Weeping

Introduction Tears, ophthalmological symptoms. Mainly related to 3 reasons. The first is excessive secretion of tears caused by tissue lesions such as cornea, iris, ciliary body, or smoke and chemicals. The second is due to the obstruction of the lacrimal duct system, the normal secretion of tears can not be smoothly discharged into the nasal cavity, so that reflux reflux. The third is due to the valgus valgus, the small tears can not be close to the tears, the tears can not enter the nasal cavity by the canaliculus, and thus overflow.

Cause

In addition to crying, there are roughly three reasons for tearing.

The first is excessive secretion of tears, often associated with stimulation of the cornea, iris, ciliary body and other tissues; the tears caused by smoke and chemical stimulation are also of this type.

The second is due to the obstruction of the lacrimal duct system, the normal secretion of tears can not be smoothly discharged into the nasal cavity, so that reflux reflux, clinically can be confirmed by lacrimal irrigation.

The third is due to the valgus valgus, the small tears can not be close to the tears, so that the capillary drainage of the tears is destroyed, the tears can not enter the nasal cavity by the canaliculus, and thus overflow. This kind of tearing mainly occurs in elderly patients with reduced orbital palpebral muscle tension and patients with facial nerve palsy and eyelids that cannot be closed.

an examination

Related inspection

Chlamydia trachomatis fundus fluorescein angiography corneal fluorescein staining

Focus on the excessive secretion of tears or the obstruction of lacrimal passages. Do the following three tests.

1. Silmer's test: Dedicated test strips were used to measure the amount of tear secretion per minute. Under normal circumstances, the test paper can be wetted by 10~15mm, and rarely exceeds 20mm. If it exceeds 23mm, it is abnormal.

2. Hydrogenation of fluorescein through the test: 1 drop of 1% hydrogenated fluorescein liquid was spotted, and after 60 seconds, the hydrogenated fluorescein was removed by eye wash, and the nostrils were observed with a fluorescent lamp, and the fluorescent person was positive, and the negative was not observed. A negative person indicates that the lacrimal duct is obstructed. However, some cats appear after 5 to 10 minutes, so the final decision will be taken after 10 minutes.

3. lacrimal x-ray angiography: mainly to investigate the obstruction of the lacrimal sac and the nasolacrimal duct. The physiological saline was injected from the upper puncture point in advance, and the lacrimal sac was pressed to confirm that the washing liquid had flowed out from the lower punctum, and then injected with an organic iodine contrast agent and photographed by x-ray. When the lacrimal duct is blocked, the contrast agent can be seen to stay there.

Differential diagnosis

The following diseases should be identified

1. Chlamydia trachomatis acute onset: When Chlamydia trachomatis infects the conjunctival epithelial cells, it proliferates and forms scattered, cap, mulberry or stuffed inclusions in the cytoplasm. The disease is slow, early acute or subacute inflammation of the orbital conjunctiva, manifestations of tears, mucopurulent secretions, conjunctival hyperemia and other symptoms and signs. The late migration behavior is chronic, and there are conjunctival scars, eyelid varus, trichiasis, corneal damage caused by corneal vasospasm, which affects vision and finally leads to blindness.

2, overflow tears: long-term tears, skin flushing, rough, eczema near the internal hemorrhoids, because the patient continues to wipe down, can promote valgus valgus.

3, the lacrimal passage is not blocked:

(1) occlusion of the punctum: the lacrimal punctum is membranous atresia;

(2) obstruction of the lacrimal canal: the needle is inserted from the small point of the tear, and the liquid immediately flows back from the small point of the tear;

(3) nasolacrimal duct obstruction: the needle is inserted from the lower punctum, first smooth, and then flows out from the upper punctum, no mucus or purulent discharge reflux;

(4) stenosis of the nasolacrimal duct: the needle is inserted from the small point of the tear, part of the fluid is refluxed, and a small amount of liquid flows into the nasopharynx.

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