Anatomi Sistem Lakrimal

• Sekresi
• Glandula Lakrimalis
• Pars Orbitalis (terletak pada bagian temporal anterior orbita)
• Pars Palpebralis (terletak di segmen temporal fornik konjungtiva superior)
• Glandula Lakrimalis Accesorius (1/10 kelenjar utama)
• Glandula Krause
• Glandula Wolfring

• Ekskresi
• Punktum lakrimalis (superior, inferior)
• Kanalis Lakrimalis
• Saccus Lakrimalis
• Duktus Nasolakrimalis
• Meatus Inferior
Drainage Air Mata
• Air mata mengalir dari lakuna lakrimalis melalui punctum superior et inferior dari kanalikuli ke Saccus
Lacrimal yang terletak di dalam fossa lacrimalis. Ductus nasolakrimalis berlanjut ke bawah dari saccus dan
bermuara ke dalam meatus inferior dari rongga nasal (lateral terhadap turbinatum inferior). Air mata diarahkan
ke dalam punctum oleh isapan kapiler, gaya berat, dan berkedip. 
Canaliculi Laceration
DIAGNOSIS
• Canalicular lacerations are identified by direct observation of a
laceration medial to the punctum or by probing (usually with a
Bowman probe) of the canalicular system.
• Canalicular laceration may not be obvious on presentation. (
Fig. 2) In young children, an examination under anesthesia with
dilation and probing may be necessary to make the diagnosis.
• Severe medial laceration with lateral displacement of the medial
canthus alerts the physician to obvious underlying lacrimal
system damage. (Fig. 3)
• The proximal end of the laceration is easily identifiable with the
use of a Bowman probe, (Fig. 4) but the distal/nasal portion of
the canaliculus is often more difficult to identify. The surgeon
begins by cleaning the wound and looking for white circular
tissue within the pink area of orbicularis muscle. If this is not
identified easily, fluorescein or air may be injected via a 27 gauge
cannula into the opposite punctum. The surgeon may then
observe dye appearance or bubbles (when the nasal canaliculus
of interest is submerged) emanating from the nasal portion of
the canaliculus.
 LACRIMAL SAC & NASOLACRIMAL
DUCT INJURIES
• As previously mentioned, the management of lacrimal sac and nasolacrimal duct injuries should not be explored at
the initial surgery if there is no obvious laceration. The rationale is that it is difficult in adequate assessment and
repair especially of the severe injury because of soft tissue edema and hemorrhage. Trauma to lacrimal pathways
can produce temporary or permanent dysfunction. Temporary dysfunction is caused by lacrimal compression by
posttraumatic edema. There were studies that showed spontaneous resolution of traumatic epiphora within 6
months after primary fracture repair. Persistent dysfunction is a result of direct causes such as detachment of the
medial canthal ligament with subsequent sac compression and pumping failure.

• Irrigation of the system during primary fracture reconstruction or early postoperative period is not helpful due to
edema and inflammation of the nasolacrimal duct. We recommend better assessment 1–3 months after trauma
when resolution of edema and soft tissue injuries permit the definitive evalua- tion. Using fluorescein dye instilled
into inferior cul- de-sac then waiting 5 min to reevaluate, if dye still persists in cul-de-sac, it means that there is
nasolacrimal duct obstruction. The other investigation that is useful for evaluating post-traumatic nasolacrimal duct
obstruction is CT scan and dacryocystography (DCG) or combined CT and DCG. The combination of CT and DCG will
give the useful information of complexity of anatomical change after trauma and repair, identify location of the
lacrimal sac, bony structure, plate and screw implantation, and nasal septum which help in planning surgery.

Source: atlas of lacrimal surgery

 LACRIMAL SAC & NASOLACRIMAL
DUCT INJURIES
• For obvious laceration of the lacrimal sac or nasolacrimal duct there
are different techniques to perform. Some authors advise applying
silicone tube from punctum through the lacrimal sac and nasolac-
rimal duct, but only if this can be done easily. If any difficulty is
encountered, the attempts should be curtailed to avoid damage to
the canalicular system. Subsequent DCR surgery may be done, if
necessary, when the healing process is complete, usually 6 months
after injury.

Source: atlas of lacrimal surgery

ANEL TEST
 Jenis – Jenis Pemeriksaan
• Pemeriksaan fisik mata yang bertujuan untuk mengetahui ada
tidaknya obstruksi serta pada ductus nasolacrimal:
• Dye disappearance test (fluoresin, slit lamp)
• Fluoresence clearance test (fluoresin 2%)
• Jones Dye Test (Jones Dye Test I dan II, fluoresin)
• Anel Test (menilai fungsi ekskresi lakrimal ke dalam rongga hidung, NACL)
• Probing Test (letak osbstruksi, sonde/probe)

Source: penyakit sistem lakrimal – airlangga university press

Definisi
• Pemeriksaan untuk melihat patensi duktus lakrimalis, menilai fungsi
eksresi lakrimal ke dalam rongga hidung

• The Anel test is performed by cannulating the lower lacrimal point and
injecting physiological saline. When the system becomes patent, the
patient will taste salt. The test is simple and inexpensive but does not
distinguish between levels of obstruction.

• Negative  ada obstruksi (regurgitasi), Positif  tidak ada obstruksi

(ada reaksi menelan pada pasien)