Tuesday, April 20, 2021

Lacrimal sac syringing

Lacrimal Sac Syringing


REQUIREMENTS: Anesthetizing eye drops, 25G broken needle and another sterile needle, syringe with sterile normal saline, punctum dilator (used only when punctum opening is small) 

• Explain the procedure to the patient and take consent

• Anesthetize the using eye drops
• Aspirate 2 ml normal syringe by using a sterile needle attached to the syringe

• Then replace this needle with a broken 25G needle

• POSITION: The patient can be supine with the examiner at the head end of the patient or the patient can be in a semi-recumbent position
• Pull the lower lid downwards and outwards as this causes the eversion of eyelid and straightening of horizontal canaliculus. Identify the lower punctum in bright light
• Hold the 25G broken needle attached to syringe by right index and thumb and place it on the punctual opening

• Twist it with the light pressure and introduce into the punctum first in vertical direction (downward) 

• Then change it to horizontal direction and push it medially by rotator movement-following the course of the canaliculus (first vertically then horizontally)

• Now push the piston of syringe attached to the needle, and inject 1ml of saline into the canaliculus slowly (as fast injection may give false positive regurgitation test), and ask the patient if saline has reached his/ her throat. Alternatively, note the swallowing movement of the neck

• Water is going freely into the throat - Lacrimal passage is patent

• Water is not going into the throat, instead, it is regurgitating through the upper punctum and partly through the same punctum: 

Common Canalicular Duct block: 
a) Soft Stop to needle 
b) Fast regurgitation 
c) Clear fluid coming out through the upper puncta generally 

Nasolacrimal Duct block: 
a) Hard Stop to needle 
b) Slow regurgitation 
c) Turbid fluid regurgitation (water is mixed with pus, mucus, mucopus or mucoid material) 

 • If little water is going onto the throat after forced syringing (some part is coming out through punctum), It is called partial nasolacrimal duct block

Written by our guest author Krishna Borse
Illustrations by Ayushi Gupta

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