ABSTRACT
PURPOSE: Lacrimal bypass is the creation of a fistula connecting the conjunctiva with the lacrimal sac or nasal cavity. Bypass is indicated in canalicular obstruction or agenesis; sac absence, destruction or prior excision; lacrimal pump failure; or dacryocystorhinostomy failure. We aim to review the various techniques that have been developed over the last century for lacrimal bypass. METHODS: We conducted a comprehensive literature review of techniques which have focused on creating a conduit extending from the conjunctiva or canaliculi to the lacrimal sac, or extending that bypass to the nasal cavity bypass. RESULTS: The main techniques reviewed include canaliculodacryocystorhinostomy, conjunctivodacryocystostomy, conjunctivorhinostomy, conjunctivodacryocystorhinostomy, and conjunctivoductivodacryocystorhinostomy. CONCLUSION: Lacrimal bypass surgery has evolved due to innovation in microsurgical techniques, instruments and materials. Conjunctivodacryocystorhinostomy with Jones tube insertion is the predominant bypass technique, reflecting a culmination of historical developments. Understanding the variety of lacrimal bypass techniques is important for exploring alternative options when necessary.
ABSTRACT
The various surgical options for lacrimal tract reconstruction include canaliculodacryocystorhinostomy; fundal transposition; Conjunctivodacrocystorhinostomy with Jones tube; and in extreme cases conjunctivo-rhinostomy (CR) for total lacrimal bypass. The first three require partial lacrimal tract presence/ integrity while CR is indicated when the canaliculi and/or sac are nonfunctional. This report describes a novel technique of minimally invasive CR through a predominantly endoscopic endonasal approach and further discusses its advantages over other established techniques.
ABSTRACT
PURPOSE: To introduce and evaluate a minimally-invasive endoscopy-guided transcaruncular laser-assisted StopLoss Jones tube (SLJT) implantation technique for severe canalicular obstructions in primary surgeries. METHODS: We retrospectively identified 12 adult patients (12 eyes) with severe epiphora secondary to long-segment canalicular obstructions. All the 12 eyes underwent an endoscopy-guided transcaruncular SLJT implantation with an 810-nm diode laser's assistance as the primary surgical approach. Surgical and functional success rates, intraoperative and postoperative complications, as well as the need for secondary surgery, are evaluated. RESULTS: Primary surgical success was achieved in 11 of the 12 cases (92%); one patient (8%) required secondary surgery to replace an SLJT with a shorter one. Ultimately, all cases showed well-placed functioning tubes. Three of the 12 cases (25%) presented conjunctival scarring, conjunctival granulation tissue, with or without tube-associated irritation of the ocular surface. We observed no sink-in, extrusion, nor crack of the tube. Complete functional success was achieved in 83%, and moderate functional success in 17% of all patients. The functionally unsuccessful outcome was not present in this study. CONCLUSION: Endoscopy-guided transcaruncular diode laser-assisted SLJT implantation seems to be a promising minimally invasive approach for primary treatment of severe canalicular dacryostenosis. This novel technique shows high functional success rates. It seems to avoid the risk of tube malposition and extrusion, septal and turbinate injury, nasal adhesion, drainage failure, ethmoiditis, postoperative bleeding, and cutaneous scars.
Subject(s)
Dacryocystorhinostomy , Lacrimal Duct Obstruction , Adult , Endoscopy , Humans , Intubation , Lacrimal Duct Obstruction/diagnosis , Lasers, Semiconductor/therapeutic use , Retrospective StudiesABSTRACT
The problem of reconstruction of the lacrimal drainage system in cases of obliteration of both lacrimal points and/or both lacrimal canaliculi remains one of the most difficult in dacryology. The most common and effective operation for this pathology is Conjunctival dacryocystorhinostomy using tubes developed by L. Jones in 1962. However, wearing the tube for a long time and the complications associated with it can cause dissatisfaction with the treatment, even if the surgery was successful. The surgery technique and the tubes design have undergone numerous modifications to increase the amount of positive outcomes and reduce the number of complications. The results of original studies on this problem were analyzed revealing a lack of knowledge about the optimal design and material of the implant. There are few studies aimed at developing methods that ensure persistent preservation of the anastomosis after tube removal.
Subject(s)
Dacryocystorhinostomy , Lacrimal Apparatus , Conjunctiva/surgery , Lacrimal Apparatus/surgeryABSTRACT
BACKGROUND/AIMS: Although a Jones tube is considered the mainstay for epiphora in patients with total blockage of the canalicular system, it has been discouraged in children for reasons of inadequate self-care and maintenance. The purpose of this study is to compare the long-term outcome of Jones tube surgery in paediatric versus adult patients. METHODS: Retrospective, interventional case series of a single academic institution. The medical records of all children (≤16 years old) and adults (>16 years old) who underwent conjunctivorhinostomy with placement of a 130° angled extended Jones tube were reviewed. The outcome measures were patency and anatomical position of the tube, type and frequency of complications and subjective relief of epiphora. RESULTS: The study included 10 children (11 eyes) (range, 5.1-16.0 years old) and 102 adults (127 eyes) (range, 19.7-82.4 years old). The success and complication rate did not differ between the two age groups. Tube dislodgement and obstruction occurred in 4 (36.4%) of the paediatric tubes with an incidence rate of 6.1%/year and in 47 (37.0%) of the adult tubes with an incidence rate of 9.3%/year (p=0.3867). Two adults required routine self-irrigation of the tube. The median follow-up was 6.7 years for the children and 8.7 years for the adults (p=0.3430). CONCLUSION: With a similar outcome profile and minimal self-care, young age is not a prognostic nor limiting factor for surgery with angled Jones tubes. Exchange with tubes of a longer length is not required during growth.
Subject(s)
Dacryocystorhinostomy/methods , Intubation/methods , Lacrimal Duct Obstruction , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Incidence , Male , Middle Aged , Postoperative Complications/epidemiology , Retrospective Studies , Young AdultABSTRACT
AIM: To investigate the effectiveness of minimally invasive conjunctivorhinostomy for complete bicanalicular obstruction, and to evaluate the advantages, complications, and degree of satisfaction after this technique. ●METHODS: Twenty - two patients ( 22 eyes ) with complete bicanalicular obstruction were selected as the research subjects, all patients were treated by minimally invasive conjunctivorhinostomy. The post - operation follow- up lasted for 3 - 27mo. Medical records were reviewed for demographic data, surgical time, length of the tubes, duration of follow-up, patency of the tube, postoperative complications, whether satisfied or dissatisfied with this procedure. Meanwhile, the data was analyzed for evaluating the clinical efficacy of minimally invasive conjunctivorhinostomy. ●RESULTS: The overall operative success rate was 95%(21/22), and the overall patient satisfaction was 68% (15/22 ) . The post - operation complications included:granulation tissue proliferation of the lower end of the tube 2 cases (9%), middle turbinate blocked the opening of tube 3 cases ( 14%) , nasal mucosa covering the opening of tube 1 case ( 5%) , the tube was blocked by secreta 5 cases ( 23%) , foreign body sensation 10 cases (45%), dry eye 2 cases ( 9%), regurgitation of nasal secreta discharge 8 cases (36%). ●CONCLUSION: Minimally invasive conjunctivorhinostomy can treat the complete bicanalicular obstruction. This operation method is characterized by simplicity, high success rate, short operative time, less tissue trauma, less complications, without facial scarring, and it is worth clinical promotion.
ABSTRACT
A 33-year-old female suffered from bilateral mass in the medial area and epiphora for 20 years. The mass recurred after incomplete removal several times. Ocular examination showed that the puncta and papillae of the both lower and upper lids were completely missing. At operation, there was obstruction in the bony portion of the nasolacrimal duct. The mass was a distended lacrimal sac. The lacrimal sac and the mucosa of the nasolacrimal duct were compJetely excised in the right side. The excision of lacrimal sac and mucosa of the nasolacrimal duct and conjunctivo-rhinostomy using Jones tube were performed in the left side. Nine months after operation, the patient was happy with the results and there was no recurrence.
