I thank Drs Aguirre Vila-Coro and Al-Hussain for their interest in this article.1 First, one of the major drawbacks to balloon catheter dilation is the price of the balloon and associated instruments. If the same balloon can be used safely in both eyes, this substantially decreases the cost of the procedure. The following suggestions may facilitate bilateral use of the balloon. Lacrimal punctal dilation is recommended in all patients. The dilator is placed perpendicularly through the punctum, then turned and passed along the course of the canaliculus. Because the dilator is tapered, this passage allows for increased dilation of the punctum. After the balloon used in the first eye is deflated, the plunger attached to the inflation device is retracted, which creates negative pressure within the balloon and results in maximal deflation. If the balloon material remains bulky, gentle twisting of the balloon may additionally decrease its cross-sectional area (similar to refolding an umbrella). The tip of the catheter is lubricated with ointment and inserted through the upper punctum. Lateral traction on the upper eyelid should be maintained to keep the canaliculus straight and prevent an accordion-like shortening of the tissue as the catheter is passed. Gentle rotation of the instrument facilitates its passage through the canaliculus. I have used these techniques for balloon catheter dilation in more than 300 patients, and I have never been unable to use the same balloon for both eyes in patients with bilateral obstruction.
Lueder GT. Balloon Catheter Reuse in Children With Bilateral Nasolacrimal Duct Obstruction—Reply. Arch Ophthalmol. 2003;121(12):1804–1805. doi:10.1001/archopht.121.12.1804-a
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