68801 Dilation of lacrimal punctum, with or without irrigation

Name of the Procedure:

Dilation of Lacrimal Punctum (Common term: punctal dilation, Medical term: lacrimal punctum dilation)

Summary

Dilation of lacrimal punctum is a minor medical procedure that involves widening of the small openings (puncta) located at the inner corners of the upper and lower eyelids, through which tears drain from the eye into the nose. Sometimes, an irrigation process is added to flush out any blockages in the tear drainage system.

Purpose

The procedure aims to address issues related to tear drainage, such as excessive tearing (epiphora) or eye infections caused by blocked tear ducts. By enlarging the punctal openings, this procedure facilitates better tear drainage, alleviating symptoms and preventing recurrent infections.

Indications

• Excessive tearing (epiphora)
• Recurrent eye infections (e.g., conjunctivitis)
• Blocked tear ducts
• Chronic eye irritation or inflammation
• Symptoms of dry eyes due to inadequate tear drainage

Preparation

• No specific fasting or medication adjustments typically required.
• An eye examination and possibly imaging tests (e.g., dacryocystography) to assess the tear drainage system.
• Patients should inform their doctor of any medications or allergies.

Procedure Description

1. The patient is positioned comfortably, and local anesthetic drops are applied to the eye to minimize discomfort.
2. A special dilation instrument (punctal dilator) is gently inserted into the lacrimal punctum to widen the opening.
3. If irrigation is being performed, a saline solution is flushed through the tear drainage system using a cannula to remove any blockages.
4. The procedure may be repeated on the other punctum if necessary.
5. Eye drops may be prescribed to reduce inflammation and prevent infection post-procedure.

Duration

The procedure typically takes about 10-20 minutes.

Setting

The procedure is usually performed in an outpatient clinic or an ophthalmologist's office.

Personnel

• Ophthalmologist or an eye care specialist
• Trained nurse or medical assistant

Risks and Complications

• Mild irritation or discomfort
• Minor bleeding
• Infection (rare)
• Temporary swelling or redness
• Risk of punctal scarring or closure (very rare)

Benefits

• Immediate relief from excessive tearing
• Reduced risk of recurrent infections
• Improved overall eye comfort

Recovery

• Patients may experience mild irritation or watery eyes for a day or two.
• Use prescribed eye drops as directed.
• Avoid rubbing the eyes and follow any additional care instructions provided by the healthcare provider.
• Normal activities can typically be resumed immediately.

Alternatives

• Use of punctal plugs to block tear drainage temporarily.
• Medications to manage symptoms, like antibiotics for infections.
• Tear duct probing and flushing, a similar but more intensive procedure.
• Definitive surgical procedures like dacryocystorhinostomy (DCR) for chronic and severe cases.

Patient Experience

Many patients find the procedure to be quick and relatively painless, thanks to the local anesthetic. Discomfort is minimal, and most experience significant relief from symptoms soon thereafter. Pain management is typically not required, and comfort measures such as applying cool compresses can help alleviate any mild post-procedural irritation.