Dilation And Irrigation

Sterile saline provides a direct test of whether fluid can travel through the punctum, canaliculus, lacrimal sac, and nasolacrimal duct. The clinician observes how easily the fluid passes and whether it reaches the nose. This functional assessment helps identify impaired drainage and supplies information that visual examination alone may not provide.

These findings describe how the drainage pathway responds to irrigation. Resistance suggests that fluid meets an impediment, while reflux indicates that fluid is returning rather than progressing normally through the system. Passage into the nose demonstrates downstream continuity. Taken together, these observations help characterize the location or severity of impaired drainage.

Punctal dilation creates an opening large enough for the cannula to enter the canaliculus during assessment. This step supports controlled access to the lacrimal drainage pathway and allows saline to be directed toward the lacrimal sac and nasolacrimal duct. It is therefore an essential preparation for obtaining meaningful flow and resistance findings.

The pattern of fluid movement helps separate incomplete narrowing from total blockage. Some passage, despite resistance or abnormal flow, is consistent with a partially obstructed pathway, whereas failure of passage with marked resistance or reflux supports more severe blockage. This distinction matters because it can influence whether clinicians consider further probing, stenting, or surgery.

After topical anesthesia, the clinician enlarges the punctum and advances a cannula through the canaliculus. Sterile saline is then directed toward the lacrimal sac and nasolacrimal duct while the response is observed. Resistance, reflux, and fluid reaching the nose are recorded as procedural findings, allowing the examination to assess drainage rather than anatomy alone.

The procedure is particularly relevant when a patient has excessive tearing, ocular discharge, or suspected tear-duct obstruction. It can clarify whether symptoms reflect impaired lacrimal drainage and can help determine the next step in evaluation. Its use in ophthalmic assessment makes it valuable when symptoms suggest a problem within the tear-drainage pathway.

Dilation and irrigation is commonly used in pediatric care because children may present with tearing or discharge related to impaired tear drainage. The examination can provide objective information about pathway patency and obstruction. Those findings help clinicians decide whether additional probing, stenting, or surgical management should be considered for the child.

Results from the examination can do more than confirm abnormal drainage. They may show whether an obstruction is partial or complete and indicate how the pathway responds to fluid. Clinicians can use that information to select among continued evaluation, further probing, placement of a stent, or surgical management, matching treatment decisions to the observed drainage pattern.