis of dry eye?

    <p>Schirmer’s test (A)</p> Signup and view all the answers

    Which condition is characterized by autoimmune disease leading to atrophy and fibrosis of the lacrimal gland?

    <p>Keratoconjunctivitis sicca (D)</p> Signup and view all the answers

    In probing of the nasolacrimal duct, what direction should the probe be directed after reaching the bony stop?

    <p>Downwards postero-laterally targeting the canine teeth (C)</p> Signup and view all the answers

    What is the typical duration a silicone tube is advised to remain in the nasolacrimal duct?

    <p>6-12 months (A)</p> Signup and view all the answers

    What is a method used to analyze the stability of the tear film in clinical settings?

    <p>Tear film break-up time (TFBUT) (A)</p> Signup and view all the answers

    Which clinical feature is likely observed in patients with deficient tear films as a result of evaporative dry eye?

    <p>Meibomian gland dysfunction (C)</p> Signup and view all the answers

    Which of the following conditions is NOT associated with conjunctival scarring?

    <p>Keratoconjunctivitis sicca (B)</p> Signup and view all the answers

    What is the primary function of the middle aqueous layer of the tear film?

    <p>To supply oxygen needed for corneal metabolism and provide antibacterial properties via lysozymes.</p> Signup and view all the answers

    How does the inner mucinous layer contribute to corneal health?

    <p>It fills irregularities between corneal epithelial cells, creating a smooth surface that is optically important.</p> Signup and view all the answers

    What common symptom is associated with punctal obstruction?

    <p>Epiphora, which is excessive tearing due to decreased tear drainage.</p> Signup and view all the answers

    What is a significant characteristic of acute inflammation of the lacrimal gland?

    <p>It can present as gland enlargement and tenderness, commonly following mumps infection.</p> Signup and view all the answers

    What treatment is generally indicated for cases of ectropion, regardless of cause?

    <p>Treatment of ectropion typically involves surgical intervention to correct the condition.</p> Signup and view all the answers

    What is a common cause of canalicular obstruction in both congenital and acquired cases?

    <p>Trauma or trachoma are common causes of canalicular obstruction.</p> Signup and view all the answers

    In the treatment of punctal obstruction, what is one surgical approach that can be employed?

    <p>Punctoplasty, which involves the use of punctal dilators to restore drainage.</p> Signup and view all the answers

    What condition is indicated by a cystic swelling in the upper fornix due to retention of lacrimal secretion?

    <p>It is typically associated with lacrimal gland inflammation.</p> Signup and view all the answers

    What is the primary causative agent for chronic dacryocystitis?

    <p>Pneumococci are the primary causative agent in 80% of chronic dacryocystitis cases.</p> Signup and view all the answers

    What complication may arise from acute dacryocystitis if untreated?

    <p>Orbital cellulitis and cavernous sinus thrombosis are potential complications of untreated acute dacryocystitis.</p> Signup and view all the answers

    Which symptom is commonly observed during the regurgitation test for chronic dacryocystitis?

    <p>A positive regurgitation test indicates the presence of mucous or pus upon pressure on the swelling of the sac.</p> Signup and view all the answers

    What is the main purpose of dacryocystorhinostomy (DCR) in the treatment of lacrimal sac disorders?

    <p>DCR aims to create a surgical opening between the lacrimal sac and the nasal mucosa to bypass the obstruction.</p> Signup and view all the answers

    During the acute phase of dacryocystitis, what treatment options are utilized?

    <p>Treatment includes systemic and topical antibiotics, hot fomentations, lotions for pus cleaning, and incision if an abscess forms.</p> Signup and view all the answers

    What is a potential outcome if the canaliculi become obstructed during chronic dacryocystitis?

    <p>Obstruction of the canaliculi may lead to the formation of mucocele or pyocele.</p> Signup and view all the answers

    Which condition is indicated by severe pain and fever, alongside swelling over the lacrimal sac?

    <p>These symptoms are characteristic of acute suppurative inflammation of the lacrimal sac.</p> Signup and view all the answers

    What unique challenge does chronic dacryocystitis pose regarding its symptoms?

    <p>Chronic symptoms may include a vicious cycle of epiphora causing secondary conditions like eczema and ectropion.</p> Signup and view all the answers

    What is the main function of the glands located within the conjunctival stroma?

    <p>The main function is to produce tears to lubricate the eye.</p> Signup and view all the answers

    Describe how the tear film spreads over the ocular surface.

    <p>The tear film spreads due to gravity, capillary action, and blinking of the eyelids.</p> Signup and view all the answers

    In which anatomical location do the lacrimal puncti reside?

    <p>The lacrimal puncti are located about 6 mm from the inner canthus on each lid margin.</p> Signup and view all the answers

    What role does the Horner's muscle play in tear drainage?

    <p>Horner's muscle contracts during eyelid closure, creating a negative pressure that aids in suctioning tears into the lacrimal sac.</p> Signup and view all the answers

    Identify the primary arterial supply to the lacrimal gland.

    <p>The primary arterial supply comes from the lacrimal branch of the ophthalmic artery.</p> Signup and view all the answers

    How do the Glands of Krause and Wolfring differ in terms of their distribution?

    <p>Glands of Krause are more numerous and located in the conjunctival stroma, while Glands of Wolfring are fewer and situated near the upper border of the tarsal plate.</p> Signup and view all the answers

    What is the primary function of the nasolacrimal duct?

    <p>The nasolacrimal duct drains tears from the lacrimal sac to the inferior meatus of the nose.</p> Signup and view all the answers

    Explain the significance of Hasner's Valve in the nasolacrimal duct system.

    <p>Hasner's Valve helps to regulate the flow of tears from the nasolacrimal duct into the nasal cavity.</p> Signup and view all the answers

    What is the significance of a silicone tube in the treatment of infantile dacryocystitis?

    <p>A silicone tube is used to maintain patency of the nasolacrimal duct, typically kept in place for 6-12 months.</p> Signup and view all the answers

    Describe the initial steps in probing of the nasolacrimal duct (NLD) for infantile dacryocystitis.

    <p>The NLD is initially dilated using a Nettleship's dilator followed by probing 2mm vertically and 6mm horizontally.</p> Signup and view all the answers

    What are the clinical signs indicative of evaporative dry eye related to meibomian gland dysfunction?

    <p>Irritation, foreign body sensation, and increased tear film instability are common signs.</p> Signup and view all the answers

    What is the role of the Tear Film Break Up Time (TFBUT) in assessing dry eye conditions?

    <p>TFBUT measures the stability of the tear film, indicating how quickly dry spots form on the cornea.</p> Signup and view all the answers

    In cases of dacryocystitis that fail to respond by age four, what surgical procedure might be indicated?

    <p>Dacryocystorhinostomy (DCR) is indicated if congenital obstruction does not resolve by that age.</p> Signup and view all the answers

    What complications may arise from congenital absence of the lacrimal gland?

    <p>Aqueous deficient dry eye and associated symptoms like dry mouth can occur due to insufficient tear production.</p> Signup and view all the answers

    What is keratoconjunctivitis sicca and how does it relate to dry eye conditions?

    <p>It is an autoimmune disorder leading to fibrosis and atrophy of the lacrimal gland, causing severe dry eye.</p> Signup and view all the answers

    How does the presence of conjunctival scarring affect tear film stability?

    <p>Conjunctival scarring can lead to instability in the tear film and contribute to dry eye symptoms.</p> Signup and view all the answers

    What are two main treatments for congenital obstruction of epiphora?

    <p>Hydrostatic massage and dacryocystorhinostomy.</p> Signup and view all the answers

    Name one emotional and one reflex condition that can lead to excessive lacrimation.

    <p>Emotional condition: stress; Reflex condition: conjunctivitis.</p> Signup and view all the answers

    What is the likely diagnosis for a patient with epiphora caused by inadequate tear drainage due to ectropion?

    <p>Defective tear drainage.</p> Signup and view all the answers

    What procedure is typically performed when probing and dilatation fail to treat acquired nasolacrimal duct obstruction?

    <p>Dacryocystorhinostomy.</p> Signup and view all the answers

    Which type of tumors are most commonly associated with the lacrimal gland?

    <p>Mixed tumors.</p> Signup and view all the answers

    After how many weeks does tear production typically begin in newborns?

    <p>Tear production begins after 2 weeks.</p> Signup and view all the answers

    In which anatomical location does the nasolacrimal duct terminate?

    <p>The inferior meatus of the nasal cavity.</p> Signup and view all the answers

    What are two potential causes of obstructive epiphora mentioned in the content?

    <p>Congenital atresia and inflammatory conditions like trachoma.</p> Signup and view all the answers

    What is the primary goal of creating a surgical opening between the lacrimal sac and the nasal mucosa?

    <p>To allow drainage of tears directly into the nose, bypassing the obstructed naso-lacrimal duct.</p> Signup and view all the answers

    What is chronic dacryocystitis, and what typically triggers it in newborns?

    <p>Chronic dacryocystitis is the chronic inflammation of the lacrimal sac due to naso-lacrimal duct obstruction from incomplete canalization.</p> Signup and view all the answers

    What are the contraindications for performing DCR (Dacryocystorhinostomy)?

    <p>Contraindications include bad lacrimal sac conditions with extensive adhesions and bad nasal mucosa like atrophic rhinitis and polypi.</p> Signup and view all the answers

    In the context of naso-lacrimal duct obstruction, what is the purpose of lacrimal sac massage?

    <p>To help rupture any membranes obstructing the duct, facilitating tear drainage.</p> Signup and view all the answers

    What symptom is often associated with a NLD (naso-lacrimal duct) obstruction in newborns?

    <p>Persistent epiphora, or excessive tearing, is a common symptom.</p> Signup and view all the answers

    What is the recommended treatment when probing of the NLD fails for an infant with dacryocystitis?

    <p>If probing fails, dacryocystectomy may be indicated, which involves removal of the lacrimal sac.</p> Signup and view all the answers

    What is the expected outcome of applying pressure to a swollen lacrimal sac in chronic dacryocystitis?

    <p>It typically results in the expression of mucopurulent discharge.</p> Signup and view all the answers

    What initial step is taken during probing of the naso-lacrimal duct?

    <p>The probing is performed through the upper punctum under general anesthesia.</p> Signup and view all the answers

    What is the primary cause of acute suppurative inflammation of the lacrimal sac?

    <p>Naso-lacrimal duct obstruction or chronic dacryocystitis.</p> Signup and view all the answers

    Describe the symptom that would indicate a positive regurgitation test in chronic dacryocystitis.

    <p>Pressure on the swelling of the lacrimal sac causes regurge of mucous or pus.</p> Signup and view all the answers

    List two common complications associated with acute dacryocystitis.

    <p>Orbital cellulitis and cavernous sinus thrombosis.</p> Signup and view all the answers

    What is the recommended initial treatment for chronic dacryocystitis?

    <p>Treat the cause of obstruction, such as relieving congestion or removing a nasal polyp.</p> Signup and view all the answers

    What procedure is considered the operation of choice for managing chronic dacryocystitis?

    <p>Dacryocystorhinostomy (DCR).</p> Signup and view all the answers

    Identify a significant sign that accompanies acute inflammation of the lacrimal sac.

    <p>Tender swelling of the lacrimal sac.</p> Signup and view all the answers

    Which common bacterium is responsible for 80% of chronic dacryocystitis cases?

    <p>Pneumococci.</p> Signup and view all the answers

    What is the purpose of hot fomentations in the treatment of acute dacryocystitis?

    <p>To alleviate pain and promote drainage.</p> Signup and view all the answers

    What is the primary indication for performing Dacryocystorhinostomy (DCR)?

    <p>Chronic dacryocystitis.</p> Signup and view all the answers

    What conservative treatment is commonly recommended for naso-lacrimal duct obstruction in newborns?

    <p>Lacrimal sac massage.</p> Signup and view all the answers

    List one contraindication for performing DCR.

    <p>Bad nasal mucosa, such as atrophic rhinitis.</p> Signup and view all the answers

    What characterizes the symptoms of naso-lacrimal duct obstruction in newborns?

    <p>Persistent epiphora and possible purulent discharge.</p> Signup and view all the answers

    What is the main goal of probing the naso-lacrimal duct in infants?

    <p>To re-canalize the naso-lacrimal duct.</p> Signup and view all the answers

    What should be avoided during the probing of the naso-lacrimal duct to prevent complications?

    <p>Injury to the walls of the duct.</p> Signup and view all the answers

    In cases where DCR cannot be performed, what alternative surgical treatment is indicated?

    <p>Dacryocystectomy.</p> Signup and view all the answers

    What is the typical age at which tears begin to be secreted in newborns?

    <p>3 to 4 weeks after birth.</p> Signup and view all the answers

    What role do goblet cells play in the middle aqueous layer of the tear film?

    <p>Goblet cells secrete mucin, which fills irregularities between corneal epithelial cells to create a smooth corneal surface.</p> Signup and view all the answers

    Explain the difference between acute and chronic inflammation of the lacrimal gland.

    <p>Acute inflammation typically presents with enlargement and tenderness, often due to mumps, while chronic inflammation has milder symptoms and is commonly associated with trachoma.</p> Signup and view all the answers

    How does epiphora occur due to punctal obstruction?

    <p>Epiphora results from decreased tear drainage caused by punctal obstruction, leading to excessive tearing.</p> Signup and view all the answers

    What is the primary symptom of canalicular obstruction?

    <p>The primary symptom of canalicular obstruction is the presence of discharge, often with sulphur granules in cases of canaliculitis.</p> Signup and view all the answers

    Describe the treatment options available for canalicular obstruction.

    <p>Treatment may include stent cannulation, primary repair with silicon intubation, or excision of the occluded part.</p> Signup and view all the answers

    What is the significance of lysozymes found in the middle aqueous layer?

    <p>Lysozymes provide antibacterial properties in tears, helping to prevent infections.</p> Signup and view all the answers

    What treatment is recommended for ectropion regardless of its cause?

    <p>The recommended treatment for ectropion is to address the condition through surgical intervention.</p> Signup and view all the answers

    What does the term 'cystic swelling in the upper fornix' indicate?

    <p>It indicates a retention of lacrimal secretion, often pointing toward inflammation of the lacrimal gland.</p> Signup and view all the answers

    What is the primary function of the lacrimal gland in tear production?

    <p>The lacrimal gland is responsible for secreting tears, which lubricate the surface of the eye and provide nutrients.</p> Signup and view all the answers

    Describe the anatomical location of the lacrimal puncta.

    <p>The lacrimal puncta are small openings located about 6 mm from the inner canthus on each eyelid margin.</p> Signup and view all the answers

    What is the anatomical relationship between the lacrimal sac and the nasolacrimal duct?

    <p>The lacrimal sac is connected to the nasolacrimal duct, which extends to the inferior meatus of the nose.</p> Signup and view all the answers

    What role does the conjunctival goblet cell play in the tear film?

    <p>Conjunctival goblet cells secrete mucins that help to form the mucin layer of the tear film, providing lubrication.</p> Signup and view all the answers

    What are two possible treatments for congenital obstruction of the nasolacrimal duct?

    <p>Hydrostatic massage and dacryocystorhinostomy.</p> Signup and view all the answers

    Identify the two accessory lacrimal glands and their primary locations.

    <p>The Glands of Krause are found mainly near the conjunctival fornices, while the Glands of Wolfring are situated near the upper border of the tarsal plate.</p> Signup and view all the answers

    Identify one condition that can lead to epiphora due to obstructive causes.

    <p>Congenital punctual atresia.</p> Signup and view all the answers

    Explain the mechanism by which Horner's muscle aids in tear drainage.

    <p>During eyelid closure, contraction of Horner's muscle creates negative pressure in the lacrimal sac, promoting suction of tears.</p> Signup and view all the answers

    What is Hasner's Valve, and where is it located?

    <p>Hasner's Valve is a mucosal fold located at the opening of the nasolacrimal duct into the inferior meatus of the nose.</p> Signup and view all the answers

    What type of obstruction is primarily treated with dilatation and probing?

    <p>Acquired obstruction of the nasolacrimal duct.</p> Signup and view all the answers

    What is the average size of the lacrimal sac when distended?

    <p>The lacrimal sac is approximately 15 mm in length and 5 mm in width when distended.</p> Signup and view all the answers

    What emotional condition can lead to excessive lacrimation?

    <p>Crying due to sadness or stress.</p> Signup and view all the answers

    What is a surgical procedure used to treat both congenital and acquired epiphora?

    <p>Dacryocystorhinostomy.</p> Signup and view all the answers

    Describe one major difference between congenital and acquired causes of epiphora.

    <p>Congenital causes are structural defects present at birth, while acquired causes develop later due to injury or disease.</p> Signup and view all the answers

    Which tear system issue is often associated with facial palsy?

    <p>Lacrimal pump failure.</p> Signup and view all the answers

    What is the role of systemic steroids in the treatment of excessive lacrimation?

    <p>They are used to manage autoimmune conditions causing inflammation.</p> Signup and view all the answers

    What is the purpose of a Nettleship’s dilator in probing the nasolacrimal duct?

    <p>It dilates the punctum and canaliculus to facilitate the probing process.</p> Signup and view all the answers

    Describe the typical duration for keeping a silicone tube in the nasolacrimal duct during treatment for infantile dacryocystitis.

    <p>The silicone tube should be kept in place for 6-12 months.</p> Signup and view all the answers

    What condition is indicated when a DCR procedure is necessary for infantile dacryocystitis?

    <p>DCR may be indicated if the condition fails to respond by 4 years of age.</p> Signup and view all the answers

    What are the symptoms of aqueous deficient dry eye?

    <p>Symptoms include irritation, foreign body sensation, and reduced tear film stability.</p> Signup and view all the answers

    How is tear film stability objectively measured in dry eye evaluations?

    <p>It is measured using tests like Tear Film Break-Up Time (TFBUT).</p> Signup and view all the answers

    Which autoimmune condition is commonly associated with keratoconjunctivitis sicca?

    <p>Sjogren's syndrome is often linked to keratoconjunctivitis sicca.</p> Signup and view all the answers

    What is the likely cause of defective oily layer in evaporative dry eye?

    <p>Meibomian gland dysfunction leads to the defective oily layer, causing increased evaporation.</p> Signup and view all the answers

    What initial step is performed during the probing of the nasolacrimal duct for infantile dacryocystitis?

    <p>The initial step involves using a Nettleship’s dilator for dilation.</p> Signup and view all the answers

    Study Notes

    Lacrimal Apparatus

    • Almond-shaped gland located at upper-outer orbit angle in lacrimal fossa
    • 12 ducts of gland open into upper fornix
    • Supplied by lacrimal branch of ophthalmic artery and infraorbital branch of maxillary artery
    • Drains into superior ophthalmic vein
    • Small glands (Glands of Krause) similar to lacrimal glands, located within conjunctival stroma near fornices (approximately 20 in upper lid, 8 in lower lid).
    • Glands of Wolfring are few, situated near tarsal plate's upper border
    • Sebaceous Zeis glands and meibomian glands, and conjunctiva goblet cells are also part of lacrimal system

    Excretory System

    • Two small openings (lacrimal puncta) on each eyelid margin, 6mm from inner canthus
    • Two narrow, tubular canaliculi lie above each other, separated by caruncle
    • Lacrimal fossa, formed by lacrimal bone & frontal maxilla process
    • Lacrimal sac (15mm long, 5mm wide when distended) connects to nasolacrimal duct
    • Nasolacrimal duct is a membrane canal (approximately 2cm long) extending from sac to inferior meatus of nose, covered by Hasner's valve
    • Horner's muscle part of orbicularis, surrounding sac, contracts to create negative pressure during lid closure, drawing tears from conjunctival sac

    Precorneal Tear Film Layers

    • Outer Lipid Layer: Secreted by meibomian glands, prevents tear evaporation, lubricates eyelids
    • Middle Aqueous Layer: Secreted by lacrimal & accessory lacrimal glands, supplies oxygen, antibacterial (lysozymes), washes away foreign particles
    • Inner Mucoid Layer: Secreted by Goblet cells, Crypts of Henle, and Glands of Manz, makes corneal epithelium hydrophilic, fills irregularities between corneal epithelial cells, creates optically smooth surface

    Diseases of Lacrimal Gland

    • Dacryoadenitis: Inflammation of lacrimal gland, acute (common mumps complication), chronic (usually with trachoma)
    • Dacryops: Cystic swelling in upper fornix due to lacrimal secretion retention, characteristic S-shaped lid deformity
    • Dacryocystitis: Acute suppurative inflammation of lacrimal sac, caused by bacteria (pneumococci, staphylococci, streptococci)
    • Chronic Dacryocystitis: Common lacrimal sac disorder, naso-lacrimal duct obstruction, causative agents include pneumococcal, staphylococcal bacteria, and fungi. Watery eye, discharge, swelling (below medial palpebral ligament), +ve regurgitation test
    • Infantile Dacryocystitis: Chronic inflammation of newborn's lacrimal sac due to naso-lacrimal duct obstruction, characterized by membrane, accumulation of epithelial debris, and continuous watering.

    Diseases of Lacrimal Passages

    • Punctum: Epiphora (excessive tearing) the main symptom of punctal obstruction. Congenital atresia, chronic blepharitis, acquired trauma, or trachoma are causes.
    • Punctal Eversio: Epiphora, a condition where tearing is excessive, can be caused by moving puncta away from lacrimal lake, causing tears to not drain properly.
    • Canaliculitis: Actinomyces Israeli (shows discharge containing sulphur granules) causes canaliculitis.
    • Canalicular Obstruction: Congenital atresia, acquired trauma, or trachoma or causes; stent cannulation and primary repair with silicone intubation or excision of occluded part followed by re-suturing, are treatment options

    Dry Eye

    • Common condition where eyes don't have enough lubrication due to inadequate tear production or excessive evaporation
    • Types: Aqueous deficient and evaporative
    • Etiology: Congenital absence of lacrimal gland, lacrimal gland inflammation (sarcoidosis), tumors. autoimmune disease (keratoconjunctivitis sicca), infections (virus, bacteria, fungi), etc
    • Clinical features: irritation, decreased tear production (Schirmer's test), punctate epithelial erosion, diminished tear break-up time (BUT)

    Watery Eye

    • Excessive lacrimation due to emotional conditions, reflex (foreign body, blepharitis, conjunctivitis), defective tear drainage (Lid margin abnormality, ectropion, orbicularis muscle facial palsy. )
    • Obstructive epiphora from congenital, inflammatory (trauma, infections, tumors),
    • Treatment: of cause, or dacryocystorhinostomy or dacryocystectomy

    Questions

    • Sjögren's Syndrome: Atrophy and fibrosis of lacrimal and salivary glands
    • Epiphora: occurs with trachoma, chronic dacryocystitis (inflammation of the lacrimal sac), acute congestive glaucoma
    • Lacrimal Gland Tumor: Most common is mixed tumor
    • Tear Production in Newborns: After 3 weeks
    • Nasolacrimal Duct Opening: Inferior meatus of nose

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