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Thread: NLD Syringing and probing

  1. #1
    Join Date
    Oct 2017
    Riyadh, Saudi Arabia
    (Consultant Ophthalmologist at MALAZ MEDICAL GROUP)


    Default NLD Syringing and probing

    NLD Syringing and probing


    • only performed if the puncta are patent.

    • Anaesthetic

    • Instil adequate topical anaesthesia.

    • Punctal dilation by a blunt dilator gently to enlarge the puncta.

    • The lower lid should be pulled laterally to straighten the canaliculus prior to probing.

    • Use a punctal wire probe which can be smeared with chloramphenicol ointment for lubrication.

    • An attempt is made to carefully advance the probe via the lower punctum until a ‘stop’ is felt.

    • It is important to feel whether the cannula is resisted by something hard (hard stop) or soft (soft stop).

    Hard stop: this occurs if the cannula enters the lacrimal sac and can be advanced up against the medial wall of the sac which lies against the lacrimal bone. This suggests patency of the proximal portion of the nasolacrimal system.

    Soft stop: this occurs if the cannula stops at or proximal to the junction of the common canaliculus and the lacrimal sac. This suggests that there is an obstruction of one of the canaliculi or at the opening of the common canaliculus into the lacrimal sac (internal opening).

    Syringing probing attachment.php?attachmentid=3421&d=1510226767
    Syringing probing attachment.php?s=07e84516ee5141d181c9d1a0835dc7c8&attachmentid=3422&d=1510226792

    Irrigation ( syringing)

    • performed via the lower or upper punctum with a curved, blunt-tipped lacrimal cannula on a 2.5ml syringe filled with saline.
    • The tip of the cannula is gently advanced a few millimetres.
    • Again remember to pull the lid laterally. Saline is gently irrigated. If saline flows freely into the nose then the nasolacrimal drainage system is patent.
    • If there is regurgitation through the opposite punctum then common canalicular obstruction is likely.
    • If there is regurgitation through the ipilateral punctum then ipsilateral canalicular obstruction is likely.
    • If mucus or fluorescein regurgitates, then there is likely to be a dilated lacrimal sac or mucocele.

    Attached Images  
    Last edited by Reda Gomah El Garia; 11-09-2017 at 11:27 AM.

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