1. Seminar Title: ( Epiphora ) Ahmed Almohammed 291100030 Advisor : Prof. Dr. Osama El-Bassiouny Ophthalmology course

2. Epiphora = دايمـــاً ،، دمــوع ،، دمــوووع ،، دمــووووووع

3. Introduction Watering eye is an extremely common ocular symptom. Watering Eye Lacrimation Epiphora

4. THE WATERING EYE Lacrimation: is watering that occurs secondary to excessive tear production in the presence of a normal excretory system. Epiphora: is watering that occurs secondary to abnormal excretory system in the presence of normal tear secretion.Epiphora: is watering that occurs secondary to abnormal excretory system in the presence of normal tear secretion.

5. Lacrimal drainage system - anatomy

6. Lacrimal pump

7. Secretory system Normal tear secretion is necessary to keep the ocular surface moist. The tears form a thin film, which integrity is crucial for normal corneal physiology. Tear composition and secretion - three layers: I.Mucin layer: secreted by the goblet cells II.Aqueous layer: secreted by the accessory lacrimal glands (Krause and Wolfring) III.Oily layer: secreted by the Meibomian glands

8. Etiology  There are two main causes : 1- Excessive production of tears 2- Blocked drainage system

9. Excessive production of tears 1- Emotional distress (crying). 2- Increased irritation of the eyes: (e.g. smoke, dust, foreign bodies). 3-Occular inflammation : (e.g. Infective conjunctivitis) 4- Allergic conjunctivitis 5-Injury to the eye 6- Rhinitis

10. Blocked drainage system 1.Malposition of the lacrimal puncta (e.g. ectropion). 2.Obstruction (anywhere along the lacrimal drainage system, from puncta to the nasolacrimal duct). 3. Lacrimal pump failure (lower lid laxity or weakness of the orbicularis muscle).

11. Diagnosis  Diagnosis of epiphora is clinical by: 1- history presentation and observation of the lids. 2- Examinations.

12. Schirmer Tear Testing Normally, at least 15mm of the paper should turn blue within five minutes.

13. Conjunctival Fluorescein Test It is applying 2% sodium fluorescein eye drops in the conjunctival inferior fornix The patient blow the nose into a facial tissue to detect the fluorescein from same side nose i.e. patent passage. It is applying 2% sodium fluorescein eye drops in the conjunctival inferior fornix The patient blow the nose into a facial tissue to detect the fluorescein from same side nose i.e. patent passage.

14. Regurge Pressure Test It is applying direct pressure over the lachrymal sac. Positive regurge test will result in appearance of sac content in the conjunctival surface. It is applying direct pressure over the lachrymal sac. Positive regurge test will result in appearance of sac content in the conjunctival surface.

15. Irrigation of the lower lacrimal system under topical anesthesia Dilation of lachrymal punctum with a dilator Injection of saline through the dilated lachrymal punctum. Patent lachrymal drainage system is considered if the patient felt fluid in his nose.

16. Dacryocytsography (Radiographic Contrast Studies) It is injection of fluorescent dye through the conjunctival puncta. With plan X ray, the shape, position, size of the passage & site of obstruction could be diagnosed & properly managed.

17. Management 1.Treatment options depend on the severity of the epiphora and its causes. 2.In mild cases doctors may recommend just watchful waiting - doing nothing and monitoring the patient's progress. 3.Treat the cause (entropion, Foreign body or inflammation). 4.Dacryocystorhinostomy in case of (Nasolacrymal duct blockage).

18. Dacryocystorhinostomy

19. Conclusions The proper diagnosis and treatment of watering eye is important due to its impact on the outcome of many other ocular procedures. Undiagnosed and untreated watering eye substantially decreases the patients' quality of life, visual acuity and impairs social contacts.

20. Summary~  Definition : overflow of tears into the face.  Etiology : Excessive tear production or blocked drainage system.  Diagnosis: By history presentation and examination.  Management: It depend on the severity of the epiphora and its causes.

21. Reference 1. Basic Ophthalmology, Osama M. El- Bassiouny, M.B. B.Ch, M. Ch. (Oph.), Ph.D. (Oph.) 2.ABC of eyes, P T Khaw,P Shah, A R Elkington 3.Brigita Drnovšek-Olup, Eye Hospital, University Medical Centre

22. Thank You