Lacrimal Syringing, Procedure, Result, Indication and Contraindications (ROPLAS) - Eye Health Nepal

Lacrimal Syringing, Procedure, Result, Indication and Contraindications (ROPLAS)

lacrimal Syringing


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


WHY  IS SYRINGING  DONE?

  • For  diagnostic and therapeutic  purposes


Indications of Lacrimal Syringing:

  • In  epiphora (obstruction of the lacrimal drainage system. The tear spills over the lower eyelid 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


Equipment required: 

  • Large steel tray or kidney tray.
  • Gallipot.
  • Lacrimal cannula
  • Punctum dilator 
  • Syringe 
  • Eye towel 
  • Cotton swab 
  • Binocular Loupe 
  • Torchlight

Medicine required

  • 4%  Lignocaine (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 of lacrimal syringing:

  • 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 the nasal side. (The punctum is about 0.3 to 0.5 mm in diameter.)

The possible result after lacrimal syringing:

  • Fluid flows back freely from the patient`s nasolacrimal duct in the throat. Tell the patient that the fluid can be swallowed.
  • There is the regurgitation of a clear fluid from 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 the regurgitation of the fluid, the procedure is repeated 3-4 times. If the block does not open surgery should be advised.

Lacrimal apparatus anatomy


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 the endotracheal tube.


Complication:

  • Iatrogenic infection
  • Creation of false passage.

What is ROPLAS test?

ROPLAS denotes for Regurgitation on pressure over the lacrimal sac. It is a clinical test that helps in diagnosing nasolacrimal duct obstruction (NLDO) with specificity as high as 99%. This means that if ROPLAS test is positive it mostly confirms that patient has a nasolacrimal duct obstruction (NLDO).

Regurgitation on pressure over the lacrimal sac test
ROPLAS (Photo Source: https://entokey.com/evaluation-of-epiphora/)

More details about ROPLAS : 

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