Inflammation of the lacrimal gland
Inflammation of the lacrimal gland as a variant of a disease of the lacrimal ducts (dacryoadenitis) can be divided into the acute and the chronic form. On the affected side, swelling, redness and pain in the lateral eyebrow area are conspicuous. A local infection, which also affects the lacrimal gland, is just as likely to be the cause of inflammation of the lacrimal gland as a systematic disease.
Therapy with systemic antibiotics is often sufficient, but sometimes surgical opening of the inflamed area may be necessary. It is possible that the inflammation may spread to the area of the orbit, but it rarely occurs. Tumors of the lacrimal gland as a disease of the draining tear ducts are rare and often first appear due to a non-painful swelling in the area of the lacrimal gland (lateral eyebrow area).
The tumors in the area of the lacrimal gland can be benign or malignant. With increasing growth, they can displace the eyeball, so that eye mobility is disturbed or damage to the optic nerve occurs. In addition, changes may occur at the back of the eye (e.g., retinal folds, retinal bleeding, choroidal swelling).
Tumors of the lacrimal gland are surgically removed and then histologically examined. Depending on the histological findings, the further procedure is then planned. Tears flow off in the area of the inner eyelid angle via the upper and lower lacrimal point into the lacrimal duct.
These two tear ducts of the upper and lower eyelid end in the lacrimal sac via a common tear duct. The nasolacrimal duct connects the lacrimal sac and the nose. Before the opening of the nasolacrimal duct into the nose, the so-called Hasner valve is located in the area of the nasal concha.
Dacryocystitis (see extra article “Inflammation of the lacrimal ducts“). An inflammation, scarring or, although rare, a systemic disease can cause a narrowing of the lacrimal duct (lacrimal punctum). Dilatation (widening) of the lacrimal lacrimal point can often restore the flow of tears.
If there is an abnormality in the drainage of the lacrimal ducts in the area of the lacrimal tubules, the lacrimal sac or the nasolacrimal duct, surgery may be necessary. For this purpose, there are various surgical techniques with which the outflow of tears can be restored. Dacryorhinostomy according to Toti shows very good results, especially in cases of stenosis in the area of the nasolacrimal duct.
Procedure: Blood-thinning/anticoagulant medication must be discontinued before the operation. The dacryocystorhinostomy is then performed under general anesthesia. It provides a new drainage route for tears into the nose.
A silicone tube is inserted to keep this route open immediately after the operation. This may be removed after about 3 months, as the healing process is then completed to such an extent that there is little danger of adhesion. If the tube slips or gets lost prematurely, there is usually no acute danger to the surgical result.
Nevertheless, the patient should quickly see an ophthalmologist. After the operation, there is a strict ban on snowing to prevent loss or premature displacement of the tube. If the stenosis is located in the area of the lacrimal canal (Canaliculus communis), a small tube is also necessary, which is implanted.
The so-called Hasner valve sits at the end of the lacrimal duct before it opens into the nasal cavity and closes it. Usually, the Hasner valve opens shortly before the child is born. If a newborn baby has a delayed opening, this can lead to tears or recurring inflammation.
In more than 90% of these cases, the Hasner’s valve opens spontaneously during the course of the baby’s life up to the age of 1 year. Massages in the area of the lacrimal sac can promote drainage and support the opening of the Hasner’s valve. If no spontaneous opening of the Hasner’s valve is observed, an exploration of the lacrimal ducts becomes necessary.
By inserting a tear duct probe, the Hasner valve is opened mechanically. After this minimally invasive operation, local administration of decongestant and anti-inflammatory eye drops is necessary.
