Retrograde intubation dacryocystorhinostomy for proximal and midcanalicular obstruction

Abstract

Objective Retrograde intubation of canaliculi during dacryocystorhinostomy can restore canalicular patency in cases otherwise managed with bypass tubes. The surgical technique and success for this procedure are discussed. Design A retrospective, noncomparative case series with clinic or telephone interview for long-term follow-up of patients’ symptoms. Participants One hundred two patients who had undergone this particular lacrimal drainage surgery at Moorfields Eye Hospital between 1992 and 1997. Intervention All patients underwent a dacryocystorhinostomy and retrograde canaliculostomy while under general anesthetic. Main outcome measures Relief or reduction of epiphora and discharge. Results One hundred twenty-three lacrimal systems of 102 patients were included. There were 53 females and 49 males, with ages at surgery ranging from 6 to 83 years (mean, 49 years). The etiology was idiopathic (30%), herpetic canaliculitis (24%), punctal agenesis (18%), and trauma (11%); less-common causes included dacryocystitis, Stevens-Johnson syndrome, eczema, and prior radiation therapy. Both upper and lower canalicular systems were involved in the majority (73%) of patients, and in 13 (11%) systems a dacryocystorhinostomy had previously been performed. The silicone tube was placed for a mean of 2 months (range, 1 week–9 months), and the mean postoperative follow-up was 8 months (range, 2–24 months). Epiphora subjectively improved in 90 (73%) of 123 systems, of which 27 (22%) of 123 were asymptomatic. In 33 systems (27%) in which epiphora persisted, 14 (11%) have undergone closed placement of a Jones canalicular bypass tube with control of symptoms. Conclusions Retrograde canaliculostomy and intubation can spare a significant number of patients the long-term inconvenience of Jones tubes. Failure of this technique does not, however, compromise or complicate the future placement of a bypass tube.