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Watery Eyes
Published in Amy-lee Shirodkar, Gwyn Samuel Williams, Bushra Thajudeen, Practical Emergency Ophthalmology Handbook, 2019
Watery eyes, termed epiphora, may be the least of your worries on a Friday afternoon, but to the patient, epiphora can be disabling. Epiphora occurs when there is the slightest imbalance of tear production and absorption and can occur due to problems with any part of the lacrimal apparatus causing increased tear production.
Head and neck
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
The lacrimal apparatus consists of the following: Lacrimal punctum is located at the medial canthus – upper and lower canaliculi lead from it to the lacrimal sac, travelling beneath the upper and lower limbs of the medial canthal ligament.Lacrimal sac drains into the nasolacrimal duct, which empties into the inferior meatus of the lateral wall of the nose; the sac is pulled open during contraction of the palpebral fibres of orbicularis oculi and closes by elastic recoil. Valves in the canaliculi prevent reflux.
Sensory organs
Published in Aida Lai, Essential Concepts in Anatomy and Pathology for Undergraduate Revision, 2018
Lacrimal apparatus– lacrimal gland → excretory ductules → superior fornix of conjunctival sac → sup./inf. lacrimal papilla → punctum → sup./inf. lacrimal canaliculi → lacrimal sac → nasolacrimal duct → inf. meatus of nose
Congenital alacrima
Published in Orbit, 2022
Zhenyang Zhao, Richard C. Allen
A quantitative evaluation for tear production is carried out by Schirmer’s test, which remains the gold standard for diagnosing alacrima. Schirmer I is performed without topical anesthetics and tests for both basal and reflex secretion. A result of less than 5 mm of wetting after 5 minutes on Schirmer I confirms alacrima. The basal secretion rate, which is tested by Schirmer II, is variable among alacrima cases possibly relating to the remaining function from accessory lacrimal glands. The use of Schirmer III test, which anaesthetizes the cornea with nasal stimulation, is occasionally reported, but is difficult due to lack of patient cooperation, especially in children.49 The phenol red thread test can be useful in pediatric patients, which is less invasive with a shorter testing time. However, a result of less than 5 mm after 15 seconds has high sensitivity but low specificity.69 Once alacrima is determined, a focused ophthalmic exam should be conducted to evaluate the lacrimal apparatus for lacrimal duct abnormalities, the pupillary reaction for tonic pupil or anisocoria, the ocular surface for associated complications and the fundus exam for retinopathy or optic neuropathy. An orbital ultrasound, CT or MRI could be performed to look for any anatomical or developmental anomaly of the lacrimal glands.
High nasolacrimal sac-duct junction anatomical variation – retrospective review of dacryocystography images
Published in Orbit, 2021
Valerie Juniat, John Lee, Paul Sia, David Curragh, Thomas G Hardy, Dinesh Selva
In any case, knowledge of any anatomical variations may be of clinical relevance in the management of NLD pathology for patients, particularly those with epiphora, especially with recent advancements in dacryoendoscopy and NLD intubation, which necessitate familiarity with the anatomy of the lacrimal apparatus. Indeed, the presence of such anatomical variation may imply a more difficult, and possibly unsuccessful, intubation of the NLD. This is because the course of a probe or stent that is being inserted in this situation, combined with the angulation of the NLD entrance at the sac, may naturally lead into the close-ended part of the inferior sac rather than into the NLD. Anecdotally, we experienced difficulties in probing four adult patients with this anatomical variation despite using a dacryoendoscope.
Primary tubercular dacryocystitis – a case report and review of 18 cases from the literature
Published in Orbit, 2019
Poonam Sagar, Ravi Shankar, Vikram Wadhwa, Ishwar Singh, Nita Khurana
Tubercular dacryocystitis can occur at any age especially in endemic countries. In our review of 18 cases, age group ranged from 14 months to 60 years. There were 11 females and 7 males. Clinical features of dacryocystitis are epiphora and medial canthus swelling. It is very important to ask for any nasal complaints as 8 out of 18 reported cases were associated with nasal tuberculosis.5–9,12,13 Two cases had associated cutaneous tuberculosis and one had peri-ocular tuberculosis.12,16 Three patients had lacrimal fistula at presentation.3,6,15 History of failed lacrimal surgeries should raise suspicion and patients need to be investigated for underlying cause. Six out of 18 cases had failed drainage procedures in our study5,6,8,12,13,16 (Table 1). Family history of tuberculosis should be sought as a possible source of infection.3 Examination should include regional lymph node evaluation, nasal endoscopy, and any local swelling or ulcer should be carefully examined apart from lacrimal apparatus. Lymph node tuberculosis was found to be associated with two cases in our review.9,15 The importance of detecting an enlarged lymph node is that it may provide valuable clues for the cause of dacryocystitis on subsequent aspiration cytology.15 Nasal endoscopy is an essential tool for detecting any suspicious lesion in nasal cavity. Any granulations or congested friable mucosa in inferior meatus or middle turbinate should prompt for pre-operative biopsy and confirming diagnosis.