Introduction

Dilation and irrigation is a safe and easy procedure used to determine the patency of the lacrimal drainage system.

Indications

Potentially blocked lacrimal drainage system, such as in epiphora

Contra-Indications

Allergy to any medications used during the procedure.

Materials

1. Proparacaine 0.5% ophthalmic solution (or other topical anesthetic)
2. Combination antibiotic/steroid (Tobradex, Zylet), ophthalmic steroid, or saline for demonstration purposes
3. Lacrimal dilator (previously sterilized in autoclave, germicidal solution, or with alcohol)
4. Lacrimal cannula (previously sterilized in autoclave, germicidal solution, or with alcohol)
5. Syringe

Setup

1. Ensure the cannula and dilator have been previously sterilized, or sterilize now.
2. Screw cannula onto syringe
3. Remove plunger from syringe and fill with several milliliters of Tobradex/steroid/saline.  Replace plunger.
4. Instill one drop of Proparacaine 0.5% into each eye and wait for anesthesia to take effect.
5. Dilate the puncta by inserting the smallest possible dilator into puncta and rotating dilator while gently pressing downward.  Increase size of dilator until puncta is dilated to desired size.
6. Holding syringe vertically, insert cannula into dilated puncta.  Gently press downward until you experience resistance.
7. Reorient syringe horizontally, and press in further until inserted fully.
8. Inject Tobradex/steroid/saline into lacrimal drainage system, observing what happens.
9. Dispose of syringe in sharps container.

Results

If solution regurgitates from the punta, the lacrimal drainage system is blocked, and a surgical consult is appropriate.

If the patient tastes the solution in the back of their throat, the lacrimal drainage system is patent.  An ophthalmic antibiotic/steroid may be prescribed QID X 7 days in the event that a infection/inflammation of the lacrimal drainage system is suspected.

References

Casser, et. al, Atlas of Primary Eyecare Procedures, Chapter 36