Dacryocystoplasty

First choice approach will be a general with an LMA. The surgeon will be busy at the head, which makes airway management difficult mid-case when the patient needs to be deepened. When the physician passes the rod/needle from the puncta into the nasal passage, this is the most stimulating time. If you're running a MAC, you'll want to bolus some propofol 1-2 minutes prior. This may cause some bleeding in the nasal passage - another reason an LMA is a good option. Its a good practice to suction around the LMA prior to pulling it as there may be a buildup of blood.

This is a surgery to open the nasolacrimal duct. Obstruction of this duct leaves no passage for tears to drain into the nasal cavity The surgeon passes a needle/rod through the puncta and into the nasal passage. A balloon is then inflated to dilate the passage.