Lesson Summary

This video demonstrates the procedure of dilation and irrigation of the right lower lid punctum of a patient's eye.

Key steps in the procedure include:

• Anesthetize the eye by applying a few drops of Proparacaine to a cotton-tipped applicator, then hold it over the punctum for 20 to 30 seconds to ensure effective numbing and patient comfort.
• Use a punctal dilator, which can be spun or twirled between the fingers to gently enlarge the punctum opening.
• Insert the irrigation cannula carefully into the punctum and nasal canalicular system, just deep enough to irrigate without discomfort.
• Apply pressure to the syringe to push saline through the canalicular system.
• Observe for saline exiting down the patient's cheek, indicating a blockage.
• Ask the patient to alert when they feel the saline reach their nose or throat, and continue irrigation slightly beyond that point to ensure patency.
• Saline reflux confirms that the canalicular system has been successfully irrigated.

The technique requires some practice, especially to handle the cannula comfortably with different slit lamp styles, but overall it is a simple and effective method for diagnosing and managing canalicular obstructions.