Evaluation and treatment of lacrimal dysgenesis
Richard C. Allen, MD, PhD, FACS
Additional Notes: Length 04:11
This video demonstrates evaluation and treatment of a patient with lacrimal dysgenesis. The patient has bilateral absence of the upper puncta. The upper and lower lid are inspected. There appears to be a punctum on the lower lid on each side but not one on the upper lid. A punctal dilator is then used to dilate the lower punctum. A Bowman probe is used to evaluate the canaliculus where a hard stop is appreciated. The same procedure is performed on the opposite side. Fluorescein is then injected through the system which appears to be patent. This is demonstrated with fluorescein in the nose. It is determined that the upper eyelid will then be investigated to see if there is any remnant of a canaliculus. A cutdown is performed medial to where the punctum should be on the upper eyelid with Westcott scissors. The area is then carefully inspected to see if there is any remnant of a canaliculus. A pigtail probe is then used to see if the canaliculus can be identified retrograde. On the right side none can be identified. Attention is directed to the left side were the same procedure is performed. In this patient no remnant of a canaliculus can be discerned on either upper eyelid. It is determined that a monocanalicular stent will be placed through the lacrimal system. The probe is placed through the lower canaliculus and down the nasolacrimal duct. The probe is then retrieved from the nose with a groove director. This probe does not have an olive tip on the end of it. The upper punctal plug on the stent is then situated into the punctum securely. The same is then performed on the opposite side. The canaliculus is palpated and a hard stop is identified. The probe is then placed down the nasolacrimal duct and retrieved from the nose. The monocanalicular stent is then placed so that is it is secure in the punctum. Upper eyelid cutdowns are then closed as one would close an eyelid margin laceration. This is performed with the 6–0 Vicryl sutures at the edges of the tarsus followed by 7–0 Vicryl sutures at the lid margin placed in a vertical mattress fashion. At the conclusion of the case, erythromycin ophthalmic ointment is placed over the incisions. The stents are shortened. The patient will return approximate 4 months for stent removal.
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