This is Richard Allen at the University of Iowa. This video demonstrates a probing and stenting of a child with congenital nasolacrimal duct obstruction. A punctal dilator is introduced into the lower punctum. And the same is performed on the upper punctum. The dilator is first introduced vertically followed by horizontal advancement. A bowman probe is then placed. I usually start with either a 0 or 1 bowman probe. Again, placed vertically and then horizontally in order to appreciate a hard stop which indicates no canalicular obstruction. The same is done on the upper eyelid. The patient’s nose has been packed with Afrin soaked neurosurgical cottonoids. The bowman probe superiorly is then rotated and advanced down the nasolacrimal duct. The nasal packing is removed and a freer periosteal elevator is slid along the lateral side of the nose under the inferior turbinate to make metal on metal contact with the probe. The Crawford stent is then introduced into the upper punctum and canaliculus and rotated to advance it down the nasolacrimal duct. The stent is then retrieved with a Crawford hook. The hook is introduced along the lateral side of the nose and the stent is felt medial to the hook. The stent is engaged with the hook and retrieved. The same is performed on the lower eyelid. The stent is introduced through the punctum, canaliculus, and then rotated and advanced down the nasolacrimal duct. This demonstrates the retrieval of the stent. The hook is slid along the lateral nasal wall under the inferior turbinate. The hook is moved medially to feel the Crawford stent. The hook is then rotated to engage the stent and the stent is removed. Once again in life, rotation medial to engage the stent. Sometimes a little wiggling is useful in removal of the stent. The stent is then removed. The stent is then tied with three single throws. I prefer to retrieve the stent from the eyelids at the 4 month follow up. This is done by prolapsing the sent from the eyelids followed by rotation of the knot through either canaliculus or punctum. Three single throws is easy to rotate through the canaliculus and punctum. The stent is then cut and removed. Examination of the stentsshows it to be in good position without tension.
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