Transcript tearing due to outflow problem

Tearing Due to Block
Drainage System
Kimberly Cockerham, MD, FACS
Plastics-Orbit-Adult Strabismus
Zeiter Eye Medical Group, Inc.
Systematic Approach to
Tearing
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Dry
Wet
Other
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Ocular Surface
Eyelid
Orbit
The “Wet” Eye
Tear Lake High
Delayed Dye Disappearance
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2% Fluorescein in each eye
Abnormal test if:
Asymmetric
Persistent dye at:
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5 min in young
15 min in elderly
Anatomy
Puncta
Canaliculus
Lacrimal sac
Lacrimal duct
Evaluation of the Wet Eye
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If there is delayed dye disappearance:
 Inspect the puncta
 Push on lacrimal sac
 Probe the canaliculi
 Irrigate the nasolacrimal system
Punctal Stenosis
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Inflammation
Topical drops
Exposure
RX = punctopexy
Punctal Infiltration
RX = Excision and Reconstruction
Canalicular Abnormality
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Infection (canaliculitis)
Trauma
Chemotherapy
Topical medications (glaucoma drops)
Canaliculitis
Actinomyces: three snip followed by topical Pen G
Nasolacrimal Duct Obstruction
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Infection
Inflammation
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Wegner’s
Sarcoidosis
Steven’s Johnson
Herpes
Intranasal abnormality
Dacryocystitis
Lacrimal Sac Mass
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Inflammation
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Sarcoidosis
Non-specific inflammation
Neoplasia
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Squamous cell carcinoma
Lymphoma
Evaluation of the Wet Eye
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Irrigation
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Jones I
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Flows freely to mouth or nose
System not structurally blocked
Functional block still possible
No irrigation
Is Fluorescein detected in nose ?
Jones II
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Irrigate after Jones I
Is Fluorescein detected in nose ?
The Role of Imaging
Proximal Canalicular
Stenosis
Endoscopic View: Canalicular Stenosis,
RX = KTP laser
Extensive Stenosis
RX = Jones Tube
Dacryocystorhinostomy (DCR)
A Systematic Approach to Tearing
Dry:
Tear Lake Low
Normal Dye Disappearance
Other:
Tear Lake Often Normal
Dye Disappearance Often Normal
Wet:
Listen and Look for Clues
Tear Lake High
Delayed Dye Disappearance
Questions….Concerns ?
Kimberly Cockerham, MD, FACS
Plastics – Orbit – Adult Strabismus
Zeiter Eye Medical Group, Inc.