Jones Tube Insertion Research Articles

Clinical Efficacy of Orbital Computed Tomographic Assessment in Determination of the Optimal Length of the Jones Tube in Endo CDCR.

To investigate whether preoperative orbital computed tomography (CT) may be useful for predicting the optimal length of the Jones tube and determining the predictive parameters of orbital CT that are associated with the optimal length of Jones tubes in endoscopic conjunctivodacryocystorhinostomy (CDCR). The medical records of 36 patients (42 eyes) who underwent endoscopic CDCR with Jones tube insertion and preoperative orbital CT from March 2018 to April 2022 were retrospectively evaluated. Analyzing the orbital CT films using the Picture Archiving and Communication System, the distance from the lacrimal fossa to the nasal septum was measured in coronal and axial views. In the successful group, the length of the inserted Jones tube was significantly correlated with the length difference between the inserted tube and the diagonal length measured in the axial view ( r=-0.485, P= 0.030). Equivalency of the length verified in the operating room and length measured on orbital CT were demonstrated as follows: diagonal length measured in axial view (Da), horizontal length between the medial eyeball to the nasal septum in coronal view (Hc) and the estimated length (Ej) in axial view with α = tan30° and α = tan25°. The optimal length of the Jones tube is best predicted using the length of the lacrimal fossa to nasal septum in coronal and axial views. Preoperative orbital CT assessments can be noninvasive and useful in predicting adequate lengths of the Jones tube.

Surgical Outcomes of Endoscopic Conjunctivodacryocystorhinostomy Using a Castroviejo Double-Ended Lacrimal Dilator.

The aim of this study was to describe the surgical method of endoscopic conjunctivodacryocystorhinostomy with Jones tube insertion using a Castroviejo double-ended lacrimal dilator and to elucidate the surgical outcomes. Under general anesthesia and preoperative epinephrine soaking, a monopolar needle cautery instrument was used to remove the nasal mucosa over the lacrimal and maxillary bone junction. After the lacrimal and maxillary bone junction was exposed, an oval osteotomy was formed. A Castroviejo double-ended lacrimal dilator was then inserted to create a direct fistula from the conjunctiva to the nasal cavity through the bony ostium. The dilator was grasped and withdrawn using smooth forceps to determine the tube length. The selected tube was then inserted into the fistula with a guide probe. Following removal of the probe, the inserted tube was fixed with 7-0 Ethilon suturing. Among 39 patients, a total of 49 cases were examined. The success rate was 73.4% (36/49 eyes). The average surgical time was 29.1 minutes for single-eye operations and 47.3 minutes for double-eye operations. Lateral migration (6/13; 46.2%), medial migration (3/13; 23.1%), granulation tissue obstruction (2/13; 15.4%), inflammation (1/13; 7.7%), and malpositioning (1/13; 7.7%) were the noted complications that led to reoperation. In conclusion, surgical management of endoscopic conjunctivodacryocystorhinostomy using a Castroviejo double-ended lacrimal dilator has several advantages. Using this device, easier surgical procedure, shorter surgical time, and more favorable success rate can be achieved without serious complications.

Bicanalicular double silicone stenting in endoscopic dacryocystorhinostomy with lacrimal trephination in distal or common canalicular obstruction

The purpose of the study was to evaluate the clinical effects of bicanalicular double silicone stents in endoscopic transnasal dacryocystorhinostomy with lacrimal trephinized canaliculoplasty for monocanalicular and common canalicular obstruction. Bicanalicular double silicone intubation in endoscopic transnasal dacryocystorhinostomy with lacrimal trephination was performed in 58 eyes of 54 patients (5 men, 49 women; mean age: 55.9 ± 14.9 years) with epiphora due to monocanalicular and common canalicular obstruction between November 2007 and August 2010. We reviewed the records of subjects who had undergone the same surgery with a bicanalicular single intubation for same disease between March 2004 and October 2007 as controls (56 eyes of 50 patients). We evaluated age, gender, the operative side, the site of canalicular obstruction, and the effects of double silicone intubation. Complications relating to the silicone tube were also investigated. The double-stent group showed higher anatomical success rates (91.4%) and functional success rates (82.8%) than the single-stent group (75.0 and 69.6%, respectively) (p = 0.034 and p = 0.103, respectively). Bicanalicular double silicone stenting in endoscopic transnasal dacryocystorhinostomy with lacrimal trephinized canaliculoplasty may be an effective treatment for monocanalicular and common canalicular obstructions. This may also reduce more invasive surgery including Jones tube insertion (p = 0.038).

Unsuccessful Lacrimal Surgery: Causative Factors and Results of Surgical Management in a Tertiary Referral Center

Background: To evaluate possible causative factors of unsuccessful dacryocystorhinostomy (DCR) surgery, and present the surgical technique and results of revision external DCR in a tertiary referral center. Methods: During 2001–2007, 79 patients (59 female, 20 male, 83 revised DCR sites) underwent revision external DCR for the management of recurrent epiphora after unsuccessful DCR surgery. The possible reasons for unsuccessful DCR surgery were noted according to the preoperative nasal endoscopic and perioperative findings, and revision surgery was performed to address these. Results: The mean age was 43.1 ± 12.0 years, and the mean follow-up was 21.4 ± 12.4 months. At presentation, 58 patients had a history of 1 unsuccessful lacrimal surgery, 16 had 2 unsuccessful surgeries, and 5 had 3 unsuccessful surgeries. The most common preoperative endoscopic finding was nasal mucosal fibrosis and synechiae, and the most common causes of unsuccessful DCR surgery were inappropriate size and location of the bony ostium, fibrosis at rhinostomy site, and canalicular obstruction, respectively. Of the 83 revised DCR sites, 79 sites underwent external DCR with silicone intubation, and conjunctival DCR with Jones tube insertion was performed in 4 sites. Success was achieved in 78 sites (93.9%) with the first revision DCR surgery, and in 81 sites (97.6%) with the second revision. Conclusions: Revision DCR has standard concepts in common with primary DCR surgery; however, for a favorable surgical outcome, the revision surgery should address possible causative factors of failure.

The Lacrimal Bypass Tube for Lacrimal Pump Failure Attributable to Facial Palsy

To describe the use of a lacrimal bypass tube in the management of epiphora in patients with epiphora attributable to lacrimal pump failure in facial palsy. Multicenter retrospective interventional study. Information regarding patient demographics, diagnoses, symptoms, oculoplastic interventions, dacryocystorhinostomy, and Jones tube insertion were collected from patient charts. Eighteen patients were identified, in all of whom epiphora was clinically and/or radiologically assessed as being attributable to pump failure, lid laxity having been corrected. All had constant epiphora prior to Jones tube insertion. Dacryocystorhinostomy was performed in all; insertion of a Jones tube was performed simultaneously in 12, with delayed insertion in 6. Patients' subjective epiphora improved postoperatively in 15 of 18 (83.3%) and at final median follow-up of 27.5 months (range, 6 months to 31 years); symptoms were improved in 13 of 18 (72.2%). Complications occurred in 13 of 18 (72.2%), including tube extrusion and the need for repositioning. In this highly selected group of patients, Jones tube insertion led to symptom improvement in 83.3% postoperatively and in 72.2% at median follow-up of 27.5 months. Tube extrusion and migration were common, although such complications were not unexpected and were treatable.

Air regurgitation in patients on continuous positive airway pressure (CPAP) therapy following dacrocystorhinostomy with or without Lester–Jones tube insertion

AimTo describe air regurgitation as a complication in patients on continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea (OSA) following dacryocystorhinostomy (DCR) surgery with or without Lester–Jones tube...

Ballooning canaliculoplasty after lacrimal trephination in monocanalicular and common canalicular obstruction

To evaluate the clinical effect of balloon canaliculoplasty with LacriCATH after lacrimal trephination in monocanalicular and common canalicular obstruction. Silicone intubation following ballooning dilation with a 2-mm-diameter catheter after lacrimal trephination was attempted in 66 eyes of 62 patients (10 men, 52 women; mean age, 67.3 years; age range, 34-77 years) with epiphora due to monocanalicular or common canalicular obstruction between January 2003 and February 2005. A total of 56 of the 66 eyes had common canalicular obstruction, and ten had monocanalicular obstruction. The cause of obstruction in 54 (81.8%) eyes was idiopathic. Overall initial technical improvement was achieved in 64 (97.0%) eyes (common canalicular obstruction, 56/56, 100%; monocanalicular obstruction, 8/10, 80.0%) Immediate clinical improvement was achieved in 54 eyes (81.8%). The cumulative patency rates at the last clinic visit were 53.6% in cases of common canalicular obstruction and 25.0% in cases of monocanalicular obstruction. Causes of failure were combined nasolacrimal duct obstruction, recurrent monocanalicular obstruction, and acute canaliculitis. Balloon canaliculoplasty after lacrimal trephination is a simple and safe method that may be a good alternative treatment for common canalicular and distal canalicular obstructions, before resorting to conjunctivodacryorhinostomy with Jones tube insertion.

Encapsulating peritoneal sclerosis-a life-threatening condition treated successfully with adhesiolysis and Jones tube insertion.

Sir, Encapsulating sclerosing peritonitis, a life-threatening abdominal disease, is characterized by the formation of multiple fibrous adhesions. This leads to a ‘cocoon’ of fibrous tissue, encapsulating either the small or whole bowel— causing intestinal obstruction. It was first recognized as a complication of peritoneal dialysis (PD) in 1980 [1], where it usually presents as small bowel obstruction, ascites or ultrafiltration failure. It is thought to be related to both duration of catheter use and peritoneal membrane transport characteristics, being more common in ‘fast transporters’ [2]. Convincing evidence of cure has come only from adhesiolysis, which releases the fibrous adhesions [1]. Intraluminal stenting after adhesiolysis for small bowel obstruction was first described by White in 1956. Despite the technique being modified by Munro and Jones in 1978 [3], it has never gained widespread popularity in the UK. The major complication of surgery is a high recurrence rate. In one series, 11/47 patients (23.4%) experienced recurrence, 10 undergoing a second operation, and 4 requiring a third operation [4]. The mortality is uncertain, with a wide range reported (2–56%). The rationale for our technique was to further reduce mortality and recurrence rate, and provide an alternative to drug treatments (e.g. immunosuppression) whose side effects carry considerable morbidity. A 69-year-old woman, on PD for 10 years for ERF, was converted to haemodialysis in January 2003 due to recurrent peritonitis. In June 2003, she presented with recurrent ascites. An abdominal CT scan (below) suggested multiple encapsulating loculated collections in the abdomen. TPN was given for 6 weeks before surgical intervention. In September 2003, a laparotomy revealed encysted dense adhesions and a large pseudocyst in the pelvis entrapping the bowel. The adhesions were released and a Jones tube was placed through the entire length of the gastrointestinal tract. A Jones tube is a 3 m (18 gauge) tube with side perforations and a balloon at the distal end. During surgery, the tube was advanced via the nasogastric route through the entire length of the bowel and the distal end came out of the rectum. The balloon was inflated and the small bowel arranged in orderly fashion, so that even if fibrosis did occur, the bowel did not get entrapped. This was left in situ for 1 week, with TPN and haemodialysis continuing. She was discharged 7 months later and is currently well on haemodialysis, with no evidence of recurrence. In ERF patients, encapsulating peritoneal sclerosis is a rare disease and is usually a long-term complication of peritoneal dialysis. This type of surgery has to be slow (4 h in our case) and careful, releasing bowel from fibrous bands all along its length. Adhesiolysis with intraluminal stenting should be considered as an option in the treatment of encapsulating peritoneal sclerosis. Conflict of interest statement. None declared.

Restrictive strabismus following Jones tube insertion: a case series of 8 patients

Background: Restrictive strabismus and diplopia are an uncommon complication of conjunctivo-dacryocystorhinostomy, with insertion of the Lester-Jones tube. A literature review revealed only 4 published reports of this complication with a total of 4 patients affected.Methods: We report on a series of 8 patients who presented with restrictive strabismus and diplopia following Jones tube insertion.Results: Time to presentation was variable and was found to occur from several months to as long as 6 years after insertion. Treatment included topical steroid therapy initially. Surgery was done to release adhesions and scarring if topical treatment failed. Mitomycin C was used in 2 patients. Only 4 of the 8 patients had successful resolution of their diplopia with either therapy.Interpretation: Diplopia following Jones tube insertion is an infrequent complication of surgery. Medical or surgical therapy can be help resolve symptoms but is often unsuccessful.

Nasolacrimal Duct Reconstruction With Nasal Mucoperiosteal Flap

Surgical repair of lacrimal drainage apparatus may be quite difficult in patients with maxillofacial injuries involving extensive structural damage. When the primary tear tract has become nonamendable or inaccessible, it would then be necessary to set up an alternate draining route for tear passage. Conjunctivorhinostomy with a Jones tube is an effective diversionary treatment method, and yet this procedure might be plagued with problems related to alloplastic device usage. Autologous tissue is therefore best suited for nasolacrimal conduit restoration.A superiorly based mucoperiosteal flap, 11 to 13 mm in width and 20 to 25 mm in vertical length, is mobilized from lateral nasal wall and fashioned into a tubelike conduit. This construct is then turned superior-laterally and connected to the conjunctival sac. The fistula tract thus formed has a sufficiently large caliber and is lined entirely with normal mucosal epithelium. Such a feature may exert a favorable influence upon the long-term patency of the tear passage. This approach is applied successfully in 3 consecutive patients of lacrimal system obstruction, one of whom even had experienced 2 failed attempts of Jones tube insertion beforehand. The tactics and experiences in managing these 3 cases form the basis of this report.

Lacrimal drainage obstruction and dacryocystorhinostomy in children

To determine the outcome of dacryocystorhinostomy (DCR) for nasolacrimal duct obstruction (NLDO) in children. A review of medical records of 104 cases (82 patients) of paediatric DCR who underwent DCR at the Sydney Eye Hospital from 1995 to 2004. The main outcome measures included post-operative symptomatic relief of presenting symptoms, complications, subjective visibility of any scar, and general satisfaction. Statistical methods included chi(2) tests, and Student's t-tests for the comparison of variables among groups. Ninety-four external, 10 endoscopic primary procedures, and five revision procedures were included. Fifty-six of the cases were primary NLDO, and 48 were secondary NLDO. The mean follow-up was 1.44 years. Average age at surgery was 6.6+/-4.2 years (mean+/-SD). Ninety-one eyes needed DCR for the involvement of the lower lacrimal outflow system, and 13 eyes were NLDO associated with congenital punctual/canalicular dysgenesis.Most of the complications of external DCR were related to Jones tube placement. Five cases (4.8%) needed DCR revision. There was a significantly higher incidence of revision surgery in the non-stented group (P<0.01), and the Jones tube group (P<0.001) as compared with the silicone intubation stent group. External DCRs have acceptable long-term clinical and cosmetic results, and low post-operative complication rate. Cases with punctal stenosis or those requiring Jones tube insertion are associated with a higher complication rate. Silicone intubation is associated with a lower need for operative revision.

Restrictive strabismus following Jones tube insertion: a case series of 8 patients

Restrictive strabismus following Jones tube insertion: a case series of 8 patients

Silicone nasolacrimal intubation with mitomycin-C: a prospective, randomized, double-masked study

Objective To determine if mitomycin-C (MMC) application during silicone intubation (SI) can effectively substitute for dacryocystorhinostomy (DCR) or Jones tube insertion. Design A prospective, randomized, double-masked study. Participants Twenty-four patients (7 males, 17 females; aged 2–69 years) with 27 eyes (three bilateral cases) with an obstructed lacrimal system who were candidates for DCR or Jones tube. Methods All study patients underwent SI with application in a randomized, double-masked fashion of MMC or placebo, with the former receiving 0.2 mg/ml MMC for 2 minutes before SI. Main outcome measures Clinical assessment of tearing and discharge; Schirmer I and II tests at 1, 3, 6, and 12 months; and the need for eventual DCR or Jones tube insertion. Results Follow-up ranged from 13 to 23 months (mean, 18 months; median, 17 months). Seven of the 12 eyes in the MMC group and 8 of the 15 eyes in the placebo group had a successful outcome and remained symptom free. The difference was not statistically significant ( P = 0.79). Dacryocystorhinostomy or Jones tube was performed in five eyes in the MMC group and in seven eyes in the placebo group 3 to 18 months later; all had successful outcome and no complications. Untoward effects of MMC application included a slit canaliculus and a transient conjunctival injection. A successful outcome using this combined technique does not appear to correlate with age, gender, laterality, and intraoperative bleeding observed at the punctum or for the duration of symptoms. Conclusions Mitomycin-C application during SI did not benefit outcome. Complications from such application were mild and infrequent.

The Treatment of Lacrimal Apparatus Obstruction With the Use of an Inner Canthal Jones Tube Insertion via a Transcaruncular Route

To evaluate the clinical utility of the lacrimal bypass surgery using Bowman's probe in treatment of obstruction of the lacrimal apparatus. This study evaluated 124 cases of obstruction of the lacrimal passage systems with mean epiphora of 2.7 years. An incision was made on the side of the caruncle, and the lacrimal bone was penetrated between the lacrimal sac and the nasal mucosa by Bowman #0. Insertion of a Jones tube was made at the new lacrimal pathway, a puctum dilator or scissors was introduced through the caruncle and dilated across the lacrimal bone into the nasal cavity. The Jones tube was introduced over the probe into the nasal cavity, and fixed at the caruncle with nonabsorbable suture material. Complete resolution of epiphora was accomplished in 120 (96.8%) of 124 eyes; only 4 (3.2%) eyes failed during a mean of 17.1 months of follow-up. This procedure is simple and safe with no facial scarring, short operation time, high success rate, and can be performed under local anesthesia. Therefore, the clinical utility of this procedure seems to be of value in treatment of complicated obstruction of the lacrimal apparatus.

Conjunctival incision for primary conjunctivodacryocystorhinostomy with Jones tube

PURPOSE: To study a conjunctival incision approach for primary conjunctivodacryocystorhinostomy with Jones tube insertion. METHODS: This technique was applied throughout an 8-year period on 13 adult patients; each presented with complete lacrimal obstruction at the common canaliculus and excessive tearing. RESULTS: Surgical outcome was successful, with no external facial scarring. Follow-up ranged from 9 months to 7 years (median, 4.5 years). Complications included a tube exchange in one patient and occasional tearing in another. CONCLUSION: A conjunctival incision approach to conjunctivodacryocystorhinostomy (CDCR) with Jones tube insertion is an alternative technique for adult patients, especially those known (or potential) keloid-former cases, or those preferring not to undergo laser treatment and wanting to avoid an external facial scar.

Jones Tube Insertion in Children with Canalicular Agenesis

The purpose of this report is to describe a simplified method of Jones tube insertion in the management of pediatric patients with symptomatic upper and lower punctal and canalicular agenesis. A 5-year-old female with bilateral upper and lower canalicular agenesis, and a 4-year-old male with agenesis of the right upper and lower canaliculi, underwent placement of Jones tubes without performing standard external conjunctivodacryocystorhinostomy. The first child requiring bilateral Jones tube insertion has remained asymptomatic for 24 months. The Jones tube dislodged in the second patient 6 weeks postoperatively. The tube was replaced, and the child has been asymptomatic for 16 months. The technique of Jones tube insertion without a previous or concomitant external dacryocystorhinostomy may be a useful modification in the management of pediatric patients with symptomatic upper and lower canalicular agenesis.