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Infections of lacrimal pathway

  1. Chronic Canaliculitis:
    1. By actinomyces israelii (Streptothrix*)
    2. Pouting punctum and concretions in canaliculi
  2. Dacryocystitis- May be acute or chronic
    1. Chronic dacryocystitis – It common in females ( 80%) between age 40-60 years- causative organism are – Staphylococci, streptococci, pneumococci, pseudomonas pyocyanea, rarely T.B. Syphilis, leprosy
    2. Acute Dacryocystitis-  Commonest organism is – Streptococcus haemolyticus*, other – pneumococcus , staphylococcus
    3. Congenital Dacryocystitis→Due to non- canalization of NLD*. Commonly occlusion is membranous*
  1. Less than 12 month - Ocular massage*.
  2. 12 to 18 months - Syringing and Probing (May be Repeated twice)
  3. > 18 months - DCR {normally done at 4-5 yrs of age}

Diseases of Sclera

  1. Episcleritis
    It is a common benign self-limiting recurrent disorder frequently affecting young adults.
    Never progresses to true scleritis*.
  1. Nodular episcleritis
  2. Diffuse episcleritis
Clinical feature:
Phenylephrine test: veessls blanch on instillation of 10% phenylephrine

  1. Mild case- Topical steroids and/or topical NSAIDS
  2. In resistant case
    1. Oral Steroids       
    2. Oral Indomethacin
  1. SCLERITIS Phenylephrine instillation into conjunctival sac-blaching of vessels in episclerits
    It is a inflammation of the scleral coat of the eye.
  1. Scleritis In systemic diseases
    Patients of particularly necrotizing scleritis may have one of the following systemic diseases
    1. Rheumatoid arthritis*
    2. Connective tissue vascular* disorders like Polyarteritis nodosa, Systemic lupus erythematosus, Wegener’s granulomatosis
    3. Miscellaneous
      1. Relapsing Polychondritis                                      
      2. Herpes Zoster   
      3. Surgically induced scleritis.                                            
      4. ​TB in India
  1. Treatment
    1. Oral NSAIDS
    2. Oral Steroids
    3. Immunosuppressive drugs- These are indicated in necrotizing inflammatory scleritis.
      There is no effective treatment for necrotizing:- non-inflammatory scleritis (called “Scleromalacia perforans”)
      Scleromalacia Perforans – it is anterior necrotizing scleritis without inflammation
      *  Common in women with long- standing seropositive rheumatoid arthritis*
  1. C/F: 
  1. Asymptomatic and starts with yellow necrotic scleral patch
  2. Large areas of exposed uvea due to scleral thinning
  3. Spontaneous perforation is rare, unless intraocular pressure is elevated
Treatments: No effective treatment
USG Finding of post posterior Scleritis = T wave sign

Iron Lines:
Ferrys - bleb
Stalkers – Pteryigum
Hudson stahli - Cornea
Fleischer ring – base of keratoconuus

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