Tear Duct Probing and Balloon Dilation скачать в хорошем качестве

Tear Duct Probing and Balloon Dilation

This is Dr. Scott Larson showing you a nasolacrimal duct probing and balloon dilation. Dr. Christie Carter assisted me on this case. The family of this child kindly agreed to allow me to create this instructional video. We start by placing Afrin soaked cotton tipped applicators in the nares on both sides. This helps shrink the nasal mucosa and reduce bleeding. Next we use punctal dilators to gently enlarge the puncta and canaliculus. This is done on both upper and lower puncta. Bowman probes are introduced into the lower puncta, and the probes are advanced into the lacrimal sac. When the tip of the probe is in the proper position, there will be a feeling of a “hard stop”. The probe is then advanced inferiorly into the lacrimal duct. Often there is a feeling of a “pop” if there is a membraneous obstruction in the lacrimal duct. The tip of the probe is confirmed to be in the inferior meatus with a larger bowman probe through the nares. The bowman probes are then removed and a lacrimal balloon, (in this case a 3 mm Lacricath balloon) is passed into the inferior meatus in the same fashion as the Bowman probe. The pumps have been pre-filled with saline and are attached to the end of the ballon and the pumps are twisted with the plunger in the locked position. Each balloon is then inflated to 8 atmospheres and held in place for 90 seconds. The balloons are then deflated quickly by releasing the plunger lock. The balloons are then re-inflated for 60 seconds. We then retract each ballon about 5 mm so that they now higher in the lacrimal duct. The two inflations are repeated, one for 90 seconds and the other for 60 seconds. The balloons are then deflated and the plunger on the pump is pulled all the way out so the indicator needle on the pressure gage shows negative pressure. This will collapse the balloon completely, facilitating balloon extraction. If the inferior meatus is tight a Freerer elevator can be used to in-fracture the inferior turbinates. This is done by a small rotation of the turbinate medially to allow for more space in the inferior meatus. In this case the space was adequate and the in-fracture was not performed. A flexible suction catheter is then placed into the inferior meatus and a lacrimal cannula is placed into the canaliculus. A small volume of fluorescein solution is irrigated through the system to ensure it is free and patent. The face is then cleaned and an antibiotic/steroid eye drop is placed in each eye.