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Diseases of the lacrimal apparatus

Last updated: December 3, 2019

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The lacrimal apparatus consists of the lacrimal gland, which secretes the aqueous layer of the tear film, the lacrimal sac, into which the tears drain, and the nasolacrimal duct, through which the tears drain into the nose. Inflammation of the lacrimal gland is called dacryoadenitis and is commonly caused by viral or bacterial infections. The condition typically presents with conjunctival hyperemia, S-shaped ptosis, mucopurulent discharge, and discomfort. Dacryostenosis refers to the congenital or acquired obstruction of the nasolacrimal duct (NLD) and presents with excessive tearing. NLD obstruction can cause stasis of tears in the lacrimal sac, which predisposes to secondary bacterial infection of the sac, known as dacryocystitis. The diagnosis is usually clinical, and may be supported by bacterial cultures, imaging (CT, x-ray), and probing of the nasolacrimal duct. Treatment is often conservative (e.g., NSAIDs, warm compresses), but may also require antibiotics in cases of bacterial infections or invasive procedures to remove obstructions (e.g., NLD dilation).

Acute dacryoadenitis
Definition
Etiology
Clinical features
Diagnostics
Treatment

References:[1][2][3][4][5][6]

Congenital dacryostenosis

Acquired dacryostenosis

References:[2][7][8][9][10][11][12]

Acute dacryocystitis
Definition
Etiology
Clinical features
Diagnostics
  • Clinical
  • Pus culture
  • Blood culture: in patients with systemic symptoms (fever)
  • Dacryocystography (DCG) : in patients with dacryostenosis secondary to trauma (altered anatomy) or suspected tumors (to locate the tumor)
Treatment

The lacrimal gland should not be probed during acute infection, since this may cause bacteria to spread to to other locations.

References:[2][10][13][14][15]

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