From the Research
Syringing of the nasolacrimal duct is a diagnostic and therapeutic procedure that should be performed with caution, considering the potential risks of iatrogenic injury to the lacrimal drainage system, and is most effectively used in conjunction with other diagnostic tools to determine the location and severity of the obstruction 1. The primary outcomes of syringing include determining the location and severity of the obstruction while potentially providing temporary relief of symptoms.
- During the procedure, saline solution is irrigated through the punctum into the lacrimal system.
- If the fluid passes freely into the nose or throat, the duct is patent; resistance or reflux through the opposite punctum indicates partial or complete obstruction. Management following syringing depends on the findings.
- For partial obstructions, conservative measures may be recommended, including warm compresses, digital massage of the lacrimal sac, and antibiotic drops like tobramycin 0.3% or ofloxacin 0.3% if infection is present.
- For complete obstructions, surgical intervention such as dacryocystorhinostomy (DCR) is often necessary, with high success rates of around 90% as reported in the literature 2. Patients should be advised that syringing may cause temporary discomfort, minor bleeding, or rarely, infection. The procedure works by physically clearing minor obstructions and debris while identifying the need for more definitive treatment in cases of anatomical blockage. Repeated syringing is generally not recommended as it can damage the delicate epithelial lining of the nasolacrimal system and is not effective for long-term management of complete obstructions. In children with congenital nasolacrimal duct obstruction, probing may be an effective treatment option, with a success rate of 66% in one study, although the evidence is not yet conclusive 3. The use of stents in children with nasolacrimal duct obstruction requiring surgical intervention has been reported to have high success rates, but the main complication is stent dislodgement 4. A systematic, combined treatment approach to nasolacrimal duct obstruction, including conservative management, high-pressure syringing, probing, and silicone intubation, has been shown to be highly successful, with a cure rate of 100% in youngsters under 2 years of age and 94.5% in children 2 to 6 years old 5.