Naso-lacrimal
duct obstruction
Non-surgical treatment
1. Lacrimal sac irrigation
Using a fine blunt
lacrimal cannula and sterile saline solution , syringing the drainage pathway.
This procedure is beneficial in case stenosis of lacrimal sac ( Dacryostenosis
) and temporary Naso-lacrimal duct obstruction. The hydrostatic pressure will
wash out and clear the drainage system
2. Probing , Sac Irrigation and Massage
( Siam Procedure 1 )
In case permanent
obstruction of Naso-lacrimal duct . Insert lacrimal probe through the punctum
to rupture the obstruction in the Naso-lacrimal duct until it reaches the nasal
cavity. Leave the probe for 1 hour to restore the Naso-lacrimal tract for awhile,
this will help stop the bleeding too. However , after removing the lacrimal
probe , bleeding usually occur. The blood will clot in the Naso-lacrimal duct
and followed by healing process and fibrosis. This is the reason why probing
in the adult becomes unsuccessful, according to the standard procedure. This
can be solved by using the refrigerated normal saline to irrigate the sac until
the bleeding completely stop ( several irrigation until the reflux normal saline
become clear ). It is recommended to massage the lacrimal sac area by " Massage
2 " method before using Spersadexoline eyedrop, to create hydrostatic pressure
down through Naso-lacrimal duct four times a day to prevent the blockage. Follow
up check is done by the lacrimal sac irrigation once a week for 1 month.
Success
of the treatment by Siam Procedure 1 depends on 4 factors:
2.1 Non-infected lacrimal sac
2.2 Probing and retained the probe for one hour
Lacrimal sac massage
It is a very useful method and critical to the success of treatment. It's not exactly massage but really sac compression. Use finger tip with nail cut short , compress on the medial canthal ligament ( rubbery hard sensation ) to the lacrimal sac underneath , four times a day at 3 consecutive pumping at a time
Massage 1 for emptying lacrimal sac content
through the puncta
Method supero-temporal gaze
massage the lacrimal sac area
Massage 2 to create hydrostatic
pressure down through N-L duct
Method close eyelid
the finger press on the puncta and lacrimal sac area
3. Probing , Retained Thai Probe ,
Sac Irrigation and Massage ( Siam Procedure 2 )
Insert the lacrimal
probe via the punctum and passing through the Naso-lacrimal duct until it reaches
the nasal cavity and leave the probe for half an hour, then remove the lacrimal
probe and immediately insert the Thai Probe . Use adhesive tape to hold the
handle of the probe with the patient's forehead. Leave the probe for one week.
After removing the Thai Probe , irrigate the lacrimal sac several times until
clean. Suggest Massage 2 method four times a day for one month This procedure
is used when the Siam Procedure 1 is not successful and most patients responded
and completely cured with this procedure. ( Repeated insertion and retaining
of the Thai Probe increase the rate of success , aside from reducing the days
that tha patients need to leave the probe on )
The picture shows a patient with a Thai Probe
With closed eye
With opened eye
