Lesson Summary

Before performing a dilation and irrigation (D&I) procedure, it is essential to have all necessary equipment prepared and organized to ensure efficiency and maintain sterile technique.

Essential Equipment:

• Punctal Dilator: Used to enlarge the punctal opening before irrigation.
• Lacrimal Cannula: Disposable preferred for ease and sterility; sizes range from 23 to 27 gauge (higher gauge means smaller diameter). A 25 gauge curved cannula is often preferred for easier insertion. Some use a 45-degree bend cannula, which is also acceptable.
• Syringe: 3 mL or 5 mL syringes are available. 3 mL syringes are easier to handle, especially for smaller hands, but 5 mL syringes are preferred to avoid refilling during the procedure, which can be time-consuming.
• Sterile Saline: Usually about 4 mL needed for each procedure, so filling a 5 mL syringe is practical.
• Topical Anesthetic: Tetracaine or proparacaine for patient comfort.
• Tissue Paper: Given to patients before the procedure to catch saline runoff or drainage from nose/throat during or after the procedure.
• Sodium Fluorescein Strips: Not essential for the irrigation itself but useful for diagnostic tests like fluorescein dye disappearance test.
• Alcohol Swabs: For cleaning dilators and tools.
• Gloves: Worn for sterile technique by most practitioners.

Room and Setup Considerations:

• Organize all equipment on a surgical tray: gloves, saline, cannula, syringe, dilator, alcohol swabs, tissues.
• Recline the patient's exam chair and support their head for comfort.
• Use an overhead light for better visualization.
• Some practitioners prefer having an assistant or technician for eyelid retraction and to manage tissues and supplies.
• Sterile field setup is critical to prevent contamination.
• The procedure can be done either at the slit lamp or outside it; slit lamp provides magnification but may be awkward depending on the design of the equipment.
• Using single-use instruments when possible and practicing proper hand hygiene increases safety.

Tray Setup and Supplies:

• Curved cannula, syringe, sterile saline, surgical trays, and single-use kits can be purchased from suppliers like Dry Eye Rescue and Oasis Medical.
• A sharps container is needed for safe disposal of cannulas after use.
• Maintaining sterile technique and avoiding reuse of cannulas are vital to patient safety.
• Proper organization of the setup streamlines the procedure and minimizes interruptions.