I prefer bicanalicular stenting over monocanalicular stenting in pediatric patients that have failed probing alone for congenital nasolacrimal duct obstruction. I think it is important to feel comfortable with nasal anatomy, which helps you in retrieving stents. Although nose bleeds can be scary, you can almost always control them with with Afrin soaked neurosurgical cottonoids.
For a written transcript of this video, please see below:
This is Richard Allen at the University of Iowa. This video demonstrates probing and stenting and also fluorescein irrigation in a patient with a unilateral congenital nasolacrimal duct obstruction.
A punctal dilator is placed vertically and then horizontally.
The same is done on the upper lid.
A number one Bowman probe is then introduced through the canaliculus where a hard stop is appreciated.
The same is done on the upper lid.
Fluorescein is then introduced and injected through the lower system.
As you can see this refluxes through the upper punctum indicating a nasolacrimal duct obstruction.
The Bowman probe is then placed through the upper system and down the nasolacrimal duct.
The patient's nose had been previously packed with Afrin® [oxymetazoline] soaked neurosurgical cottonoids. The nasal packing is removed.
A #5 Bowman probe is then slid along the lateral nasal wall in the area of the inferior meatus and moved medially where metal on metal contact is made with the other Bowman probe.
The Crawford stent is then placed through the upper system and down the nasolacrimal duct.
This is then retrieved from the nose with the Crawford hook.
The same is performed through the lower system.
Again, the Crawford hook is placed along the lateral nasal wall, rotated medially to engage the Crawford stent, and the stent is removed from the nose.
On the left side, the patient was less symptomatic.
The puncta are dilated with the dilator.
The Bowman probe demonstrates no canalicular obstruction by palpating a hard stop.
Fluorescein injection through the upper canaliculus shows no reflux through the lower punctum, indicating that the nasolacrimal duct is patent.
This is confirmed with fluorescein on the nasal packing.
The stents are then tied and allowed to retract into the nose.
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