The notion surfaces that, as fish evolved, left the sea and colonised the land, they then needed not only a supply of tears for their ocular surface to function, but also a means by which tears could be eliminated. The fascinating study of abnormalities of this system, which are common, frequently debilitating, and can be challenging to manage, is the purpose of this thesis. An attempt has been made initially to assess our current state of knowledge in the Introduction. In subsequent chapters, new concepts including plerolacrima, temporal plical shift and videoreflective dacryomeniscometry are introduced; some of these should prove useful clinically. Quality of life in affected preoperative and postoperative cohorts is then assessed. Original publications have been achieved in all but one of the following subsections. Conjunctivochalasis in watery eye patients has been examined for the first time in a sizeable study clinically and histopathologically. The lateral tarsal strip procedure has been described as a new method of dealing with the punctal apposition syndrome. A new assessment for success in dacryocystorhinostomy (DCR) surgery, the Valsalva bubble test, has been carried out. Tear osmolality has been studied in watery eye cohorts and compared with normal controls; this study suggests that tear production decreases significantly with obstructed lacrimal outflow. Videoreflective dacryomeniscometry has shown that watery eye patients have a higher tear meniscus than normal controls, and that this normalises following DCR surgery. Lower eyelid tensometry has been shown in patients to be unchanged compared with normal controls. Computerised tomography of the lacrimal drainage region has been used to study patients with nasolacrimal duct obstruction. The detailed clinical mechanics of syringing the canaliculus have been described. Transcaruncular medial orbitotomy surgery for laxity of the medial canthal tendon has been tested in human cadavers, and evaluated in adult living humans. In summary, this thesis may be regarded as a tentative approach to a re-evaluation of the clinical management of the watery eye.
| Identifer | oai:union.ndltd.org:ADTP/243010 |
| Date | January 2007 |
| Creators | Francis, Ian C, School of Medicine, UNSW |
| Publisher | Awarded by:University of New South Wales. School of Medicine |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | Copyright Ian C Francis, http://unsworks.unsw.edu.au/copyright |
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