NORTH CAROLINA OPTOMETRY
BOARDS EXAM QUESTIONS &
ANSWERS SOLVED 100% CORRECT!!
1 of
85
Definition
Diagnostic tests will depend on the patient presentation and
clinical suspicion.
CT or MRI should be used when there is suspicion of traumatic,
mechanical, or neoplastic obstruction. If there is suspicion for
neoplasm, contrast is preferred, and scans should evaluate
the lacrimal sac, orbit, and paranasal sinuses.
Dacryocystography is a radiographic procedure that involves
dilating the lower punctum, inserting a small catheter,
injecting
contrast, and then imaging with x-ray or CT. Dacryocystography will
visualize any blockage, trauma, inflammation, fistulas, diverticuli,
, tumors, or other anatomic abnormalities, but it does not
differentiate well between the type of blockage. Due to modern
imaging,
dacryocystography is now rarely used.
Dacryoscintography utilizates radionuclide tracers and gamma-gram
imaging to examine the lacrimal drainage system. This method can
detect incomplete obstructions and uses very little radiation, but it
is less helpful in identifying complete obstructions or lacrimal
neoplasms.
For infectious etiologies, discharge should be sent for culture and
susceptibilities. Cases associated with inflammatory ocular findings
should include C-ANCA, angiotensin converting enzyme levels, and
chest X-ray. Concerning masses should be biopsied. Closed biopsies
are done with blunt needles passed through a skin crease or medial
canthal incision. A positive biopsy and subsequent tumor resection
will postopone surgical management of the NLDO
Give this one a try later!
What laboratory testing
should be performed to test How is secondary nasolacrimal duct
for secondary nasolacrimal obstruction treated?
duct obstruction?
What are the signs and symptoms What is the cause of neoplastic
of secondary nasolacrimal duct secondary nasolacrimal duct
obstruction? obstruction?
Don't know?
2 of 85
, Term
What is the cause of mechanical secondary nasolacrimal
duct obstruction?
Give this one a try later!
Trauma includes both accidental and iatrogenic insults. Accidental trauma most
commonly includes bone injury (such as naso-orbito-ethmoid fractures). Trauma
is often mechanical, but can also be chemical, drug induced, or radiation
induced.
These may be bacterial, viral, fungal, or even parasitic infections. There are many
bacterial causes, but the most common pathogens are Staphylococcus,
Streptococcus, and Actinomyces species. The most common infectious cause
of SANO is dacryocystitis.
Causes of inflammation may be endogenous or exogenous. Examples of
endogenous inflammation are sarcoidosis and granulomatosis with
polyangitis (GPA, formerly known as Wegener's granulomatosis). Examples of
exogenous
inflammation are burns, allergies, eye drops (such as antiviral,
chemotherapeutic, or radiotherapy agents). and radiation.
Mechanical SANDO may occur with obstruction anywhere along the
nasolacrimal duct, and examples include sinus mucoceles or
dacryoliths.
Mechanical obstruction fo the canaliculi can cause dacryocystitis
and indirectly lead to NLDO.
Don't know?
3 of 85
Term
, What are the signs and symptoms of infectious
secondary nasolacrimal duct obstruction?
Give this one a try later!
If the etiology is infectious, there may be a thickened canalicular portion
of the eyelid, an erythematous punctum, conjunctival injection, expressible
punctal discharge, or even occasionally a lacrimal fistula. There may
also be swelling of the lacrimal sac.
If the etiology is traumatic, a flattened nasal bridge, telecanthus, or a facial
scar may be present. Facial bony abnormalities may also be apparent on
external exam. Bloody punctal discharge is highly suggestive of neoplasm.
Symptoms may occur over several hours to several days and is characterized
by pain, erythema, and edema over the medial canthus and the area overlying
the lacrimal sac at the inferomedial portion of the orbit. The redness can
extend to
involve the bridge of the nose. Purulent material can sometimes be
expressed from the puncta and tearing may be present.
Excessive tearing and discharge are the most common symptom. Changes in
visual acuity may be present due to tear film production. Erythema involving
the entire orbit ad pain with extraocular movement are not typically associated
with dacrycystitis and should prompt the health care provider to search for
alternative diagnoses.
Don't know?
4 of
85
Term
BOARDS EXAM QUESTIONS &
ANSWERS SOLVED 100% CORRECT!!
1 of
85
Definition
Diagnostic tests will depend on the patient presentation and
clinical suspicion.
CT or MRI should be used when there is suspicion of traumatic,
mechanical, or neoplastic obstruction. If there is suspicion for
neoplasm, contrast is preferred, and scans should evaluate
the lacrimal sac, orbit, and paranasal sinuses.
Dacryocystography is a radiographic procedure that involves
dilating the lower punctum, inserting a small catheter,
injecting
contrast, and then imaging with x-ray or CT. Dacryocystography will
visualize any blockage, trauma, inflammation, fistulas, diverticuli,
, tumors, or other anatomic abnormalities, but it does not
differentiate well between the type of blockage. Due to modern
imaging,
dacryocystography is now rarely used.
Dacryoscintography utilizates radionuclide tracers and gamma-gram
imaging to examine the lacrimal drainage system. This method can
detect incomplete obstructions and uses very little radiation, but it
is less helpful in identifying complete obstructions or lacrimal
neoplasms.
For infectious etiologies, discharge should be sent for culture and
susceptibilities. Cases associated with inflammatory ocular findings
should include C-ANCA, angiotensin converting enzyme levels, and
chest X-ray. Concerning masses should be biopsied. Closed biopsies
are done with blunt needles passed through a skin crease or medial
canthal incision. A positive biopsy and subsequent tumor resection
will postopone surgical management of the NLDO
Give this one a try later!
What laboratory testing
should be performed to test How is secondary nasolacrimal duct
for secondary nasolacrimal obstruction treated?
duct obstruction?
What are the signs and symptoms What is the cause of neoplastic
of secondary nasolacrimal duct secondary nasolacrimal duct
obstruction? obstruction?
Don't know?
2 of 85
, Term
What is the cause of mechanical secondary nasolacrimal
duct obstruction?
Give this one a try later!
Trauma includes both accidental and iatrogenic insults. Accidental trauma most
commonly includes bone injury (such as naso-orbito-ethmoid fractures). Trauma
is often mechanical, but can also be chemical, drug induced, or radiation
induced.
These may be bacterial, viral, fungal, or even parasitic infections. There are many
bacterial causes, but the most common pathogens are Staphylococcus,
Streptococcus, and Actinomyces species. The most common infectious cause
of SANO is dacryocystitis.
Causes of inflammation may be endogenous or exogenous. Examples of
endogenous inflammation are sarcoidosis and granulomatosis with
polyangitis (GPA, formerly known as Wegener's granulomatosis). Examples of
exogenous
inflammation are burns, allergies, eye drops (such as antiviral,
chemotherapeutic, or radiotherapy agents). and radiation.
Mechanical SANDO may occur with obstruction anywhere along the
nasolacrimal duct, and examples include sinus mucoceles or
dacryoliths.
Mechanical obstruction fo the canaliculi can cause dacryocystitis
and indirectly lead to NLDO.
Don't know?
3 of 85
Term
, What are the signs and symptoms of infectious
secondary nasolacrimal duct obstruction?
Give this one a try later!
If the etiology is infectious, there may be a thickened canalicular portion
of the eyelid, an erythematous punctum, conjunctival injection, expressible
punctal discharge, or even occasionally a lacrimal fistula. There may
also be swelling of the lacrimal sac.
If the etiology is traumatic, a flattened nasal bridge, telecanthus, or a facial
scar may be present. Facial bony abnormalities may also be apparent on
external exam. Bloody punctal discharge is highly suggestive of neoplasm.
Symptoms may occur over several hours to several days and is characterized
by pain, erythema, and edema over the medial canthus and the area overlying
the lacrimal sac at the inferomedial portion of the orbit. The redness can
extend to
involve the bridge of the nose. Purulent material can sometimes be
expressed from the puncta and tearing may be present.
Excessive tearing and discharge are the most common symptom. Changes in
visual acuity may be present due to tear film production. Erythema involving
the entire orbit ad pain with extraocular movement are not typically associated
with dacrycystitis and should prompt the health care provider to search for
alternative diagnoses.
Don't know?
4 of
85
Term
