68815 Probing of nasolacrimal duct, with or without irrigation; with insertion of tube or stent

Name of the Procedure:

Probing of Nasolacrimal Duct, with or without Irrigation; with Insertion of Tube or Stent

Summary

This procedure involves inserting a thin, flexible tube or stent through the tear duct to open up a blockage and allow tears to drain properly. It may also include irrigation (flushing out the tear duct) to clear debris or infection.

Purpose

The procedure addresses blockages in the nasolacrimal duct, which can cause excessive tearing, recurrent eye infections, or inflammation. The goal is to restore normal tear drainage and alleviate symptoms.

Indications

• Excessive tearing (epiphora)
• Recurrent eye infections
• Chronic inflammation or swelling of the tear duct (dacryocystitis)
• Congenital nasolacrimal duct obstruction in infants

Preparation

• Patients may be asked to avoid eating or drinking for several hours before the procedure if sedation is used.
• Pre-procedure assessments might include a physical examination and imaging tests like dacryocystography to evaluate the tear ducts.

Procedure Description

1. The patient is usually given local anesthesia, although general anesthesia may be required for young children.
2. A thin, flexible probe is gently inserted into the tear duct to open the blockage.
3. Irrigation with a saline solution may be performed to clear debris or infection.
4. A small tube or stent is placed in the duct to keep it open and ensure proper drainage.
5. The tube or stent remains in place for a set period, typically a few months, and is then removed or it may eventually fall out on its own.

Duration

The procedure typically takes about 30 minutes to an hour.

Setting

This procedure is commonly performed in an outpatient clinic, surgical center, or hospital.

Personnel

• Ophthalmologist or oculoplastic surgeon
• Nurses or medical assistants
• Anesthesiologist (if sedation or general anesthesia is required)

Risks and Complications

• Bleeding
• Infection
• Damage to surrounding structures
• Displacement of the tube or stent
• Failure to resolve the tear duct blockage

Benefits

• Restoration of normal tear drainage
• Relief from excessive tearing and recurrent infections
• Improved comfort and eye health
• Results are typically seen within a few days to weeks after the procedure

Recovery

• Patients are usually able to go home shortly after the procedure.
• Post-procedure care includes using prescribed antibiotic drops to prevent infection.
• Follow-up appointments are necessary to monitor healing and ensure the tube or stent remains in place.
• Most patients can resume normal activities within a day or two, but should avoid strenuous activities for a week.

Alternatives

• Conservative management with massage and antibiotics
• Balloon dacryoplasty to widen the tear duct
• Surgical procedures such as dacryocystorhinostomy (DCR) in more severe cases

Patient Experience

• During the procedure, patients may feel slight pressure or discomfort.
• Post-procedure discomfort is usually mild and can be managed with over-the-counter pain medication.
• Most patients experience significant improvement in symptoms shortly after the procedure.