Ophthalmic lacrimal sac syringing ...........

1. By. Chittranjan kumar
Enternship

2. Def of lacrimal Apparatus
It is physiological system has
formation and drainage also give nurshiment
to cornea with help of tear
HENCE
Any occlusion or defect in lacrimal
drainage detected to a investigation is called
lacrimal syringing.
Syringing is the method to test the
structural integrity of lacrimal drainage system
.

3. ANATOMY OF THE LACRIMAL
DRAINAGE SYSTEM
 Puncta
One punctum is present at the medial
end of both the superior and inferior lid.
 Vertical canaliculus
This is about 2mm long and joins the
horizontal canaliculus at a right angle
called the ampulla.

4.  Horizontal canaliculus
This is about 8mm long and usually joins
its fellow to form the common
canaliculus
 (Naso)lacrimal sac
This is about lOmm long and
funnels into the nasolacrimal duct.
 Nasolacrimal duct
This is about l2mm long and
opens into the inferior nasal meatus The
Valve of Hasner closes the

5.  Most common blockage is at junction
of sac and NLD near valve of
haustner .
 Syringing should be done with lower
canaliculus .

7. PHYSIOLOGY OF THE LACRIMAL
DRAINAGE SYSTEM
Pre –blink :-
Tear spread on the globe
Like Tear Meniscus
During blink:-
On blinking, the attachment of the
preseptal orbicularis muscle helps create
positive and negative pressure.
Due to pressure in the lacrimal sac
which sucks the tears.
This is called the tear pump.
Post-blink:-
Gravity then helps keep the sac empty.

8. PHYSIOLOGY OF THE LACRIMAL DRAINAGE
SYSTEM
Pre Blink
Tear spread on the Globe
During Blink
Post Blink
Like tear Meniscus
Lacrimal sac suck the tear
Empty the lacrimal Sac
Tear meniscus
Known as
Tear pump

9. Lacrimal punctum Dialatation
Vertically Dialatation
Horizontally Dialatation

10. Lacrimal syringing

11. No Regurgitation Regurgitation with
pus other punctum
Regurgitation other
punctum clear without
delay
Regurgitation
same punctum
Passage patent
Sac NLD junction block
Common canaliculus
block
Same canali block
Interpretation

12. EQUIPMENT REQUIRED
 Lacrimal punctum dilator
 lacrimal cannulae
 3 or 5m1 disposable sterile syringes
 Anaesthetic drops, e.g. 4% xylocaine
 cotton
 Normal saline/ Ringer lacted
 antibiotic solution
 pt Better to supine position

13. Importance of syringing
 One of the most
important prior to intra ocular
surgery .
 If syringing is abnormal
first the surgery of lacrimal sac
is required before cataract
surgery otherwise infection can
reach intra ocular causing .
Endopthalmitis

14. Diseases of lacrimal sac
 Dacryocystitis
Inflammation of Lacrimal sac is
not uncommon condition may occur in
two form
- Congenital Dacrycystitis
Occurs in new born infant.
- Adult Dacrycystitis

15. Surgery of Lacrimal sac
Dacryocystorhinostomy(DCR)
Re stablishes the lacrimal
drainage.
Dacryostectomy (DCT)
Removal of lacrimal sac.

16. THANKS
FOR
YOUR
ATTENTION
Prepared by : Chittranjan kumar
DOT final yaer