Lesson Summary

Contraindications for Dilation and Irrigation Procedure

• Absolute Contraindications:
  • Acute dacryocystitis with significant inflammation
  • Preseptal cellulitis or orbital cellulitis (avoid spreading bacteria through the nasolacrimal system)
  • Recent trauma to the lacrimal apparatus (risk of unknown anatomical changes)
  • Recent nasolacrimal system surgery (allow time for healing)
• Relative Contraindications:
  • Patients with significant anxiety or inability to remain still and cooperative during the procedure
  • Narrow punctal openings (though smaller gauge cannulas may still be used)
  • Known canalicular scarring
  • Acute conjunctivitis (better to wait until infection/inflammation resolves)

Precautions for the Procedure

• Maintain sterility throughout the entire dilation and irrigation (D&I) procedure.
• Use adequate topical anesthesia:
  • Apply proparacaine drops on the ocular surface
  • Soak a sterile cotton-tip applicator (contip) with proparacaine and hold it on the punctum for 20–30 seconds for added comfort
• Never force instruments against resistance to avoid puncturing the canalicular wall.
• Communicate constantly with the patient:
  • Inform the patient to verbally notify you when they feel saline in the nose or throat (some prefer raising a hand, but verbal cues are easier to observe during slit lamp use)
  • Perform the procedure behind the slit lamp if possible, which helps reduce patient anxiety and allows better focus
  • Alternatively, performing the procedure outside the slit lamp is acceptable depending on provider preference and patient comfort
• Defer the procedure if there is an acute infection – treat the infection first and wait for resolution before performing D&I for safety and patient comfort.