infromedial injection of 3 ml local anesthetic drugs and assessing the pain during lacrimal duct intubation and probability of false tracking

After entering the OR; the patient will be cannulated and fully monitored with basic monitors (pulse oximeter, NIBP & ECG), a nasal cannula is connected to the patient to deliver oxygen.

We gave the patient 5 ml of propofol to decrease the discomfort felt by the patient during injection of local anesthesia. Benox eye drops is applied to the operative eye in both groups.

Patients were allocated into 2 groups; each group is 25 patients Group 1: We used a 25G/ 1" length needle to inject 3ml of lidocaine: bupivacaine (1:1) with 30 IU hyaluronic acid, 0.5ml below the inferior punctum in the lower lid medial margin.

Group 2: We used a 25G/ 1" length needle to inject 3ml of lidocaine: bupivacaine (1:1) with 30 IU hyaluronic acid classical medial canthal injection

During surgery, we will assess the pain degree during probing using Verbal Rating Scale (0 to 10 scale where 0 is no pain an 10 is unbearable pain), to assess the efficiency of this single low volume injection.

Inclusion Criteria:

• adults undergoing lacrimal duct intubation surgery
• Patients' physical status by the American Association of Anesthesiology (ASA): ASA I, II, III.
• Age between 18-70, both sexes.
• Axial lengths ranging between 22-28mm.

Exclusion Criteria:

• ASA IV.
• Patient age less than 18 or more than 70 years.
• Coagulation disorders (e.g. patients on warfarin (INR<1.5)
• Communication difficulties preventing reliable assessment.
• High myopia (axial length more than 28mm) and medial staphylomas.