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.


  • For  diagnostic and therapeutic  purposes


  • 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


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


  • 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


  • 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.


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