Page 125 - NAME OF CONDITION: REFRACTIVE ERRORS

obstruction in the lacrimal excretory system. The test qualitatively establishes the

patency or stenosis or complete obstruction of the canaliculi, lacrimal sac or
nasolacrimal duct but does not give any information on functional insufficiencies.

STANDARD PROCEDURE:
1. Place a drop of topical anesthetic in the conjunctival cul-de-sac.
2. The punctum and the ampulla are dilated with a punctual dilator.
3. A blunt lacrimal canula is placed in the inferior canaliculus and the lower eyelid is
pulled down and laterally to straighten the lower canaliculus and evert the
punctum away from the ocular surface.

4. The tip is placed first vertically and then horizontally with the eyelid on stretch.
The tip is advanced 6-7 mm into the canaliculi and sterile water is used as an
irrigant. The irrigation should begin in the canaliculi so that the incoming
passages are dilated and the mucosa is less traumatized.
5. Irrigation should be preferred when the tip is in the lacrimal sac. Simultaneous
probing can also be done with the same tip of the canula. A hard stop rules out
canalicular obstruction whereas a soft stop is indicative of such obstructions.
6. Irrigation should now be interpreted. In a normal passage the saline is felt in the
nose or the throat by the patient. Regurgitation through the opposite punctum

with a hard stop suggests a nasolacrimal duct obstruction. Regurgitation through
the opposite punctum with a soft stop suggests a common canalicular block. In
cases of upper or lower canalicular block, regurgitation is seen through the same
puncta. Partial regurgitation is associated with partial blocks respectively.

b) Investigations:

Chronic dacryocystitis is usually diagnosed by history, physical examination and
simple investigations where needed.

Microbiological work up: A regular microbiological examination is not necessary
unless there are recurrent attacks of acute dacryocystitis, lacrimal abscess or any
associated canaliculitis. If additional microbiological work up is needed or other
imaging modalities like computed tomography or dacryocystography is the felt need
than a referral to higher center must be thought of.

c) Treatment:

The treatment of choice in chronic dacryocystitis is dacryocystorhinostomy (DCR).
Additional procedures along with dacryocystorhinostomy like intubation, use of
adjunctive pharmacotherapy like mitomycin-C and canalicular trephining depends
upon multiple factors like presence of canalicular obstructions, intra-sac synechiae or

125