Lacrimal Disorders
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Transcript Lacrimal Disorders
Oculoplastics and Lacrimal
Disorders
Epiphora
Blepharitis
Nasolacrimal duct occlusion
Eyelid malposition
Ectropion
Entropion
Eyelid tumours
Basal cell carcinoma
Squamous cell carcinoma
Epiphora: Anatomy and Physiology
Blepharitis
• Blepharitis involving
predominantly the skin and
lashes tends to be staphylococcal
and (or) seborrheic in nature,
whereas involvement of the
meibomian glands may be either
seborrheic, obstructive, or a
combination (mixed).
• The pathophysiology of
blepharitis is a complex
interaction of various factors,
including abnormal lid-margin
secretions, microbial organisms,
and abnormalities of the tear
film.
Management
• The mainstay of treatment is an
eyelid hygiene regimen, which
needs to be continued long term
– Warmth
– Massage
– Cleansing
•
Topical antibiotics are used to
reduce the bacterial load.
• Topical corticosteroids and oral
antibiotic preparations may be
helpful in patients with marked
inflammation with specialist
monitoring
OMG- I’ve been
diagnosed with
blepharitis
Nasolacrimal duct obstruction
• Occurs in approximately 5-6% of
infants.
• A sticky, watery eye with positive
regurgitation on pressure over
the lacrimal sac confirms the
diagnosis.
• As there is a high spontaneous
rate of remission (60-90%) in the
first year of life, probing should
be delayed until 10-12 months of
age.
• Parents can be instructed to
undertake lacrimal sac massage
during the intervening period.
Earlier probing is only justified if
their is severe recurrent infection.
Recanalisation: Probing to DCR
• Probing of the naso-lacrimal
duct is the first line of
treatments
• With persistent epiphora
and recurrent infection, it
may be necessary to
perform a
dacryocystorhinostomy
(DCR).
• Bicanalicular silicone
incubation with Crawford,
Juneman or Ritleng tubes
can be carried out
Eyelid malposition
Tumours: Benign
Steps to differentiating benign
from malignant
Basal Cell Skin Cancer
Small raised bump
Smooth, pearly
appearance.
Central necrotic area
Telangectasia
Sometimes like a scar that is
flat and firm to the touch.
Squamous Cell Carcinoma
Sun exposed areas of skin
such as the ears, lower lip,
and the back of the hands
Skin that have been burned
or exposed to chemicals or
radiation
Often appears as a firm red
bump, may feel scaly or
bleed or develop a crust
Sebaceous carcinoma
Chronic blepharitis
Recurrent chalazion
Melanoma
Change
Contour
Colour
Size