diseases of the lacrimal apparatus

Knowledge of the anatomical and topographical features of the lacrimal organs, their relationships with surrounding organs and tissues allows us to better understand the mechanism of lacrimal drainage, the etiopathogenesis of diseases of the lacrimal ducts, as well as the correct choice of rational treatment methods.

Anatomically and functionally, the lacrimal apparatus can be divided into three sections: tear-producing, tear-receiving and tear-receiving.

The tear-producing department is represented by the lacrimal gland (glandula lacrymalis) and accessory lacrimal glands (glandula lacrymalis accesoria): in the fornix of the conjunctiva of the Krause gland and at the upper edge of the cartilage of the Waldeyer gland.

The lacrimal-receiving section is represented by the conjunctival sac with the lacrimal duct (rivus lacrymalis), the lacrimal caruncle, the semilunar fold and the lacrimal lake.

The lacrimal department successively includes lacrimal openings (puncta lacrymalia), lacrimal canaliculi (canaliculi lacrymalis), lacrimal sac (saccus lacrymalis) and nasolacrimal duct (ductus nasolacrymalis).

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Content

• 1 Diseases of the eyelids
• 2 Diseases of the lacrimal organs
• 3 Diseases of the conjunctiva
• 4 Diseases of the sclera
• 5 Diseases of the cornea
• 6 Lens diseases
• 7 Diseases of the vitreous body
• 8 Disease of the iris
• 9 Retinal diseases
• 10 Diseases of the optic nerve
• 11 Disorders of aqueous humor circulation
• 12 Diseases of the oculomotor system
• 13 Diseases of the eye socket
• 14 Refractive errors (ametropia)
• 15 Notes

Dacryocystitis

Inflammation of the lacrimal sac is called dacryocystitis. This pathology is observed in approximately 5% of patients suffering from diseases of the tear-producing organs, and this disease occurs much more often in women than in men. It can have both acute and chronic forms; a special case is dacryocystitis of newborns.

The disease requires conservative or surgical treatment. In case of an abscess, the abscess is drained and the cavity is washed. The most common surgical treatment option for dacryocystitis is dacryocystorhinostomy (formation of a direct anastomosis between the nasal cavity and the lacrimal sac).

Diseases of the eyelids

• Cryptophthalmos is a complete loss of differentiation of the eyelids.
• Coloboma of the eyelid is a full-thickness segmental defect of the eyelid.
• Ankyloblepharon - partial or complete fusion of the edges of the eyelids.
• Upper eyelid ptosis is an abnormally low position of the upper eyelid.
• Gunn's syndrome is an involuntary raising of the upper eyelid.
• Inversion of the eyelid - the edge of the eyelid is turned towards the eyeball.
• Blepharitis is inflammation of the edges of the eyelids.
• Trichiasis is abnormal eyelash growth with irritation of the eyeball.
• Edema of the eyelid is an abnormal amount of fluid in the tissues of the eyelids.
• Preseptal cellulitis is diffuse swelling of the eyelids.
• Eyelid abscess is a purulent inflammation of the eyelids.
• Stye is an inflammation of the meibomian glands at the edge of the eyelid.
• Lagophthalmos is incomplete closure of the palpebral fissure.
• Blepharospasm is an involuntary contraction of the muscles of the eyelid,
• Keratoconjunctivitis sicca - dry eye syndrome.

Dacryoadenitis

One of the most common diseases of the lacrimal gland is dacryoadenitis. This pathology can occur in acute and chronic form. Acute dacryoadenitis is usually diagnosed in children and young adults. It can be either one- or two-sided. Often acute dacryoadenitis occurs as a complication of mumps, influenza, sore throat and some other diseases.

Characteristic signs of acute inflammation of the lacrimal gland are swelling of the upper eyelid, as well as pain in this area. The swelling can be extensive and so severe that the palpebral fissure closes. People who are weakened may develop an abscess or cellulitis.

In acute dacryoadenitis, there is an inward and downward displacement of the eyeball with limited mobility, and possible protrusion. Doubling of visible objects occurs. The conjunctiva is swollen. The general condition worsens (sleep disorder, loss of appetite, headaches, fever).

In the case of the chronic form of dacryoadenitis, a dense to the touch but painless swelling is noted in the area of ​​the lacrimal gland, which gradually increases in size. Sometimes a chronic disease becomes a consequence of acute dacryoadenitis.

Treatment of the disease involves drug therapy (antibiotics in the form of injections and ointments, vitamin drops, sulfonamides, a general course of antibiotics) and physiotherapeutic procedures. For severe pain, analgesics are prescribed. If the disease is chronic, radiotherapy may be performed. If an abscess occurs, it is opened and the cavity is washed with antibiotics.

Diseases of the lacrimal apparatus: causes and types

In diseases of the lacrimal system, any components of the lacrimal apparatus can be affected: the lacrimal gland, the excretory ducts of the gland and the lacrimal ducts.

• dacryoadenitis - inflammation of the lacrimal gland; • epiphora - abundant release of tear fluid from the eyes, beyond the normal limits, and deficiency of tear fluid (persistence of congenital hypolacrimia, Sjögren's syndrome); • dacryostenosis (narrowing) and inflammation of the lacrimal ducts. Inflammatory diseases of the lacrimal ducts include: canaliculitis - an inflammatory disease of the lacrimal canaliculus and dacryocystitis - inflammation of the lacrimal sac, which occurs in both newborns and adults; • congenital anomalies of the lacrimal ducts (aplasia, fistulas, diverticula, etc.) • neoplasms (tumors) of the lacrimal ducts

Causes

Diseases of the lacrimal gland can be congenital or acquired, resulting from any inflammatory diseases, tumors or injuries:

• Acute inflammation of the lacrimal gland (acute dacryoadenitis) most often develops against the background of mumps (mumps) in children, less often - another infectious disease (influenza, pneumonia, scarlet fever, typhoid fever, etc.). • Chronic dacryoadenitis occurs with certain blood diseases, syphilis, tuberculosis. • Sjögren's syndrome (“sicca syndrome”), characterized by damage to the lacrimal and salivary glands, is autoimmune in nature and can be observed in systemic connective tissue diseases. • Congenital diseases include hypoplasia (underdevelopment), aplasia (absence) and hypertrophy (increase in size) of the lacrimal gland.

Diseases of the lacrimal ducts can be congenital (developmental abnormalities) or acquired, associated with nerve damage, infectious diseases, tumors, inflammatory diseases of the eyes (conjunctivitis, etc.) and nose; autoimmune disease (Sjögren's syndrome). Foreign bodies (for example, eyelashes) can also cause disruption of the outflow of tears.

Canaliculitis (inflammation of the lacrimal duct) most often has a fungal nature, but sometimes develops as a result of the introduction of a foreign body. It can also complicate the course of chronic conjunctivitis.

Dacryocystitis (inflammation of the lacrimal sac) usually occurs when there are disturbances in the outflow of tears, which are caused by narrowing and fusion of the nasolacrimal duct (congenital or acquired, for example, as a result of inflammation). In this case, the tear fluid stagnates in the lacrimal sac, and conditions are created for the development of infection in the lacrimal sac. Since the disruption of tear outflow is permanent, dacryocystitis often becomes chronic.

Dacryocystitis (inflammation of the lacrimal sac) can be provoked by: injuries, diseases of the nose and paranasal sinuses, decreased immunity, diabetes mellitus, occupational hazards, sharp fluctuations in ambient temperature, etc. An important cause of the development of dacryocystitis are pathological processes in the nasal cavity and paranasal sinuses. Sometimes the cause of obstruction of the nasolacrimal duct is damage due to trauma, often surgical (during puncture of the maxillary sinus, maxillary sinus).

How do they manifest themselves?

If a child has a swollen upper eyelid almost from birth, constant lacrimation or, on the contrary, a complete absence of tears, and an elevated temperature, he most likely has some kind of congenital anomaly in the development of the lacrimal apparatus.

Acute inflammation of the lacrimal gland (acute dacryoadenitis) can be either unilateral or bilateral. The disease most often occurs in children against the background of infectious mumps (mumps). In this case, the child experiences swelling of the upper eyelid, which quickly or gradually increases in size. The eyelid turns red and swells. All this is accompanied by pain in the outer corner of the eye.

Then there is a headache, weakness, weakness, and body temperature rises. Due to swelling, the edge of the eyelid takes on an S-shape. Over the course of several days, the process progresses rapidly: swelling and swelling of the eyelid increase, as a result of which the eye may be closed by a swollen eyelid. The pain intensifies. Under pressure from the dense, swollen lacrimal gland, the eyeball shifts downward and inward, resulting in complaints of double vision. The pain in the gland area becomes very severe. The lymph nodes in the area behind the ear become enlarged, and the swelling spreads to the temples.

With canaliculitis (inflammation of the lacrimal canaliculus), the patient is bothered by lacrimation, purulent discharge from the inner corner of the eye, and sometimes swelling and redness at the inner corner of the eye. When pressing on the area of ​​the lacrimal canaliculus, you can see the discharge of pus from the lacrimal openings. Canaliculitis is quite rare and, as a rule, has a chronic course.

Dacryocystitis is characterized by lacrimation and discharge of pus from the eye. As a result, patients often experience inflammation of the conjunctiva and the edges of the eyelids. With prolonged narrowing of the nasolacrimal duct, the lacrimal sac expands - a bean-shaped protrusion of the skin appears at the inner corner of the palpebral fissure, which sometimes reaches a large size (dropsy of the lacrimal sac). If you press on this swelling, mucus or pus is released from the lacrimal openings; less often, the contents of the lacrimal sac are emptied into the nose through the duct.

Dacryocystitis most often affects middle-aged people - from 30 to 60 years old; dacryocystitis in newborns also occurs. Dacryocystitis occurs 7-8 times more often in women than in men. The disease usually has a long course. Chronic dacryocystitis can be complicated by phlegmon of the lacrimal sac or purulent corneal ulcer.

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Mikulicz syndrome

A specific set of symptoms - a progressive symmetrical enlargement of the salivary and lacrimal glands, displacement of the eyeballs inward and downward, involvement of the lymph nodes in the process - was named after the doctor Mikulicz, who first described this pathology in 1892.

The causes of the disease have not yet been clarified. According to various theories, the disease can develop as a result of tuberculosis and leukemia (pseudo-leukemia).

Treatment should be aimed at combating the underlying disease. Radiotherapy is performed locally. In addition, arsenic-based drugs are used for Mikulicz syndrome.

Diseases of the lacrimal organs

The classification of the pathology of the lacrimal organs is based on the clinical and anatomical principle, taking into account the etiopathogenesis and features of the course of clinical forms of the disease. It reflects the localization of the pathological process, its nature, concomitant diseases and is quite practical both for choosing diagnostic methods and targeted therapy, and for analyzing the effectiveness of various methods of treating this pathology.

Tumors and cysts of the lacrimal glands

Tear-producing organs can be affected as a result of the development of neoplasms - such as mixed tumors of the lacrimal glands, adenocarcinoma, sarcoma, cylindroma.

Mixed tumors are usually diagnosed in older people and are characterized by slow growth. Such tumors are characterized by protrusion of the eyeball and neurological pain. Sometimes there are visual disturbances. Often the development of a tumor is accompanied by pathological changes in the fundus (optic nerve atrophy, neuritis). In some cases, such tumors recur and metastasize.

The clinical picture of cylindroma resembles that of mixed tumors, but the prognosis for the disease is worse (in approximately every fourth case there is a death). With adenocarcinoma, the mortality rate is even higher, the clinical picture is the same. Sarcoma of the lacrimal glands is severe, the prognosis is unfavorable, especially in cases where the disease is detected in childhood or adolescence.

Cysts arise due to clogging of the excretory ducts of the lacrimal gland and can reach the size of a hazelnut. In this case, the tumor does not cause pain. Treatment consists of opening the cyst and creating a connection between the cyst cavity and the conjunctival cavity.