Lacrimal disorders

Lacrimal disorders

OVERVIEW:

Lacrimal disorders refer to diseases and abnormalities of tear production and tear film. The most common lacrimal disorder is dry eye. Lacrimal duct disorders, seen in the pediatric age group, often result in overflow tearing.

System(s) affected: Skin/Exocrine
Genetics: None
Incidence/Prevalence in USA: Very common and more often seen in arid climates of the desert Southwest
Predominant age: Dry eye symptoms increase with age. Most common in the elderly.
Predominant sex: Female > Male

SIGNS AND SYMPTOMS:

• Gritty sensation to the eyes
• Visual blurring
• Redness
• Excessive tearing and mucus production
• Inadequate tears on the ocular surface

CAUSES:

Poor tear production and/or rapid evaporation of the tears

RISK FACTORS:

Individuals who live in arid regions, are on diuretics or have a history of collagen vascular diseases such as rheumatoid arthritis, Sjogren's syndrome, Bell's palsy, eyelid abnormalities and thyroid disease, are most at risk.

DIAGNOSIS

DIFFERENTIAL DIAGNOSIS:

Lacrimal disorders need to be differentiated from ocular infections and allergy. Another important consideration is the variety of anticholinergic affecting drugs that decrease tear production.

LABORATORY:

Tear production can be measured using a Schirmer's filter strip after instillation of topical anesthetic. Wetting of less than 10 mm of the slip after 5 minutes is indicative of insufficient tear production.

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS:

In Sjogren's syndrome infiltration of the lacrimal gland with inflammatory cells may be evident

SPECIAL TESTS:

N/A

IMAGING:

None

DIAGNOSTIC PROCEDURES:

Staining of the ocular surface with fluorescein will show areas of abnormal uptake and patches of drying. Rose bengal will be taken up by dead or dying epithelial cells and may be a more sensitive test.

TREATMENT

APPROPRIATE HEALTH CARE:

Outpatient

GENERAL MEASURES:

• Those with systemic illnesses predisposed to dry eye should be informed and instructed in the appropriate use of artificial tear supplements
• Cool mist vaporizer and home humidification is helpful

SURGICAL MEASURES:

N/A

ACTIVITY:

No restrictions

DIET:

No special diet

PATIENT EDUCATION:

All individuals with systemic illnesses predisposed to dry eye, menopausal women, and those residing in arid climates or over the age of 60 should be instructed in the use of artificial tear supplements to combat dry eye symptoms

MEDICATIONS

DRUG(S) OF CHOICE:

• Artificial tear drops excluding those that have preservatives. The dosage of the drop varies depending on the severity of the symptoms. Usually one drop in each eye several times throughout the day can prevent ocular discomfort.
• The use of a bland ophthalmic ointment at bedtime between the eyelid and the eye can help prevent drying of the eye at night
• Vitamin A supplements

Contraindications: N/A
Precautions: N/A
Significant possible interactions: N/A

ALTERNATIVE DRUGS:

N/A

FOLLOW UP

PATIENT MONITORING:

Monitor early to determine the effectiveness of treatment. Occasionally the use of more viscous drops or increased frequency of tear supplements may be required.

PREVENTION/AVOIDANCE:

• Prevent exposure to eye irritants from pollution, cigarette smoke, and sun exposure
• Ensure adequate vitamin A intake in the diet or as a supplement

POSSIBLE COMPLICATIONS:

Severe dry eye can lead to corneal break-down, secondary invasion by bacteria and eye infections

EXPECTED COURSE AND PROGNOSIS:

Lacrimal disorders can be adequately managed with artificial tear supplements. Blocked tear ducts can be managed with probing and punctal dilation and/or dacryocystorhinostomy procedures in more severe cases.

MISCELLANEOUS

ASSOCIATED CONDITIONS:

Sjogren's syndrome and age-related factors more commonly seen in the elderly population

AGE-RELATED FACTORS:

Pediatric: May find lacrimal duct blockage in infants
Geriatric: Most common in this age group
Others: N/A

PREGNANCY:

Dry eyes can frequently be associated with pregnancy in an otherwise healthy individual. Vitamin A intake should not exceed 6000 IU a day.

SYNONYMS:

Epiphora (excessive tearing)

ICD-9-CM:

375.11 Dacryops
375.15 Tear film insufficiency, unspecified

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Medical Diagnosis » L » Lacrimal disorders