Disease of Lacrimal
Apparatus
Presented by : Pranay Gahat
M optom 1st year
Anatomy of Lacrimal Apparatus
• The lacrimal apparatus is not fully developed at birth. The lacrimal
gland will continue to grow and develop until the child is about 3 to 4
year old.
Lacrimal glands
Lacrimal gland includes main and
accessory .
• Main lacrimal gland
It consist of an upper orbital and lower
palpebral part .
1. Orbital part
Orbital part is larger , about the size and of a small almond , and is situated in the fossa
at the outer part of the orbital plate of fronral bone .
2. Palpebral part
palpebral part is small and consider of only one or lobules . It is situated upon the course
of the ducts of orbital part and separated by LPS muscle.
• Accessory lacrimal gland
1 . Gland of Krause . These are microscopic gland lying beneath the palpebral conjunctiva
between fornix and the edge of tarsus.
2. Glnad of Wolfring . These are present near the upper border, of the superior tarsal plate
Dieses of Lacrimal Apparatus
Epiphora: it is characterised by overflow of tears from the conjunctival
sac. The condition may occur either due to excessive secretion of tears or
may result from inadequate drainage (outflow) of normal secreted tears .
Causes of hyperlacrimation
1. Primary hyperlacrimation . It may occur in early stages of Lacrimal
gland tumours and cyst and due to the effect of strong
parsympathomimetic drugs.
2. Reflex hyperlacrimation. It results from stimulation of sensory
branches of fifth nerve due to irritattion of cornea and Conjunctival.
2 . Cause of epiphora:
• Physiolocal cause is lacrimal pump failure due to lower lid laxity or
weakness of orbicularis muscle.
• Mechanical obstructions in Lacrimal passages may lie at the level of
punctum, canaliculus , lacrimal sac , nasolacrimal duck .
Clinical evaluation for watering eye
1. Ocular examination with diffuse illumination using magnification
2. Fluorescein dye disappears test (FDDT)
3. Regurgitation test .
4. Lacrimal stringing test.
5. Jones dry eye
Congenital Dacryocystitis
• It is an inflammation of the lacrimal sac occuring in newborn
infant;and and thus also knows as dacryocystitis neonatorum.
Etiology
• Membranous occlusion at it’s lower end , near the valve of Hasner is
Common cause.
• Common bacteria associated with congenital dacryocystitis are
staphylococci , pneumococci and streptococci.
Clinical feature
• Epiphora , usually developing after seven days of birth. It is followed
by copious mucopurulent discharge from the eye .
• Regurgitation test is usually positive, i.e , when
pressure is applied over the lacrimal sac area,
purulent discharge from lower punctum.
• Swelling on the sac area may appear
eventually.
Treatment : depend upon the age at which the child is brought . The
treatment modalities employed are as follows:
• Massage over the lacrimal sac area and topical antibiotics constitute
the mainstay of treatment of congenital NLD block.
• Lacrimal syringing with norml saline and antibiotic solution. Lacrimal
irrigation help to open the membranous occlusion by exerting
hydraulic pressure. Syringing may done once a week or once in two
weeks .
• Probing of NLD with Bowman’s probe . It should be performed in
case the condition is not cured by the age of 6 months. It usually
performed under general anesthesia . In most instance , a single
probing will relieve the obstruction .
• Dacryocystorhinostomy (DCR) : When the child is brought very late
or repeated probing , then conservative treatment by massaging ,
topical antibiotics and intermittent lacrimal syringing should be
continued up to 4 year . After that DCR should be performed.
Congenital dacryocoele
• A congenital dacryocoele (amniontocoele) is collection
of amniotic fluid or mucus in the lacrimal
sac caused by an imperforate Hasner
valve. Appear as bluish cystic swelling .
• Treatment :
Resolution is Common with only conservative
treatment , but if this fail, probing is usually
adequate.
Thank you
