Optha pdf for students specially for mbbs students

It is a nice presentation about watering of eye

1. WATERING EYE
NAME: GAGAN T
ROLL NO : 41
REG NO : 21M3931

2. The Watering Eye
oIt is characterised by overflow of tears from the conjunctival sac
oThe condition may occur either due to excessive secretion of tears
(hyperlacrimation) or may result from inadequate drainage (outflow) of normally
secreted tears (epiphora).

3. ETIOLOGY
HYPERLACRIMATION
Primary hyperlacrimation
Reflex hyperlacrimation
Central lacrimation
EPIPHORA
Physiological
Mechanical obstruction

4. CAUSES OF HYPERLACRIMATION
1.Primary hyperlacrimation: It occurs due to direct stimulation of the lacrimal gland. It may
occur in early stages of lacrimal gland tumours and cysts and due to the effect of strong
parasympathomimetic drugs.
2.Reflex hyperlacrimation: It results from stimulation of sensory branches of fifth nerve due
to irritation of cornea or conjunctiva.
3.Central lacrimation:The exact area concerned with central lacrimation is still not known. It
is seen in emotional states, voluntary lacrimation and hysterical lacrimation .

5. CAUSES OF EPIPHORA
1.Physiological causeis 'lacrimal pump' failure due to lower lid laxity or weakness of
orbicularis muscle
2.Mechanical obstructionin lacrimal passages may lie at the level of punctum,
canaliculus, lacrimal sac or nasolacrimal duct.
Inadequate drainage of tears may occur due to physiological or anatomical (mechanical) causes.

6. 1.Punctal: Eversion of lower punctum and punctal obstruction
2.Canalicular obstruction:Canaliculitis - Commonest cause is actinomyces
3.Lacrimal sac: These include congenital mucous membrane folds, traumatic strictures,
dacryocystitis, specific infections like tuberculosis and syphilis, dacryolithiasis and tumours
4.Nasolacrimal duct: Congenital lesions include noncanalization, partial canalization or
imperforated membranous valves. Acquired causes of obstruction are traumatic strictures,
inflammatory strictures, idiopathic stenosis, tumours and diseases of the surrounding bones

7. TESTS
1.Ocular examination with diffuse illumination using magnification
2.Regurgitation test
3.Fluorescein dye disappearance test
4.Lacrimal syringing test.
5.Jones dye tests.
6.Dacryocystography.
7.Radionucleotide dacryocystography

8. Ocular examination with diffuse illumination
using magnification
It should be carried to rule out any cause of reflex hypersecretion located in lids,
conjunctiva, cornea, sclera, anterior chamber, uveal tract and so on. This examination
should also exclude punctal causes of epiphora and any swelling in the sac area

9. Regurgitation test
A steady pressure with index finger is applied over the lacrimal sac area above the medial
palpebral ligament. Reflux of mucopurulent discharge indicates chronic dacryocystitis with
obstruction at lower end of the sac or the nasolacrimal duct

10. Fluorescein dye disappearance test (FDDT)
In this test, 2 drops of fluorescein dye are instilled in both the conjunctival sacs and
observations are made after 2 minutes. Normally, no dye is seen in the conjunctival sac. A
prolonged retention or dye in conjunctival sac indicates inadequate drainage which may
be due to atonia of sac or mechanical obstruction

11. Lacrimal syringing test
It is performed after topical anesthesia with 4% xylocaine
Normal saline is pushed into the lacrimal sac from lower
punctum with the help of a syringe and lacrimal cannula.
A free passage of saline through lacrimal passages into the nose
rules out any mechanical obstruction.
In the presence of partial obstruction, saline passes with
considerable pressure on the syringe.
In the presence of obstruction no fluid passes into nose and it
may reflux through same punctum (indicating obstruction in the
same or common canaliculus) or through opposite punctum
(indicating obstruction in lower sac or nasolacrimal duct)

12. Jones dye tests
It is performed to differentiate between watering due to partial obstruction of the lacrimal
passages from that due to primary hypersecretion of tears.
Two drops of2% fluorescein dye are instilled in the conjunctival sac and a cotton bud
dipped in 1% xylocaine is placed in the inferior meatus at the opening of nasolacrimal
duct.
After 5 minutes, the cotton bud is removed and inspected. A dye-stained cotton bud
indicates adequate drainage through the lacrimal passages and the cause of watering is
primary hypersecretion.
While the unstained cotton bud (negative test) indicates either a partial obstruction or
failure of lacrimal pump mechanism
JONES PRIMARY TEST

13. Jones dye tests
When primary test is negative, the cotton bud is
again placed in the inferior meatus and lacrimal
syringing is performed.
 A positive test suggests that dye was present in the
sac but could not reach the nose due to partial
obstruction
A negative test indicates presence of lacrimal pump
failure.
JONES SECONDARY TEST

14. Dacryocystography
To perform it a radiopaque material such as lipiodol, pantopaque, dianosil or condray-280
is pushed in the sac with the help of a lacrimal cannula and X-rays are taken after 5
minutes and 30 minutes to visualize the entire passage.

15. Radionucleotidedacryocystography
It is a noninvasive technique to assess the functional
efficiency of lacrimal drainage apparatus.
A radioactive tracer (sulphur colloid or technetium)
is instilled into the conjunctival sac and its passage
through the lacrimal drainage system is visualized
with an Anger gamma camera