Download - TIPUS PP dd
-
7/15/2019 TIPUS PP dd
1/40
Anatomy & Physiology ofAnatomy & Physiology of
The Lacrimal SystemThe Lacrimal System
dr. Nyimas Faridadr. Nyimas Farida
Consultant:Consultant:
dr. Riani Erna, SpMdr. Riani Erna, SpM
1
Literature reviewThursday, October 25th
2012
OPHTHALMOLOGY DEPARTMENT OFSRIWIJAYA UNIVERSITYDR. MOH. HOESIN HOSPITAL PALEMBANG
2012
-
7/15/2019 TIPUS PP dd
2/40
Tearing
Disorders
2
most common dilemmas forophthalmologists encounter
Evaluation & diagnostic test difficult
to interpret
Involves surgical techniques andfrequently have unpredictable results
-
7/15/2019 TIPUS PP dd
3/40
LacrimalSystem
3
The lacrimal s
ystemcomprises structures
involved in the
production anddrainage of tears
-
7/15/2019 TIPUS PP dd
4/40
4
-
7/15/2019 TIPUS PP dd
5/40
5
-
7/15/2019 TIPUS PP dd
6/40
6
-
7/15/2019 TIPUS PP dd
7/40
The entire lacrimal drainageapparatus is of ectodermal origin
AAO Section 2, 2009-20107
EMBRYOLOGY
-
7/15/2019 TIPUS PP dd
8/40
DEVELOPMENT OF THE LACRIMAL DRAINAGE SYSTEMDEVELOPMENT OF THE LACRIMAL DRAINAGE SYSTEM
8Duanes Ophthalmology, 2007 Edition, Volume 1
-
7/15/2019 TIPUS PP dd
9/40
The 7 th week of pregnancy
(15-22 mm):20 mm the main lacrimalgland was formed
22 mm lacrimal glandappears
The 10th
week of pregnancy,the development of aponeuroticdivides lacrimal gland intopalpebral and orbital lobes
Embriology
-
7/15/2019 TIPUS PP dd
10/40
The 15 th -16 th week of
pregnancy orbital andpalpebral lobes lacrimal glandswere formed
At the end of the 16 th week ofpregnancy each orbital andpalpebral lobes receives the
flow of blood.
The 7 th month of pregnancy
lacrimal canal was opened
Embriology
-
7/15/2019 TIPUS PP dd
11/40
At the end of pregnancy lacrimal gland doesnt
develop yet and tears not
secrete
After birth lacrimal gland
doesnt develop optimal toarrive 3 th month
Embriology
-
7/15/2019 TIPUS PP dd
12/40
12
-
7/15/2019 TIPUS PP dd
13/40
1. The almond-shaped orbital portion, locatedin the lacrimal fossa in the anterior uppertemporal segment of the orbit, is separated fromthe palpebral portion by the lateral horn of thelevator palpebrae muscle.
2. The smallerpalpebral portion is located justabove the temporal segment of the superiorconjunctival fornix.
13
Secretory Apparatus
Main Lacrimal Gland
-
7/15/2019 TIPUS PP dd
14/40
14
Accessory Lacrimal Gland
Glands of Krause Glands of Wolfring
-
7/15/2019 TIPUS PP dd
15/40
15
Excretory Apparatus
Punctum Lacrimal A kind of round and oval openinglies on top of the lacrimal papilla
and on the palpebra medial margomargin. 0,5 mm
Each superior and inferiorpalpebra has one punctum
-
7/15/2019 TIPUS PP dd
16/40
16
Canaliculi Lacrimal 2 mm vertical segment & 8-mmhorizontal segment. The angle 90 degrees, and thecanaliculi dilate at the junction toform the ampulla.
In most individuals, the horizontalportion of the canaliculi converges toform the common canaliculus.
Nonkeratinized, stratified squamousepithelium, surrounded by elastictissue.
The oblique entrance of the
-
7/15/2019 TIPUS PP dd
17/40
The lacrimal sac sits within thelacrimal fossa.
The lacrimal sac is lined by adouble-layered epithelium
3-5 mm above the superior portion of
themedial canthal tendon
10 mm below the fundus to the
osseous 17
Lacrimal Sac
Fundus
Body
-
7/15/2019 TIPUS PP dd
18/40
18
Nasolacrimal Duct
12-mm superior intraosseous
portion
5-mm inferior membranous
portion
Connecting inferior end of lacrimal sac
with inferior nasal meatus The bony nasolacrimal canal isapproximately 1 mm in diameter
-
7/15/2019 TIPUS PP dd
19/40
19
Blood Supply & Lymphatics
The blood supply of the lacrimalgland is derived from the LacrimalArtery.
The Vein that drains the glandjoins the Ophthalmic Vein.
The Lymphatic drainage joinswith the Conjunctival
Lymphatics to drain into the
Preauricular Lymph Nodes.
-
7/15/2019 TIPUS PP dd
20/40
20
(1)The lacrimal nerve (sensory),
a branch of thetrigeminal first division;
(2) The great superficial petrosalnerve (secretory)
which comes from thesuperior salivary nucleus;
(3) Sympathetic nervesaccom an in the lacrimal
-
7/15/2019 TIPUS PP dd
21/40
Week 5,5th of gestation
main lacrimal gland
Week 15th -16th of gestation
palpebral lobes lacrimal glands Month 7th of gestation
lacrimal canal
Week 6th after birth
lacrimal glands produce tears
21
-
7/15/2019 TIPUS PP dd
22/40
MECHANISM OF LACRIMAL DRAINAGEMECHANISM OF LACRIMAL DRAINAGE
(ROSENGREN-DOANE)(ROSENGREN-DOANE)
AAO Section 7, 2009-2010
22
-
7/15/2019 TIPUS PP dd
23/40
23
MECHANISM OFMECHANISM OF
-
7/15/2019 TIPUS PP dd
24/40
24
MECHANISM OFMECHANISM OF
LACRIMAL DRAINAGELACRIMAL DRAINAGE
-
7/15/2019 TIPUS PP dd
25/40
TEARS FUNCTIONSTEARS FUNCTIONS
To provide a smooth refracting surface To provide a moist environment Preventing infection
Transport metabolites & remove waste
products Protect the eye from noxious stimuli
Remove particles & debris
25
-
7/15/2019 TIPUS PP dd
26/40
TEARSTEARS
Rate of secretion : 0,8-1,2 L/min Total secretion : 1,5 cc/day Produced : Main lacrimal gland 95%
26
-
7/15/2019 TIPUS PP dd
27/40
Tear pH : 7,14-7,82 bicarbonate (HCO-3) Tear osmolarity : 300304 mOsm/L isotonic
Ionic concentrations : Na+
, K+
& Cl+
COMPOSITION OF TEARSCOMPOSITION OF TEARS
27
-
7/15/2019 TIPUS PP dd
28/40
The major tear proteins :
lysozyme, secretory IgA (sIgA), lactoferrin,
lipocalin & peroxidase Growth factors :
EGF, HGF, TGF,TGF1,TGF2, bFGF, TNF,
GM CSF
Serotonin : 2,74 1,99 ng/mL
COMPOSITION OF TEARSCOMPOSITION OF TEARS
28
-
7/15/2019 TIPUS PP dd
29/40
29
COMPOSITION OF TEARSCOMPOSITION OF TEARS
Ocular Surface Disease, 2001
-
7/15/2019 TIPUS PP dd
30/40
Ocular Surface Disease, 2001
COMPOSITION OF TEARSCOMPOSITION OF TEARS
30
-
7/15/2019 TIPUS PP dd
31/40
Jones I test Jones II test
Anel test Fluorescein test Dacryosystography
EVALUATION OF TEAR DRAINAGEEVALUATION OF TEAR DRAINAGE
31
-
7/15/2019 TIPUS PP dd
32/40
ANEL TESTANEL TEST
32
-
7/15/2019 TIPUS PP dd
33/40
ANEL TESTANEL TEST
No obstruction
33
-
7/15/2019 TIPUS PP dd
34/40
Stenosisof the
canaliculus
Stenosis withinthe lacrimal sac
ANEL TESTANEL TEST
34
-
7/15/2019 TIPUS PP dd
35/40
1. A drop of fluorescein
2. A cotton bud soaked in anaesthetic
3. After 5 minutes :
- Fluorescein (+) Primary Jones Test (+)- Fluorescein (-) Primary Jones Test (-)
4. Next, wash the excess fluorescein :
- Fluorescein (+) Secondary Jones Test (+)
- Fluorescein (-) Secondary Jones Test (-)
JONES DYE TESTJONES DYE TEST
(PRIMARY & SECONDARY)(PRIMARY & SECONDARY)
35
-
7/15/2019 TIPUS PP dd
36/40
PRIMARY JONES TESTPRIMARY JONES TEST
36
-
7/15/2019 TIPUS PP dd
37/40
SECONDARY JONES TESTSECONDARY JONES TEST
37
-
7/15/2019 TIPUS PP dd
38/40
Dacryocystography imagesthe lower lacrimal system &can demonstrates a possible
stenosis (arrow) withoutsuperimposed bony structures
DACRYOCYSTOGRAPHYDACRYOCYSTOGRAPHY
38
-
7/15/2019 TIPUS PP dd
39/40
To diagnose the above abnormalityproperly is needed the understanding
of lacrimal apparatus anatomically andphysiologically.
If the diagnose is so proper that thetherapy can be optimal and prognosis
is better.
CONCLUSIONCONCLUSION
39
-
7/15/2019 TIPUS PP dd
40/40
THANK YOU
40