Diseases of the lacrimal system.
Disorders of the Lower Lacrimal System
Dacryocystitis
Inflammation of the lacrimal sac. It is usually the result of obstruction of the nasolacrimal duct and is unilateral in most cases.
Dacryocystitis acuta / Dacryocystitis purulenta or phlegmonosa
Etiology: most common pathogens are Staphylococci, Pneumococci, Pseudomonas aeruginosa, due to the obstruction (congenital, after infection, trauma or operation of paranasal sinuses)
Symptoms: Strong pain (radiating to forehead and area of teeth), reddening, swelling and warming of lacrimal sac,fever, lymphadenopathy. In incomplete obstruction of lacrimal duct, pus leaves punctum lacrimale If infection spreads: Dakyophglemone → increased risk of sinus cavernosus thrombosis
DD: Hordeolum (gerstenkorn), orbital cellulitis associated with reduced motility of eyeball
Treatment
- acute inflammation: local and systemic antibiotics, desinfecting compresses, ggf incision
- after actue inflammation: Dacryozystography
Chronic Dacryocystitis
Etiology: Obstruction of ductus nasolacrimalis with chronic conjunctivitis or rhinitis, tumors of lacrimal sac.
Symptoms: Epiphora, no signs of inflammation visible, widening of lacrimal sac, chronic conjunctivitis at medial angle. Applying pressure to the inflamed lacrimal sac causes large quantities of transparent mucoid pus to regurgitate through the punctum. Chronic inflammation of the lacrimal sac can lead to a serpiginous corneal ulcer.
Treatment: Surgical intervention is the only effective treatment in the vast majority of cases. This involves either a dacryocystorhinostomy (creation of a direct connection between the lacrimal sac and the nasal mucosa; or removal of the lacrimal sac.
Dacryocystitis Neonatorum / congenital dakryo stenosis
Epidemiology: 5- 7% of neonates
Canaliculitis
Definition: Inflammation of the lacrimal ducts
Etiology: Rarerly isolated, pathogens: Aktinomyceten, Nocardia, Fungi, Mycobacteria, Candida albicans, Asperigillus, Chlamydia
Symptoms:The canaliculus region is swollen, reddened, and often tender to palpation. Pus or granular concrements can be expressed, epiphora, accompanying conjunctivitis
Treatment: Antibiotics with eyedrops and ointments according to pathogens. Successful treatment occasionally requires surgical incision of the canaliculus.
Diseases of the lacrimal gland
Keratoconjunctivitis sicca (aka Sicca syndrome, tockenes Auge, Xerophtalmie)
Epidemiology: About 30% of all 40 yo, >80% women
Pathophyiology: Tear film is insufficient or instable → disturbed use of cunjuctiva and cornea → non infectios Keratopathy.
Etiology
- insufficient secretion of tears: lacrimal gland atrophy due to age (most often cause), aplasia of lacrmial gland, Sjörgen – Sydnrom, SLE, Sarkoidose, Leukemia, Trachom, rheumtoid arthritis, Mumps, chronic Dakryoadenitis, tumours, chronic conjunctivitis
- disturbance of mucin layer: Vitamin A deficiency, Steven- Johnson Syndrome, chronic cunjunctivitis, burns,
- disturbance of lipid layer: chronic Blepharitis, injuries