Syringing of the Eye (Lacrimal Syringing)
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Table of Content
- What is Syringing of the Eye (Lacrimal Syringing)?
- Anatomy of the Tear Drainage System
- What Is the Nasolacrimal Duct?
- What is the ROPLAS Test?
- Why is Syringing Done?
- Indications & When to Do Syringing
- Eye Syringing Procedure
- What if the Syringing Procedure Cannot Be Performed?
- Which Type of Anaesthesia is Used in Lacrimal Syringing?
- What is Congenital Nasolacrimal Duct Obstruction?
- Interpreting Results & What They Mean
- Risks, Contraindications & Safety Precautions
- Pre-Procedure & Post-Procedure Care
- Limitations of Syringing & Next Steps
- Top Eye Specialists in Mumbai at Eye Solutions
What is Syringing of the Eye (Lacrimal Syringing)?
Syringing of the eye, also called lacrimal syringing, is a simple outpatient procedure used to check if the tear drainage system (lacrimal passages) is open and functioning properly.
It helps determine whether excess tearing or watery eyes are due to a blocked tear duct.
This syringing eye test is safe, quick, and painless. It is not a surgery – only a minor diagnostic procedure that takes a few minutes and causes minimal discomfort.
Anatomy of the Tear Drainage System
The Lacrimal System
The lacrimal system has two parts:
- The secretory system – which includes the lacrimal gland, located in the upper outer part of the eyelid (near the temple). It produces tears to keep the eye moist and clean.
- The drainage system – which collects and drains the tears from the surface of the eye into the nose.
The drainage pathway includes:
- Puncta (tiny openings on the eyelids)
- Canaliculi (small tubes leading to the lacrimal sac)
- Lacrimal sac
- Nasolacrimal duct – the final passage that empties into the nose.
These structures together ensure tears flow properly from the eye into the nasal cavity.
What Is the Nasolacrimal Duct?
The nasolacrimal duct carries tear fluid from the lacrimal sac into the nose. It is the most common site for blockage in the tear drainage system.
When this duct is blocked, tears cannot drain properly, leading to watery eyes, discharge, or infections – a common reason for performing lacrimal sac syringing.
What is the ROPLAS Test?
ROPLAS (Regurgitation on Pressure over the Lacrimal Sac) is a simple clinical test done before the lacrimal syringing procedure.
Your doctor gently presses over the lacrimal sac area near the inner corner of your eye:
- If infected or stagnant fluid regurgitates back onto the eye through the punctum, the test is ROPLAS positive, indicating a nasolacrimal duct blockage.
- If no fluid regurgitates, it is ROPLAS negative, meaning the duct is likely open or patent.
This test helps decide whether syringing is required to confirm the diagnosis.
Why is Syringing Done?
The lacrimal syringing test is done to:
- Evaluate the patency (openness) of the tear drainage passages
- Identify the site of blockage in patients with constant watering or discharge
- Confirm the diagnosis of nasolacrimal duct obstruction (NLDO)
- As a preoperative screening test, especially before cataract surgery, to rule out hidden infections that can complicate surgery
Thus, syringing of the eye plays a crucial role in both diagnosis and surgical safety.
Indications & When to Do Syringing
Your eye doctor may recommend a syringing eye test if you have:
- Continuous watering of eyes (epiphora)
- Sticky discharge or repeated infections
- Suspected nasolacrimal duct blockage
- Preparation for eye surgeries (e.g., cataract, LASIK)
- Follow-up after DCR (Dacryocystorhinostomy) surgery to confirm patency
Eye Syringing Procedure
Watch: how lacrimal syringing is done (1 min).
The lacrimal syringing procedure is simple and quick:
- The doctor prepares a 2 ml syringe filled with sterile saline or distilled water and attaches a fine 27-gauge cannula.
- Topical anaesthetic eye drops are applied to numb the eye.
- The lower eyelid is gently pulled down to expose the lower punctum.
- The cannula is inserted into the punctum and advanced into the canaliculus.
- Saline is slowly injected.
- If the passage is open, the patient feels the fluid in the nose or throat (it may taste slightly salty).
- If there is a blockage, the fluid comes back onto the eye surface or through the upper punctum.
This simple step helps the doctor locate and assess any block in the tear duct.
What if the Syringing Procedure Cannot Be Performed?
Sometimes, the punctum (the small tear opening) is very narrow, preventing the cannula from entering.
In such cases, your ophthalmologist will gently use a punctum dilator to widen the opening before attempting syringing again.
This ensures that the procedure is performed safely and comfortably.
Which Type of Anaesthesia is Used in Lacrimal Syringing?
- Only topical anaesthetic eye drops are used.
- These numbing drops make the eye syringing procedure completely painless, and their effect lasts for a few minutes.
- No injections or sedation are needed.
What is Congenital Nasolacrimal Duct Obstruction?
In infants, congenital nasolacrimal duct obstruction (CNLDO) occurs when the tear duct fails to open completely after birth.
Symptoms include watery eyes and sticky discharge.
Most cases resolve naturally with gentle lacrimal sac massage, but if it persists, the child may need nasolacrimal duct probing or a surgical correction later.
Lacrimal syringing in children helps confirm whether the duct has opened.
Interpreting Results & What They Mean
- Fluid passes freely into the throat or nose: Tear duct is open (patent)
- Fluid regurgitates onto the eye surface: Nasolacrimal duct obstruction present
- Partial regurgitation: Partial block in the system
These findings help your ophthalmologist decide whether medical treatment, probing, or DCR surgery is needed.
Risks, Contraindications & Safety Precautions
Lacrimal syringing is a very safe OPD procedure.
Mild discomfort, watering, or temporary redness may occur for a short while after the test.
Contraindications include:
- Acute dacryocystitis (active infection)
- Recent nasal or eye trauma
In such cases, the test is postponed until the infection subsides.
Proper sterilization and gentle technique ensure safety and patient comfort.
Pre-Procedure & Post-Procedure Care
Before the procedure:
- No special preparation is needed.
- Inform your doctor about allergies or previous eye surgeries.
After the procedure:
- Mild watering or irritation may occur – this settles within a few hours.
- Use prescribed eye drops if given.
- Avoid rubbing the eyes.
- You may resume normal activities immediately.
Limitations of Syringing & Next Steps
While lacrimal syringing effectively detects the presence or absence of blockage, it may not precisely locate the level of obstruction.
If results are inconclusive or if surgery is planned, your doctor may suggest further tests like:
- Dacryocystography (DCG)
- Dacryoscintigraphy
- Endoscopic DCR evaluation
If a block is confirmed, the next step may be DCR surgery (Dacryocystorhinostomy) – a definitive and highly effective treatment.
Top Eye Specialists in Mumbai at Eye Solutions
Dr. Akshay Nair
MBBS, DNB, Oculoplasty Fellowship
Department
Oculoplasty
Expertise
Oculoplasty, Ocular Aesthetics
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Frequently Asked Questions
Is eye syringing painful?
No. The lacrimal syringing procedure is done under numbing drops and is painless, though you may feel mild pressure or a cool sensation.
Why do we do syringing in the eye?
To check if the tear drainage system is open or blocked, especially in patients with watering eyes or before eye surgeries.
What happens if the lacrimal ducts are blocked?
If the lacrimal ducts are blocked, tears cannot drain properly, causing watering or infection. Your doctor may recommend DCR surgery, which creates a new passage for tear drainage and provides a long-term cure.
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