From the Research
Ropivacaine (ROPLAS) is not recommended for lacrimal syringing as it is a local anesthetic typically used for nerve blocks and epidural anesthesia, not for tear duct procedures. For lacrimal syringing, the standard approach involves using sterile saline solution or balanced salt solution to flush the nasolacrimal system. Prior to the procedure, topical anesthetic eye drops such as proparacaine 0.5% or tetracaine 0.5% should be applied to minimize discomfort. The procedure involves inserting a blunt cannula into the punctum and gently irrigating with 2-5 ml of solution to clear any obstructions. If resistance is encountered, gentle pressure should be applied but never forced to avoid damaging the delicate lacrimal structures.
Some studies have evaluated the use of regurgitation on pressure over the lacrimal sac (ROPLAS) as a diagnostic tool for nasolacrimal duct obstruction, but these studies do not support the use of ropivacaine in lacrimal syringing 1, 2, 3. In fact, the most recent and highest quality study on the topic, which compared post-cataract surgery endophthalmitis rates using syringing or ROPLAS as a preoperative screening tool, did not mention the use of ropivacaine in lacrimal syringing 3. Another study published in 2025 found that lidocaine was ineffective in reducing pain during lacrimal lavage, and that the procedure is generally painful, especially in patients with nasolacrimal duct obstruction 4.
Therefore, based on the available evidence, the use of ropivacaine (ROPLAS) is not recommended for lacrimal syringing, and instead, sterile saline solution or balanced salt solution should be used to flush the nasolacrimal system, with topical anesthetic eye drops applied prior to the procedure to minimize discomfort. Key points to consider when performing lacrimal syringing include:
- Using sterile saline solution or balanced salt solution to flush the nasolacrimal system
- Applying topical anesthetic eye drops prior to the procedure to minimize discomfort
- Inserting a blunt cannula into the punctum and gently irrigating with 2-5 ml of solution to clear any obstructions
- Avoiding forced pressure to prevent damaging the delicate lacrimal structures
- Being aware of the potential for mild discomfort, tearing, and a salty taste in the mouth as the solution drains into the nasal cavity.