External Examination and Palpation

Mass Inferior Medial Canthal Tendon

A careful history must be combined with the external exmination of the lacrimal system that begins with an inspection of the face, external ocular surface, and eyelid structure including the position and contour of the eyelid and eye blink Table 3.4 . Periorbital and facial asymmetry are looked for, as well as the lid malposition, bulges in the medial canthal area, facial nerve palsy, etc. Table 3.4. Watering patients external inspection and palpation Table 3.4. Watering patients external...

Mechanisms of Tear Drainage

Lacrimal Pump

Drainage of tears involves a number of different mechanisms Table 1.3 . Physical factors, such as gravity, respiration, and evaporation, have been suggested. A decisive role is played by capillary attraction, aided by contraction of the lacrimal portion of the orbicularis muscle with blinking, as well as distension of the lacrimal sac by the action of the orbicularis muscle 19 . The mucin diversity of the epithelium of the naso-lacrimal ducts together with TFF peptides that are able to...