Tearing Due to Block Drainage System

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Tearing Due to Block Drainage System

• Kimberly Cockerham, MD, FACS
• Plastics-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 High Delayed 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
• Wegners
• Sarcoidosis
• Stevens 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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Proximal Canalicular Stenosis
Endoscopic View Canalicular Stenosis, RX KTP
laser
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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 High Delayed Dye
Disappearance
A Systematic Approach to Tearing
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Questions.Concerns ?
Kimberly Cockerham, MD, FACS Plastics Orbit
Adult Strabismus Zeiter Eye Medical Group,
Inc.