Probing of nasolacrimal duct, with or without irrigation; with transluminal balloon catheter dilation
CPT4 code
Name of the Procedure:
Probing of nasolacrimal duct, with or without irrigation; with transluminal balloon catheter dilation.
Common names: Nasolacrimal duct probing with balloon dilation, Balloon catheter dilation of tear duct.
Summary
Nasolacrimal duct probing with balloon catheter dilation is a minimally invasive procedure that involves clearing a blocked tear duct by inserting a balloon catheter to dilate it. This helps restore normal tear drainage from the eyes to the nasal cavity.
Purpose
The procedure addresses nasolacrimal duct obstruction, which causes excessive tearing (epiphora) due to blocked tear drainage. The goal is to reopen the tear duct to allow tears to drain properly, alleviating symptoms like watery eyes, discomfort, and potential recurrent eye infections.
Indications
- Persistent epiphora or excessive tearing.
- Recurrent eye infections such as dacryocystitis.
- Congenital nasolacrimal duct obstruction in infants or persistent blockage in adults.
- Failure of conservative treatments like massage or antibiotics.
Preparation
- Patients may need to undergo diagnostic tests such as lacrimal syringing or imaging studies to confirm the blockage location.
- Fasting may be required if general anesthesia or sedation is planned.
- Medication adjustments may be necessary, particularly anticoagulants or blood thinners.
Procedure Description
- The patient receives local anesthesia or sedation for comfort.
- A thin probe is inserted into the nasolacrimal duct via the lower eyelid to confirm the obstruction site.
- A balloon catheter is threaded through the duct and inflated to dilate the duct.
- The balloon is deflated and removed carefully.
- The duct may be irrigated with saline solution to ensure it remains clear.
Tools: Nasolacrimal probe, Balloon catheter, Irrigation syringe. Anesthesia: Local anesthesia or sedation.
Duration
The procedure typically takes about 30 minutes to 1 hour.
Setting
The procedure is usually performed in an outpatient surgical center or a hospital's outpatient department.
Personnel
- Ophthalmologist or oculoplastic surgeon.
- Anesthesiologist or sedation nurse (if sedation is used).
- Surgical nurse or assistant.
Risks and Complications
- Minor bleeding or bruising.
- Infection at the probe site.
- Recurrence of duct blockage.
- Rare case of tear duct trauma or scarring.
Benefits
- Relief from excessive tearing and discomfort.
- Reduction in recurrent eye infections.
- Improvement in quality of life, typically noticeable within a few days to weeks after the procedure.
Recovery
- Patients can usually go home the same day.
- Post-procedure care includes using prescribed antibiotics or anti-inflammatory drops to prevent infection.
- Avoid rubbing the eyes for at least a week.
- Follow-up appointment a few weeks post-procedure to assess duct patency.
Alternatives
- Conservative treatments (e.g., massage, antibiotics).
- Stenting or intubation of the nasolacrimal duct.
- Dacryocystorhinostomy (surgical creation of a new tear drainage pathway).
- Risks and benefits of alternatives vary; for example, dacryocystorhinostomy is more invasive but offers a permanent solution in severe cases.
Patient Experience
- Mild discomfort or pressure during the procedure, typically managed with local anesthesia or sedation.
- Minor soreness or bruising around the eye post-procedure.
- Pain relievers may be prescribed to manage post-procedure discomfort.
- Most patients experience significant improvement in symptoms within a few days to weeks.