You can detect a block in the canaliculus by the direct reflux, the common canaliculus by the reflux from the upper canaliculus when syringing the lower and vice versa, or somewhere in the duct by the distention of the sac and then reflux. You are quite right that it isn't possible to localise the block to any specific point in the duct.
I guess it is possible, now that ive read it up. On syringing via the lower punctum, when the normal saline regurgitates via the same punctum, it indicates a block in the lower canaliculus. When the normal saline regurgitates via the upper punctum upon syringing via the upper canaliculus, it indicates a block in the upper canaliculus or the common canaliculus.
It may be due to lacrimal sac obstruction.. To confirm it put your index finger around the sac area while syringing.. If you can feel the pressure from fluid.. The obstruction is beyond common canaliculus..
Nice video sir. Great job done. But i have a small question for you. In the patient above, Where exactly is the block? Is it in the upper canaliculus, lower canaliculus or the common canaliculus ir the sac?
@@maya-dn9fl Hi Maya. Many surgeons use corneal shields, but the shield needs to be both placed onto the cornea and removed. It turns out that the risk of corneal abrasion from removing the shield is greater than from the surgery. There is therefore no net protection but actually an increased risk. I don't use shields as routine. Best wishes. Ric
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You can detect a block in the canaliculus by the direct reflux, the common canaliculus by the reflux from the upper canaliculus when syringing the lower and vice versa, or somewhere in the duct by the distention of the sac and then reflux. You are quite right that it isn't possible to localise the block to any specific point in the duct.
I guess it is possible, now that ive read it up. On syringing via the lower punctum, when the normal saline regurgitates via the same punctum, it indicates a block in the lower canaliculus.
When the normal saline regurgitates via the upper punctum upon syringing via the upper canaliculus, it indicates a block in the upper canaliculus or the common canaliculus.
It may be due to lacrimal sac obstruction.. To confirm it put your index finger around the sac area while syringing.. If you can feel the pressure from fluid.. The obstruction is beyond common canaliculus..
Nice video sir. Great job done. But i have a small question for you. In the patient above, Where exactly is the block? Is it in the upper canaliculus, lower canaliculus or the common canaliculus ir the sac?
A Hard stop is not pleasant for most so why no anesthesia?
Hi. Its important to have gentle hands! So long as you're gentle this should be much less painful than the sting of anaesthetic. Best wishes. Ric
Right eye nasolacrimal duct. Left eye not blocked.
Ric
How is it possible to establish the exact location of the block in the naso lacrimal system using this syringing?
Can't wait for my shaky hand partner to do this to me in lab in like 30 minutes. Gonna be fun -_-
whats the size of the needle??
Hi. It's not actually a needle, rather a lacrimal cannula. I've only ever seen them in one size - thankfully very small! Best wishes, Ric
@@riccaesar thank you , we also use # 26 needle , it does the job :-)
@@riccaesar why not protecting the eye to prevent an accident? Like wearing a seatbelt even thought one is an excellent driver.
@@maya-dn9fl Hi Maya. Many surgeons use corneal shields, but the shield needs to be both placed onto the cornea and removed. It turns out that the risk of corneal abrasion from removing the shield is greater than from the surgery. There is therefore no net protection but actually an increased risk. I don't use shields as routine. Best wishes. Ric
@@riccaesarThanks a lot for your reply.