TMOD (Lacrimal System)

Canaliculitis

Caused by infection of Actinomyces israelii

Red, tender punctum with epiphora

Presents with pouting puncta and will express white discharge and concretion in canaliculus (yellow sulfur grandules)

Canaliculitis Treatment/Management

Remove concretions vis expression

Then perform irrigation with antibiotic solution and rx oral antibiotics (penicillin recommended with culture)

Warm compress

If no response to tx, they may require sx: curettage, canaliculotomy, marsupialization

FU every 5-7 days

Nasolacrimal Duct Obstruction

2 types

Congenital Nasolacrimal Duct Obstruction - membrane over valve of hasner

Acquired Nasolacrimal Duct Obstruction - involutional stenosis

• evaluate with jones test

• jones 1 test: NaFl in eye, wait 5 mins, insert cotton tip or have pt blow their nose. if NaFl on applicator/tissue then duct is open (positive) if negative then do jones 2

• jones 2 test: dilate and irrigate

Nasolacrimal Duct Obstruction Treatment/Management

Congenital Nasolacrimal Duct Obstruction - Spontaneously resolve by 1st birthday (if not may need to probe). can apply digital massage BID-QID

Acquired Nasolacrimal Duct Obstruction - If dilation and irrigation does not work, rx top antibiotic/steroid. for severe cases, sx for silicone intubation, dacryoplasty, or dacryocystorhinostomy

Dacryocystitis

Infection of lacrimal sac below the medial canthal tendon ( if above, think tumor) by Streptococcus pneumoniae in adults and Haemophilus influenza in children

Tender with epiphora

May present with fever (ask about recent cold), red, swollen lacrimal sac that express mucopurulent discharge with palpation, conjunctivitis

Dacryocystitis Treatment/Management

DO NOT prove the nasolacrimal duct if pt is having an acute infection because it can spread the infection!

Warm compress regularly

Rx topical antibiotic (polytrim) or oral/IV antibiotics (keflex) depending on severity

If conjunctivitis is present, rx top antibiotic

Once infection is resolved, consider dacryocystorhinostomy

FU daily until improvement

Consider CT scna or lacrimal gland biopsy in cases. ofsuspected malignancy

Dacryoadentitis

Inflammation of lacrimal gland

Acute (fron imfection) or chronic (from inflammatory disorder)

• acute: fever and +PAN

• chronic: restricted EOM movement

Painful superior eyelid

S-shaped ptosis

Dacryoadentitis Treatment/Management

Acute: oral or IV medication (anitbiotic if from bacterial infection or antiviral if from virus) and may require surgical excision

Chronic: tx underlying inflammatory disorder