Tearing Due to Block Drainage System
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Tearing Due to Block Drainage System
Kimberly Cockerham, MD, FACSPlastics-Orbit-Adult Strabismus
Zeiter Eye Medical Group, Inc.
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Systematic Approach to Tearing
Dry Wet Other
Ocular Surface Eyelid Orbit
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The “Wet” Eye
Tear Lake HighDelayed Dye Disappearance
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2% Fluorescein in each eye Abnormal test if: Asymmetric Persistent dye at:
5 min in young 15 min in elderly
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Anatomy
Puncta
Canaliculus
Lacrimal sac
Lacrimal duct
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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
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Punctal Stenosis Inflammation Topical drops Exposure
RX = punctopexy
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Punctal Infiltration
RX = Excision and Reconstruction
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Canalicular Abnormality Infection (canaliculitis) Trauma Chemotherapy Topical medications (glaucoma
drops)
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Canaliculitis
Actinomyces: three snip followed by topical Pen G
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Nasolacrimal Duct Obstruction
Infection Inflammation
Wegner’s Sarcoidosis Steven’s Johnson Herpes
Intranasal abnormality
Dacryocystitis
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Lacrimal Sac Mass
Inflammation Sarcoidosis Non-specific inflammation
Neoplasia Squamous cell carcinoma Lymphoma
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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 ?
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The Role of Imaging
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Endoscopic View: Canalicular Stenosis,
RX = KTP laser
Proximal Canalicular Stenosis
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Extensive Stenosis
RX = Jones Tube
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Dacryocystorhinostomy (DCR)
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Dry: Tear Lake Low
Normal Dye DisappearanceOther:
Tear Lake Often NormalDye Disappearance Often Normal
Listen and Look for CluesWet:
Tear Lake HighDelayed Dye Disappearance
A Systematic Approach to Tearing
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Questions….Concerns ?Questions….Concerns ?Questions….Concerns ?Questions….Concerns ?
Kimberly Cockerham, MD, Kimberly Cockerham, MD, FACSFACSPlastics – Orbit – Adult StrabismusPlastics – Orbit – Adult Strabismus
Zeiter Eye Medical Group, Inc.
Kimberly Cockerham, MD, Kimberly Cockerham, MD, FACSFACSPlastics – Orbit – Adult StrabismusPlastics – Orbit – Adult Strabismus
Zeiter Eye Medical Group, Inc.