Lecturer

Michel Belliveau
MD, FRCSC
Oculoplastic & Orbital Surgeon at The Ottawa Hospital and Children's Hospital of Eastern Ontario

• Review the principles that guide the management of lacrimal drainage system disorders
• Outline a practical approach to the tearing patient
• Highlight some special clinical scenario in dacryology
• Introduce dacryocystorhinostomy (DCR), its rationale, complications and their management

In this video case-based course, Dr. Michel Belliveau will walk participants through the evaluation and treatment of the tearing patient. Some of the topics that will be discussed include:

• The fundamentals of tear production and drainage including a brief overview of the lacrimal drainage system
• Pathology that can prevent the proper drainage of tears
• Methods to identify the cause of tearing disorders
• Methods used to treat conditions that impede proper tear drainage

Before moving on to the lecture, take a moment to examine the image below. An 82 year old presents with excessive tearing. Why?

• Significant lower lid laxity (ectropion)

  CORRECT

  Significant lower lid laxity (ectropion) is present as the lower lid is located away from the globe. This is a common cause of epiphora.

• Involutional entropion

  Involution entropion occurs when there is laxity of the lid, but it rotates inward into the globe. Lashes frequently rub against the cornea and a corneal epitheliopathy can ensue.

• Cicatricial ectropion

  Here the lid rotates outward due to lid or skin scarring

• Symblepharon

  With a symblepharon, there is scarring of the conjunctiva and adherence of the palpebral to tarsal conjunctiva. This may be caused by drying, medication and inflammation.