Name of the Procedure:

Probing of Nasolacrimal Duct, with or without Irrigation; Requiring General Anesthesia

Summary

Probing of the nasolacrimal duct is a procedure that involves inserting a thin, flexible instrument called a probe through the tear duct to clear any blockages. Sometimes, the procedure includes flushing the duct with a saline solution. This version of the procedure requires the patient to be under general anesthesia.

Purpose

This procedure addresses blockages in the nasolacrimal duct, which can cause excessive tearing or recurrent eye infections. The goals are to open up the blocked duct, restore normal tear drainage, and resolve symptoms associated with the blockage.

Indications

• Persistent tearing (epiphora)
• Recurrent eye infections
• Swelling or discharge from the inner corner of the eye
• Failure of less invasive treatments like massage or antibiotic drops

Preparation

• Fasting for 8 hours prior to the procedure if general anesthesia is used.
• Adjustments to current medications as directed by the healthcare provider.
• Pre-procedure assessment including a physical exam and possibly imaging studies to confirm the blockage.

Procedure Description

1. The patient is placed under general anesthesia.
2. The surgeon gently inserts a thin metal probe through the punctum (small openings in the eyelid) into the nasolacrimal duct.
3. The probe is advanced to clear the blockage.
4. The duct may then be irrigated with saline to ensure it is fully open.
5. The surgeon may repeat the process in the other eye if necessary.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

The procedure is usually performed in a hospital or an outpatient surgical center.

Personnel

• Ophthalmologist or oculoplastic surgeon
• Anesthesiologist
• Surgical nurses and support staff

Risks and Complications

• Minor bleeding
• Infection
• Reaction to general anesthesia
• Re-blockage of the duct
• Tearing that may persist or recur

Benefits

• Relief from excessive tearing
• Reduced risk of eye infections
• Improved eye comfort and function

Recovery

• Patients may go home the same day after recovering from anesthesia.
• Mild discomfort or a gritty sensation in the eye is common and usually resolves within a few days.
• Avoid rubbing the eyes and follow any prescribed eye drop regimen.
• Follow-up appointment typically within a week to assess healing.

Alternatives

• Non-invasive treatments like warm compresses, tear duct massage, or antibiotic eye drops.
• Dacryocystorhinostomy (DCR) for more severe cases or when probing is unsuccessful.
• Each alternative varies in invasiveness, effectiveness, and recovery time.

Patient Experience

• During the procedure under general anesthesia, the patient will be unconscious and will not feel any pain.
• Post-procedure, there may be mild discomfort, manageable with over-the-counter pain medication.
• Most patients can resume normal activities within a few days but should avoid strenuous activity according to physician advice.