Lacrimal System Diseases Overview

Lacrimal System Diseases

• The presentation covers various diseases related to the lacrimal system
• Diseases include congenital anomalies, acquired lacrimal disease, dacryocystitis, dacryoadenitis, and canaliculitis
• Specific types discussed include congenital dacryocele, and congenital nasolacrimal duct obstruction (NDO)
• Acquired NDO may be primary or secondary depending on the cause

Congenital Lacrimal Anomalies

• Congenital dacryocele (aka dacryocystocele, amniotocele, mucocele) is present at birth, often unilateral
• It's caused by an obstruction in the canalicular opening in the lacrimal sac
• The obstruction causes a bluish-gray cystic swelling of the lacrimal sac
• Symptoms include a firm swelling when palpated
• Possible differential diagnosis includes meningoencephalocele, capillary hemangioma, and dermoid cyst

Congenital Nasolacrimal Duct Obstruction (NDO)

• Approximately 6% of newborns (as high as 20% may show symptoms) have NDO
• NDO is often caused by incomplete canalization of the nasolacrimal duct
• It typically involves an obstruction of the nasolacrimal duct at the nasal end
• Infants with trisomy 21, EEC Syndrome, branchiooculofacial syndrome, CHARGE syndrome, or Goldenhar Syndrome have an increased risk of NDO
• Symptoms typically include chronic tearing with or without debris

Clinical Presentation (General)

• Patients experiencing chronic/intermittent tearing and debris or swelling are key indicators
• Firm swelling could be indicative of problems
• Additional symptoms may include erythema, purulent discharge, increased tear meniscus, increased tearing, blood-stained tears or discharge, and discharge/crusting.

Treatment (General)

• Conservative management often includes warm compresses and digital massage
• Antibiotics may be necessary, especially if infections are present.
• Probing or surgery may be required for more severe cases
• Spontaneous resolution is possible in many cases, particularly within several months

Acquired Lacrimal Disease (NDO)

• Acquired NDO, often termed PANDO/SANDO, may be a result of non-specific inflammation in the tear drainage system
• Possible causes include infections, inflammation, neoplasms, trauma, or mechanical blockages
• The clinical diagnosis involves observing the disappearance of dye, dilation, and irrigations testing; Jones I/II procedures may also be used

Dilation and Irrigation (D&I) Procedure

• Dilation of the tear duct and irrigation with saline solution aid in relieving blockages
• A blunt-tipped 21/23-gauge lacrimal cannula is essential
• Repeated procedures or anesthetic application may be required

Dacryostenosis

• This is another name for NDO
• There may be issues with the valve

Dacrocystorhinostomy (DCR)

• A surgical procedure to create a new pathway for tears to drain into the nose
• This is used when the tearing passage is blocked
• The surgery bypasses the blocked tear drainage system

Dacrycystitis

• Inflammation within the nasolacrimal sac, often caused by obstruction of the tear drainage passage
• It can be acute or chronic and congenital or acquired regardless of the type.
• It is common in Caucasian adults with about 75% of cases found in women
• Acute dacryocystitis is caused by obstruction of the nasolacrimal duct (tears stagnate, bacteria proliferate; becomes infection)
• Possible obstruction causes include long/narrow nasolacrimal ducts, sacs, or trauma
• Chronic dacryocystitis is caused by chronic infection, inflammation, or tumor

Acute Dacryoadenitis

• Related to infection (with bacteria like Staphylococcus aureus and Streptococcus pneumoniae, as well as viral infections, including Epstein-Barr, adenovirus, mumps, herpes simplex, and herpes zoster)
• Usually unilateral, but may be bilateral
• Common in children and young adults
• Characterized by temporal upper eyelid swelling, erythema, warmth, and tenderness, and possible symptoms such as fever, discharge, tearing, conjunctival chemosis, and swollen preauricular nodes

Chronic Dacryoadenitis

• Most often associated with inflammation or systemic issues (including, but not limited to, Sjögren syndrome, sarcoidosis, Crohn's disease, and granulomatosis with polyangiitis)

Caniculitis

• This inflammation of the lacrimal canaliculus may be primary or secondary
• Primary canaliculitis often develops from infection.
• Secondary canaliculitis often originates from issues with punctal plug placement or intubation
• Usual organisms include Actinomyces israelii, Staphylococcus species, Streptococcus species, or Pseudomonas aeruginosa
• It is often misdiagnosed initially

Other Important Issues

• Differential diagnosis must include related conditions such as glaucoma
• Acquired lacrimal disease can involve a blockage in the lacrimal outflow system

This quiz explores various diseases of the lacrimal system, including both congenital and acquired conditions. Key topics include congenital anomalies, dacryocystitis, and the differences between primary and secondary nasolacrimal duct obstruction. Test your knowledge on the signs, symptoms, and diagnoses of these fascinating medical conditions.