同济大学：《眼科学》课程电子教案（PPT课件讲稿）泪道疾病 THE WATERING EYE

THE WATERING EYE Dr.JUN ZOU Shanghai Tenth People's Hospital 2016-3-9 .Ljubljana,Slovenia Eye Hospital,University Medical Centre

THE WATERING EYE Dr. JUN ZOU Shanghai Tenth People's Hospital 2016-3-9 •Ljubljana, Slovenia Eye Hospital, University Medical Centre

Introduction Watering eye is an extremely common ocular symptom. Watering eye lacrimation epiphora Failure to differentiate these two conditions can result in unwarranted and improper medication of a large number of patients

Introduction • Watering eye is an extremely common ocular symptom. Watering eye lacrimation epiphora Failure to differentiate these two conditions can result in unwarranted and improper medication of a large number of patients

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

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

Secretory system Lacrimal gland:orbital part(2/3) palpebral part(1/3) Accessory lacrimal glands:Krause Wolfring

Secretory system • Lacrimal gland: orbital part (2/3) palpebral part (1/3) • Accessory lacrimal glands: Krause Wolfring

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: the mucin layer:secreted by the goblet cells;alters the surface tension of the tears and increases its adherence to the cornea. the aqueous layer:secreted by the accessory lacrimal glands (Krause and Wolfring)or in the presence of ocular irritation the main lacrimal gland. the oily layer:secreted by the Meibomian glands;prevents tear film evaporation

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: • the mucin layer: secreted by the goblet cells; alters the surface tension of the tears and increases its adherence to the cornea. • the aqueous layer: secreted by the accessory lacrimal glands (Krause and Wolfring) or in the presence of ocular irritation the main lacrimal gland. • the oily layer: secreted by the Meibomian glands; prevents tear film evaporation

A new tear film model showing additional layers and interfaces (a six-layer model): AIR Oily layer Polar lipid monolayer Absorbed mucoid Aqueous layer Mucoid layer Glycocalyx' CORNEAL EPITHELIUM Previous reports had vastly underestimated the thickness of mucus

A new tear film model showing additional layers and interfaces (a six-layer model): Previous reports had vastly underestimated the thickness of mucus

Ocular surface and lacrimal glands function as an integrated unit. The Healthy Eye Secretomotor Nerve Impulses Lacrimal Glands Tears Support and Maintaio Ocular Surface Ocular Surface Neural Stimulation

Ocular surface and lacrimal glands function as an integrated unit

Secretory system Pathology of the tear film: deficiency of the aqueous layer -keratoconjunctivitis sicca. deficiency of mucous or meibomian secretions instability of the tear film(compensatory excessive aqueous secretion -paradoxical watering)

Secretory system • Pathology of the tear film: • deficiency of the aqueous layer - keratoconjunctivitis sicca. • deficiency of mucous or meibomian secretions - instability of the tear film (compensatory excessive aqueous secretion - paradoxical watering)

Lacrimal drainage system -anatomy Common canaliculus Punctum Canalicuus (8 mm) 8 mm -Amputls 2 mm Lacrimal sac (10 mm) 12m Middle turbinate Nasolacrimal Ampulla (2 mm duct (12 mm) Common canaloulus Valve of Hasner manmy te lcimal ecrymn byChne 2007E

Lacrimal drainage system - anatomy

The anatomy of tear production and flow Lacrimal gland Ca Lacrimal sac Middle turbinate Nasolacrimal duct Inferior turbinate

The anatomy of tear production and flow