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Anatomy & Physiology ofAnatomy & Physiology of

The Lacrimal SystemThe Lacrimal System

dr. Nyimas Faridadr. Nyimas Farida

Consultant:Consultant:

dr. Riani Erna, SpMdr. Riani Erna, SpM

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Literature reviewThursday, October 25th

2012

OPHTHALMOLOGY DEPARTMENT OFSRIWIJAYA UNIVERSITYDR. MOH. HOESIN HOSPITAL PALEMBANG

2012


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Tearing

Disorders

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most common dilemmas forophthalmologists encounter

Evaluation & diagnostic test difficult

to interpret

Involves surgical techniques andfrequently have unpredictable results


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LacrimalSystem

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The lacrimal s

ystemcomprises structures

involved in the

production anddrainage of tears


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The entire lacrimal drainageapparatus is of ectodermal origin

AAO Section 2, 2009-20107

EMBRYOLOGY


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DEVELOPMENT OF THE LACRIMAL DRAINAGE SYSTEMDEVELOPMENT OF THE LACRIMAL DRAINAGE SYSTEM

8Duanes Ophthalmology, 2007 Edition, Volume 1


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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


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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


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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


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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.

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Secretory Apparatus

Main Lacrimal Gland


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Accessory Lacrimal Gland

Glands of Krause Glands of Wolfring


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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


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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


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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


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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


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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.


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(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


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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

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MECHANISM OF LACRIMAL DRAINAGEMECHANISM OF LACRIMAL DRAINAGE

(ROSENGREN-DOANE)(ROSENGREN-DOANE)

AAO Section 7, 2009-2010

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MECHANISM OFMECHANISM OF


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MECHANISM OFMECHANISM OF

LACRIMAL DRAINAGELACRIMAL DRAINAGE


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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

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TEARSTEARS

Rate of secretion : 0,8-1,2 L/min Total secretion : 1,5 cc/day Produced : Main lacrimal gland 95%

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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

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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


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Ocular Surface Disease, 2001


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Ocular Surface Disease, 2001


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Jones I test Jones II test

Anel test Fluorescein test Dacryosystography

EVALUATION OF TEAR DRAINAGEEVALUATION OF TEAR DRAINAGE

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ANEL TESTANEL TEST

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ANEL TESTANEL TEST

No obstruction

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Stenosisof the

canaliculus

Stenosis withinthe lacrimal sac

ANEL TESTANEL TEST

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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)

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PRIMARY JONES TESTPRIMARY JONES TEST

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SECONDARY JONES TESTSECONDARY JONES TEST

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Dacryocystography imagesthe lower lacrimal system &can demonstrates a possible

stenosis (arrow) withoutsuperimposed bony structures

DACRYOCYSTOGRAPHYDACRYOCYSTOGRAPHY

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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

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THANK YOU

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