Tearing and Lacrimal Drainage Describe the anatomy of the drainage system?



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Tearing and Lacrimal Drainage
Describe the anatomy of the drainage system?
2mm-7mm-3-4mm-10mm (sac)-12mm (bone)- 3-5 mm out
What causes tearing?
Reflex, eyelid malpositions, lacrimal drainage obstruction
Describe the tear pump.
Opposite of what you think:

Close>sac opens and draws

Open>Sac collapses forcing tears down NLD (Rosenmuller)
Treat Obstructive tearing.
Punctal ectropion or stenosis: punctoplasty
Punctal dilation
DCR

1.8mm incision 10mm from rim

2.reflect periosteum to posterior lacrimal crest revealing fossa

3.enter nose with curved hemostat and then rongeur to posterior lacrimal crest and past anterior crest anteriorlly

4.Flaps created in sac and nasal mucosa

5.6-0 vicrayl to suture edges of flaps

6.Close skin
Complications?
Nose bleed: nasal packs, embolization

Scar: massage



90-95% success rate
CanaliculoDCR for proxiaml obstruction with 8mm of healthy canaliculus

ConjunctivoDCR the proxiaml end is shot


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