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Tearing Due to Block Drainage System

Tearing Due to Block Drainage System. Kimberly Cockerham, MD, FACS Plastics-Orbit-Adult Strabismus Zeiter Eye Medical Group, Inc. Systematic Approach to Tearing. Dry Wet Other Ocular Surface Eyelid Orbit. The “Wet” Eye. Tear Lake High Delayed Dye Disappearance.

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Tearing Due to Block Drainage System

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  1. Tearing Due to Block Drainage System Kimberly Cockerham, MD, FACS Plastics-Orbit-Adult Strabismus Zeiter Eye Medical Group, Inc.

  2. Systematic Approach to Tearing • Dry • Wet • Other • Ocular Surface • Eyelid • Orbit

  3. The “Wet” Eye Tear Lake High Delayed Dye Disappearance

  4. 2% Fluorescein in each eye • Abnormal test if: • Asymmetric • Persistent dye at: • 5 min in young • 15 min in elderly

  5. Anatomy Puncta Canaliculus Lacrimal sac Lacrimal duct

  6. Evaluation of the Wet Eye • If there is delayed dye disappearance: • Inspect the puncta • Push on lacrimal sac • Probe the canaliculi • Irrigate the nasolacrimal system

  7. Punctal Stenosis • Inflammation • Topical drops • Exposure RX = punctopexy

  8. Punctal Infiltration RX = Excision and Reconstruction

  9. Canalicular Abnormality • Infection (canaliculitis) • Trauma • Chemotherapy • Topical medications (glaucoma drops)

  10. Canaliculitis Actinomyces: three snip followed by topical Pen G

  11. Nasolacrimal Duct Obstruction • Infection • Inflammation • Wegner’s • Sarcoidosis • Steven’s Johnson • Herpes • Intranasal abnormality Dacryocystitis

  12. Lacrimal Sac Mass • Inflammation • Sarcoidosis • Non-specific inflammation • Neoplasia • Squamous cell carcinoma • Lymphoma

  13. Evaluation of the Wet Eye • Irrigation • Flows freely to mouth or nose • System not structurally blocked • Functional block still possible • Jones I • No irrigation • Is Fluorescein detected in nose ? • Jones II • Irrigate after Jones I • Is Fluorescein detected in nose ?

  14. The Role of Imaging

  15. Proximal Canalicular Stenosis Endoscopic View: Canalicular Stenosis, RX = KTP laser

  16. Extensive Stenosis RX = Jones Tube

  17. Dacryocystorhinostomy (DCR)

  18. Dry:Tear Lake Low Normal Dye DisappearanceOther: Tear Lake Often NormalDye Disappearance Often NormalListen and Look for CluesWet:Tear Lake High Delayed Dye Disappearance A Systematic Approach to Tearing

  19. Questions….Concerns ? Kimberly Cockerham, MD, FACS Plastics – Orbit – Adult Strabismus ZeiterEye Medical Group, Inc.

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