Ocular Disease - Lacrimal Disorders
Last Modified: 2013-02-10
- Maintain cornea and conj in normal state
- Provide lubrication and oxygen for cornea and conj
- Ensure smooth refraction surface
- Pathway for movement of cytokines and proteins secreted by the lacrimal gland
- CN VII damage
- Multiple Neuromatosis
- System Rx - antihistamines, beta blockers, antispasmodic, diuretics, TCA, SSRI, psychotropics
- Intermittent burning and tearing
- Grittiness, FB sensation
- itching and redness
- intermittent blurred vision
- mattering of lids and lashes
- Reduction in height of inferior tear meniscus
- Cellular debris in tear film
- abnormal accumulation of mucus in inferior cul de sac
- conjunctival injection
- dull appearance of eye
- ave tear meniscus height is 0.2 mm
- tear film debris and mucus strands (mod-severe)
- assess lipid layer - thin appears gray, thick has bright colors
- Blepharitis - due to staph - scaly exudate around eyelash bases, dilated BV on lid margin
- Meibomianitis - inflammation around MG orifices, pouting of gland orifices, solification of secretions - low TBUT
Tear Evaporation RateNormal: 15-45 secBorderline: 10-15 secAbnormal: <10 sec
lowest when awake and rises for first two hours then remains constant throughout the day
- Mild to moderate symptoms; no signs.
Mild to moderate conjunctival signs
- Patient counseling, preserved tears,
environmental management, use of
hypoallergenic products, water intake.
- Moderate to severe symptoms. Tear film signs, mild corneal punctate staining, corneal staining, visual signs.
- Unpreserved tears, gels, ointments, cyclosporine A, secretagogues (A secretagogue is a substance that causes another substance to be secreted.) topical steroids, nutritional support (flaxseed oil).
- Severe symptoms. Marked corneal punctate staining, central corneal staining, filamentary keratitis.
- Tetracyclines, punctal plugs.
- Severe symptoms. Severe corneal staining, erosions, conjunctival scarring.
- Systemic anti-inflammatory therapy
- Oral cyclosporine,
- Moisture goggles,
- Punctal cautery,
Glycerin-containing ProductsCarboxymethylcellulose (CMC) - Refresh tears, Refresh liquigelHypromellose (HPMC) - Tears Naturelle, Genteal
Lipid-based ProductsGlycerin - Advanced Eye ReliefGlycerin w/ HPMC - Tears Naturelle Forte, VisineGlycerin w/ CMC - Optive
Polyethylene Glycol and Propylene GlycolRefresh Edura, Soothe
PEG & PG with HP Guar, Systane Ultra
- strands of mucous attached to the epithelial surface
- often unilateral and recurring
- patients with extremely dry eye
- tx: remove strands with forceps and rx ATs and ointments
30% newborns have delayed valve of Hasner opening - most open spontaneously within months
Dacryostenosis - narrowing of canaliculi
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