Diseases of lacrimal glands

Diseases of lacrimal glands

   1,Acute dacryoadenits—it is an acute inflammation of the lacrimal gland.

   2,Chronic dacryoadenitis– it is a chronic inflammation of the lacrimal gland.

   3,Keratoconjunctivitis sicca (dry eye)– due to decreased tear production.

   4,Lacrimation– due to increased tear production

(3) Keratoconjuntivitis Sicca (dry eye)

   It is a clinical condition where the tear production is insufficient to maintain normal tear film.

   Aqueous layer abnormalities are caused by

   1,Involutional (senile)

   2,Sjogren syndrome. It can be

      Primary– if dry eyes associated with dry mouth

     Secondary– if associated with CT disorders.

   3,Trauma– can be post surgical,or post  radiational

   4,Inflammatory—sarcoidosis.

   Mucin layer abnormalities are caused by

   1,Trachoma

   2,Vit A deficiency

   3,Alkaline burn

   4,S.J. syndrome

   Lipid layer abnormalities are caused by

    Blepharitis.

   

Clinical Features

  1,Hot, burning and gritty FB sensation due to punctate keratitis.It becomes worse in the sun, wind or hot climate.

  2,Presence of stringy mucus discharge causing transient blurring of vision.

  3,Pain worse with blinking due to development of filamentary keratitis.

  4,Decreased marginal tear strip.

Investigations

  1,Tear film break up time (BUT)—is reduced to less than 10 seconds

  2,Schirmer`s test—tip of a whatman`s filter paper of size 5 x 35mm is placed in the conjunctival sac and its wetting is noted after 5 minutes—in dry eyes it is 6mm or less.

Treatment

   1,Tear substitutes—artificial tears

   2,Mucolytic agents—such as acetylcysteine drops for corneal filaments and mucus plaques

  3,Reduction of drainage by occlusion of puntii.It can be done;

     a,By silicon buttons—temporary

     b,By cauterization– permanent

  4,Surgery– transplantation of parotid duct in to the conjuntiva.

(4)Lacrimation

  It is watering of an eye due to increased tear production.

 Causes

  1,Psychic stimulation eg; happiness and sorrow.

  2,FB in the conjunctiva and cornea

  3,Inflammation

     a, conjunctivitis

     b, keratitis

     c, iridocyclitis

  4,Acute congestive glaucoma

  5,Abnormal regeneration of 7th nerve after its palsy, may result in tearing during eating (crocodile tears)

  6,Hyperthyroidism