LYMPHATICS AND GLAUCOMA SURGERY,Daljit Singh study

Lymphatics, the vital drainage channels for aqueous.
Daljit Singh

The conjunctival lymphatics are either totally neglected or receive a cursory mention, in ophthalmic text books and sadly even in books devoted to glaucoma.
Over 50 % of aqueous drainage is through uveo-scleral outflow. There no other structures except lymphatics that shall drain the out-coming aqueous, normally and after a filtration surgery. Damage to lymphatics can jeopardize glaucoma surgery results.
Under a slit lamp microscope, the lymphatics produce corrugation of the light reflex. The presence of pigment at the limbus highlights the presence of the lymphatics. Sometimes fascinating patterns of lymphatics can be charted. The channels may be visible all around the limbus. Trauma of any kind including surgical can introduce blood inside the lymphatics, making them stand out beautifully. On a rare occasion, one may see lymphatics coursing over the blood vessels, and running parallel to the limbus.
A microtrack filtration may fill up the lymphatics close to the limbus.
Inside the operation theater, subconjunctival injection of hydrocortisone might enter the lymphatics and thus highlight them. Injury at the limbus may fill up the adjoining lymphatics. Air injection can fill up the lymphatics. Trypan blue injection at the limbus can outline the huge network of conjunctival lymphatics. The dye may sometimes fill up a circular channel in the periphery of the cornea in the place where one finds lucid interval of arcus senilis. A case that had been operated upon by microtrack as an emergency. Next day, trypan blue was injected in the anterior chamber- it beautifully demonstrated the conjunctival network of lymphatics.

All ophthalmologists need to be aware of lymphatics. They may hold key to success in glaucoma surgery. The future operations may be designed around them.

Category:

Science & Technology

Tags:

• Conjunctival
• lymphatics
• Daljit Singh