Efficacy of wound exclusion combined with silicone tube bicanalicular intubation in the treatment of pigmented nevi of the lacrimal punctum

Abstract

Objective: To investigate the clinical efficacy of wound exclusion combined with silicone tube bicanalicular intubation for treatment of pigmented nevi of the lacrimal punctum. Methods: A retrospective case series analysis was conducted. Clinical data were collected from patients with pigmented nevi of the lacrimal punctum who underwent wound exclusion combined with silicone tube bicanalicular intubation at the Ophthalmology Center of Zhejiang Provincial People's Hospital from April 2020 to February 2023. During the surgery, a linear silicone tube was annularly placed to support the punctum and lacrimal canaliculus under local anesthesia, followed by the pigmented nevus excision under a surgical microscope. The linear silicone tube was removed at 4 to 6 weeks postoperatively. The duration of surgery and postoperative recovery status were recorded and summarized, including the recurrence of the pigmented nevus, epiphora, shape and position of the punctum, medial canthal morphology, and local scar condition. Results: This study included a total of 15 patients, 5 males and 10 females, with an average age of (47.7±13.5) years (range, 19 to 65 years). Two patients had pigmented nevi of the upper punctum, and 13 had pigmented nevi of the lower punctum. All nevi grew around the punctum and were completely excised during the surgery, which lasted (21.8±2.4) minutes on average. By 2 weeks postoperatively, all wounds healed with conjunctivalization, and new punctum openings formed. By 4 to 6 weeks postoperatively, the eyelid margin morphology was almost normal, when the linear silicone tube was removed. The follow-up ranged from 6 months to 2 years. No recurrence of the pigmented nevus was observed during the follow-up. The puncta were well formed without the symptom of epiphora, the medial canthal morphology was basically symmetrical to the healthy side, and the eyelid margin scars were inconspicuous, with a satisfactory appearance. No complications such as punctal occlusion, trichiasis, entropion, and ectropion occurred. Conclusions: For exophytic pigmented nevi of the punctum that do not deeply involve the lacrimal canaliculus, using the wound exclusion combined with silicone tube bicanalicular intubation during the nevus excision may reduce surgical trauma. This simple and feasible method can achieve good therapeutic effects and cosmetic outcomes.