Ophthalmology · MU Sofia

33. Diseases of the lacrimal gland - acute and chronic dacryoadenitis, mikulicz syndrome, tumours of the lacrimal gland (Dry eyes, excessive waterig)

Covers dry eye as a symptom complex, its causes such as aqueous, mucin and lipid deficiency, and the tests used (tear break-up time and Schirmer test) with treatment options. It then explains watering eye, separating hyperlacrimation from epiphora and listing mechanical obstruction sites along the lacrimal drainage path. The note ends with swelling of the lacrimal gland, including acute and chronic dacryoadenitis, Mikulicz's syndrome, dacryops and lacrimal gland tumours, with two pictures.

Inside: 2 sections · 2 labelled pictures · 15 flashcards · 4 min

Topic 33 of 91 in the MU Sofia syllabus for Ophthalmology (Medicine, Year 4). The free AceMed note covers it in 2 sections, about 515 words (4 min of reading), with 15 flashcards.

In this note

  1. Lacrimal gland diseases Topic 23
  2. Swelling of lacrimal gland

Lacrimal gland diseases Topic 23

1. The dry eye

  • It is not a disease but complex of symptoms occurring due to a deficiency or abnormality of the tear film 7
  • Causes : Aqueous deficiency (keratoconjunctivitis sicca) (siorgen syndrome)
  • Mucin deficiency dry eye : goblet cell damage due to conjunctival damage or hypovitaminosis A, trachoma, burns radiations etc.
  • Lipid deficiency : rare ;during absence of meibomian glands /lipid abnormalities
  • Impaired Eye lid function : Expose keratitis ,symblepharon, lagopthalamos ectropian
  • Disturbances in the Epithelium of cornea as it can affect stability of tear film
  • Symptoms: irritation ,foreign body ,dryness, itching, discomfort & sore eyes
  • Signs: stringy mucus and particle like matter in tear film, conjunctival dryness, no tear strop and corneal changes → epithelial erosions
  • Tests :BUT (break up time)→ interval between blink and appearance of first randomly distributed dry spot in cornea→ less than 10 seconds=unstable film Schirmer test measure total secretions, performed with filter paper and extent of wetting is measured in distance, less than 15mm is abnormal
  • Treated : artificial tears + cyclosporine reducing inflammation Evaporation decreased by decreasing room temp+ use of protective glasses Decrease of drainage : collagen implants, tissue adhesive, laser occlusion etc.

2. The watering eye

  • Overflow of tears from the conjunctival sac either due to oversecretion of tears (Hyperlacrimation ) or obstruction of outflow (epiphora)
  • Hyperlacrimation : (primary rare which is direct stimulation of gland) Reflex: stimulation of 5th sensory due to irritation of cornea/conjunctiva Causes: lid (stye, hordeolum internum, Meibomitis,trichiasis,entropion) Conjunctiva: (conjunctivitis: infective and allergic, toxic, irritative traumatic) Sclera: episcleritis and scleritis Uveal: irititis, cyclitis, iridocyclitis ; glaucomas, orbital cellulitis
  • Epiphora Physiological → lacrimal pump failure due to lid laxity /weakness of orbicularis Mechanical obstruction → punctum, canaliculus, lacrimal sac /nasolacrimal duct Punctual; eversion→ laxity of lids, chronic conjunctivitis/blepharitis/ectropian Obstruction → congenital absence, cicatrical closure after injuries/burns/infections, rarely presence of cilia blocking it Canaliculi→ congenital obstruction, acquired→ foreign body,trauma,infection Lacrimal sac→ traumatic &congenital strictures , dacryocystitis Nasolacrimal duct→ congenital, traumatic ,inflammatory ,tumours ,bone problems -Examination in low light (avoid reflex)to check for punctual causes & swelling of sac -regurgitation test→ pressure on lacrimal sac and if mucopurulent→dacryocystitis
  • Syringe test: saline pushed down punctum ; if slow/no passage =obstruction
  • Dacryocystography→ radiopaque substance injected then x-rays checking location

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