Application of local anesthesia for DCR
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This is Richard Allen at the University of Iowa. This video demonstrates the application of local anesthetic for a patient who is undergoing an awake external DCR. Palpation of the lacrimal sac results in reflux of purulent material from the upper and lower puncta. A marking for the incision is then made along the side of the nose extending from the medial canthal tendon inferiorly toward the ala of the nose. The injection is then placed by entering the caruncle and palpation the medial orbital wall with the needle. Approximately 1 cc is place of lidocaine with epinephrine is placed. Additional local anesthetic is placed subcutaneously along the medial portion of the upper and lower eyelid. The same mixture is then placed along the marking. Local anesthesia is then placed intranasally in the area of the nasal mucosa of the middle meatus. This will allow for a comfortable awake DCR for the patient as well as excellent hemostasis.