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Lacrimal Syringing, Procedure, Result, Indication and Contraindications

lacrimal Syringing
Syringing  is a procedure for testing the patency of the lacrimal  drainage system. Normal saline (NS) is  injected into the naso lacrimal drainage system through the upper or lower punctum.

WHY  IS SYRINGING  DONE ?

  • For  diagnostic and therapeutic  purposes

Indications:

  • In  epiphora (obstruction of the lacrimal drainage system.The tear spills over the lower eye lid margin onto the cheek)
  • In  chronic conjunctivitis  not responding to the treatment.
  • Sometimes  syringing  is done  before the intraocular surgery e. g. in cataract and glaucoma surgery.
lacrimal drainage system

Equipments: 

  • Large  steel tray or kidney tray.
  • Gallipot.
  • Lacrimal cannula
  • Punctum dilator 
  • Syringe 
  • Eye towel 
  • Cotton swab 
  • Binocular  loupe 
  • Torch light

Medicines

  • 4%  xylocaine for topical  use.
  • Normal saline
  • Antibiotic  eye drops
Remember: before doing any syringing you must know the anatomy of the lacrimal drainage system

How to do syringing? Procedures:

  • Explain  to the patient, what you are going to do.
  • Make the patient comfortable in bed.
  • Wash your hands.
  • Put  two drops of 4%  xylocaine drops into the eye.
  • If you want, ask your colleague to fix binocular loupe for you.
  • Draw 2ml of normal  saline into the syringe and fix the lacrimal cannula in the syringe.
  • Dilate the lower punctum with the punctum dilator.(The  punctum dilator should be inserted first vertically for about 1mm then horizontally according to the direction of the lacrimal canaliculus).
  • First insert the cannula in the lower punctum vertically down 1-2mm then horizontally towards nasal side.( The punctum is about 0.3 to 0.5 mm in diameter.)

Possible result after lacrimal syringing:

  • Fluid flow back freely from the patient`s nasolacrimal duct in the throat. Tell the patient that the fluid can be swallowed.
  • There is regurgitation of a clear fluid form the same punctum.(block at the canaliculus)
  • There is regurgitation from the upper and lower punctum. The fluid is clear that comes out quickly (block at the common canaliculus)
  • Fluid mixed with mucopurulent  substance from the upper and lower punctum (block at the nasolacrimal duct.)
  • Give the patient antibiotic eye drops at the end of the procedure.
  • If there is regurgitation of the fluid,the procedure is repeated 3-4 times. If the block does not open surgery should be advised.
syringing result

 Contraindications:

  • Acute  dacryocystitis
  • Other acute infection in the eye e.g. Acute conjunctivitis.
  • In small children, it can be done under general anaesthesia with intubation with endotracheal tube.

Complication:

  • Iatrogenic infection.(used especially of a complication
  • Creation of false passage.