Epiphora after nasolacrimal duct fracture in patients with midfacial trauma: A retrospective study

The aim of this study was to identify the factors related to occurrence of epiphora or requirement of dacryocystorhinostomy (DCR) in patients with midfacial trauma.We performed a retrospective analysis of the medical records of 1038 patients with midfacial trauma from January 2005 to December 2015. Fifty-one patients (55 cases) diagnosed with nasolacrimal duct (NLD) fracture using facial bone computed tomography were enrolled. Correlation analysis was performed of patient- and injury-related factors, including age, sex, facial trauma etiology, accompanying injury, type and level of the NLD fracture, and time from injury to initial surgery, with the occurrence of epiphora and requirement for DCR.Epiphora occurred in 14.5% and DCR was performed in 5.5% of the patients with NLD fracture. The correlation analysis revealed no significant relationship among the factors with the occurrence of epiphora and requirement for DCR.In patients with midfacial trauma and NLD fracture, epiphora occurred in 14.5% and endoscopic DCR was performed due to persistent epiphora in 5.5% and its result was all successful.

[Preliminary study on CT retrograde intubation dacryosystography (CT-RIDC) and its impact factors]

OBJECTIVE

To observe practicality and safety of CT-RIDC for the patients with presaccular lacrimal obstruction and study the related factors. To provide guidance for the diagnosis and treatment of the patients with presaccular lacrimal obstruction.

METHODS

Fifty-four patients (75 eyes) with presaccular lacrimal obstruction, including 3 cases (5 eyes) of upper and lower lacrimal punctum atresia, 15 cases (24 eyes) of superior and inferior canalicular obstruction, 18 cases (28 eyes) of common canaliculus obstruction, 18 cases (18 eyes) of old laceration of superior and inferior canalicular, were recruited. All patients underwent the examination by using 0° and 30° ear endoscope and the imaging characteristics of the inferior orifice of nasolacrimal duct were obtained. Fifty-three cases (65 eyes) with the opening inferior orifice were randomly divided into four groups (15 eyes, 17 eyes, 17 eyes, 16 eyes) according to different angle of head hypsokinesis in the supine position. The OM lines back along the sagittal plane of the head back 10°, 20°, 30°, 40° were measured. The angles of head hypsokinesis were set in accordance with the OM line measurement results.Intubation was successful when the intubation guided needle within the set of epidural anesthetic catheter aided with endoscopy was inserted into the inferior orifice of nasolacrimal duct and then the epidural anesthetic catheter was inserted into the lacrimal duct 6 mm. The angle (θ) between the long axis of the curved part of the intubation guided needle and the long axis of the guided needle was measured. The numbers of intubation success cases in each group were recorded.χ² test was used to compare intubation success rate under the different angle of head hypsokinesis.Scheffe method was used to compare intubation success rate between each group. Contrast medium was then injected into lacrimal duct through the epidural anesthetic catheter for patients with successful intubation and CT scan was carried out. 3D model of lacrimal passage was reconstructed with CT axial scanning.

RESULTS

The intubation guided needle was successfully inserted into the inferior orifice of nasolacrimal duct in 44 eyes among 65 eyes with the opening orifice. The number of successful intubation cases were 4 eyes, 15 eyes, 13 eyes, 12 eyes and the intubation success rate was 26.67%, 88.24%, 76.74%, 75.00% according the angle of head hypsokinesis 10° group (15 eyes), 20° group (17 eyes), 30° group (17 eyes), 40° group (16 eyes). The intubation success rate of head hypsokinesis 10° group was significantly lower than that of the other groups. Multiple Comparison by Scheffe Test demonstrated that there was a remarkable difference (P < 0.05) in the intubation success rate between head hypsokinesis 10° group and the other three groups. There were no significant differences in the intubation success rate among head hypsokinesis 20° group, head hypsokinesis 30° group and head hypsokinesis 40° group. The mean of θ was 108° with a range of 93.2°-120.5° by measuring the angle θ of the successful intubation cases. According to the frequency distribution plot, most θ was in 104°-115°. The successful intubation cases (44 eyes) underwent CT scan in the same position immediately after injected contrast medium (Optiray) through the epidural anesthetic catheter. CT images of 28 eyes showed retained contrast medium in the nasolacrimal duct and lacrimal sac. The findings from CT-DCG images were basically agreed with the operation.

CONCLUSIONS

CD-RIDC may apply to pre-operative examination for the patients with the opening orifice and presaccular lacrimal obstruction.It provideed imaging evidence for diagnosis and therapy and it was safe and practical. Many factors could affect CD-RIDC. The main verified facors were the shape of the inferior orifice of nasolacrimal duct, head position of the patient and the bending angle of the tip of intubation guided needle.

Use of silicone tubes to repair canalicular lacerations via a novel method

PURPOSE

To develop a novel method to repair canalicular lacerations using silicone tubes.

METHODS

A total of 47 adult patients (47 eyes) with canalicular lacerations were collected from the outpatient department from November 2010 to December 2012. The age ranged from 16 to 53 years. Among the 47 eyes, 37 had lower canalicular lacerations, 6 had upper canalicular lacerations, and 4 had bicanalicular lacerations. A soft probe was made using a stainless steel acupuncture needle, which was inserted into the lumen of the proximal part of the catheter to increase its rigidity. The probe was then inserted into the lacrimal sac and nasolacrimal duct. After retrieval of the catheters, the two ends of the silicone tube were securely tied (end to end) to the catheters. The silicon tube outside the nostril formed a U-shape. The catheters were then pulled upward until the silicone tube was completely located in the canalicular system. The catheters were cut off of the silicone tube near the site of the connection. The two ends of the silicone tube were cut short, -2mm out of the lacrimal punctum, and tied securely, end to end. The length of the tube between the upper and lower punctum was adjusted to ensure that no tension was present in the medial cathus, and the suture was removed through the nostril. The silicone tube was removed 3-10 months after this novel canalicular intubation procedure (NCI).

RESULTS

All cases were anatomically rehabilitated after surgery. The silicone tube was removed after implanted in 3-10 months (mean 4.5 +/- 1.3 months), the average follow-up time was 11.8 months after removal. In total, 45 eyes in all 47 eyes (95.74%) were free from obstruction. Among them, 41 eyes (91.11%) achieved complete success (completely disappearance of epiphora after tube removal), 4 eyes (8.89%) achieved partial success (irritation occurs under stimulation conditions, such as wind or cold conditions), 4 eyes showed postoperative tearing, with three eyes having inferior lacrimal duct laceration, and one eye with superior canalicular laceration. Apart from two cases (4.26%) suffering inferior punctum splitting, no other associated issues occurred with the silicone tube or iatrogenic injury and lacrimal complications.

CONCLUSION

For adult patients with canalicular laceration, the NCI was an effective, atraumatic surgery, which has fewer complications than traditional canalicular suture.

Intraoperative lacrimal intubation to prevent epiphora as a result of injury to the nasolacrimal system after fracture of the naso-orbitoethmoid complex

Treatment of fracture of the naso-orbitoethmoid (NOE) complex is difficult. There are not only aesthetic issues but also functional consequences related to the lacrimal system. Because prophylactic lacrimal intubation for such fractures remains controversial, we have assessed the effectiveness of intraoperative lacrimal intubation to prevent epiphora as a result of such injuries. Thirteen patients diagnosed with craniomaxillofacial fractures including fractures of the NOE complex were included in the study; 10 had unilateral fractures and 3 bilateral. Computed tomography (CT) showed all patients had displaced fragments that had the potential to damage the lacrimal duct. In 7 patients the fractures included the canthal region and in 6 they did not. All patients were treated by open reduction and internal fixation under general anaesthesia, followed by intraoperative lacrimal intubation unilaterally or bilaterally as required. Lacrimal intubation with a silicone tube was successful in all 13 patients (16 sides). The tube was removed 2-9 months (mean 3.8) postoperatively and no subsequent epiphora were seen during follow-up (mean (3-29 months) 11.3 months). Lacrimal intubation for at least 2 months may prevent epiphora caused by injury to the nasolacrimal system after fractures of the NOE complex.

Correlation between anthropometric facial features and characteristics of nasolacrimal drainage system in connection to false passage

BACKGROUND

To determine the correlation between the anthropometric facial features and the anatomy of the nasolacrimal drainage system.

METHODS

Forty-six mid-sagittal halves of 23 cadavers were studied. The inclination of the lacrimal sac (LS) and nasolacrimal duct (NLD), and the LS-NLD angle were measured in both the sagittal and coronal planes. For the facial features, the height, length and depth of the nose, the intercanthal distance, nasal breadth, nasofacial angle, distance between the external naris, and the inferior aperture of the NLD were measured. The correlations between the angles and the facial features were calculated.

RESULTS

The LS-NLD angle was classified into three anatomical types according to the inclination of the LS and the NLD in the sagittal and coronal planes; the anterior-inward type (43.5%), anterior-outward type (37.0%), and posterior-outward type (19.5%). The nasal depth was correlated with the sagittal LS-NLD angle, and the nasal height and length were correlated with the coronal LS-NLD angle.

CONCLUSIONS

There is a large variation in the LS-NLD angle, and nasal depth, height and length can be used to predict the direction of this angle.

A clinical application of laser direction in anastomosis for inferior canalicular laceration

OBJECTIVE

To study the therapeutic efficiency and efficacy of laser-directing approach on searching for the nasal broken end of lacerated lacrimal canaliculus in anastomosis for canalicular laceration.

METHODS

Forty-nine patients (49 eyes) suffering from traumatic inferior canalicular laceration were divided into control group and laser-directing group. The distance between the lacrimal punctum and the nasal broken end of lacerated lacrimal canaliculus was more than 6 mm. During the course of management of eyelid trauma, the patients were treated by canalicular anastomosis operation with traditional method and laser-directing method in searching for the nasal broken end of lacerated lacrimal canaliculus respectively. The silicone tube of 1 mm diameter was intubated in the lacrimal passage as a stent for 4 to 6 months.

RESULTS

In the laser-directing group, the mean time in searching for the nasal broken end of lacerated lacrimal canaliculus was (5.75+/-1.49) minutes and the mean time of operation was (49.21+/-3.37) minutes; both were significantly shorter than that of the control group (P<0.01). The cure rate of the laser-directing group was 96.55%, higher than that of the control group but without statistical significance (P>0.05).

CONCLUSIONS

The laser-directing method is much quicker and more convenient to searching for the nasal broken end of the lacerated lacrimal canaliculus than the traditional approach, and patients suffer less pain and damaging in canalicular anastomosis operation.

[Repair of canalicular lacerations using silicone tubes(80 cases)]

PURPOSE

Long-term canalicular intubation is preferred for improving the prognosis of canalicular lacerations. We have improved the intubation step by step from methods I to V. The present paper describes the modifications that we previously made as well as the prognosis of each method.

SUBJECTS AND METHODS

During the past 13 years, 80 cases of canalicular lacerations underwent the intubation with silicone tubes in our department. The methods used are designated by I (placed in the affected side), II(ring-form intubation into the lacrimal sac), III(loop-form intubation into the nasal cavity), IV(Fayet's tube with a punctal plug is placed in the affected side), and V(a KAWAI open tube with a punctal plug is placed in the affected side).

RESULTS

Each of the canalicular intubations improved the prognosis: the ratio of patients showing improvement was 85.7% for method I, 94.7% for II, 97.3% for III, and 100% for IV and V. Methods IV and V caused fewer complications during long-term intubation.

CONCLUSION

Method V that we developed permits tear drainage, and decreases epiphora. The punctal plug prevents the tubing from dropping out, and therefore permits longer placing of the canalicular tubing than does method II or III. Thus, our method V seems to improve the prognosis of canalicular laceration repairing.

[Lacrimal duct treatment with ring intubation in injuries of the upper and lower eyelids]

BACKGROUND

Treating injuries of the lacrimal system with a silicon intubation is an approved method to prevent post-traumatic epiphora.

MATERIALS AND METHODS

Between 1990 and 1999, operations were carried out on 44 patients with injuries of the canaliculi with silicon ring intubations. Interesting for us were the age distribution, causes of injuries, localisation and mid- to long-term postoperative complications.

RESULTS

The age of the patients was between 1.75 and 74 years, 48% of the injuries were caused by household accidents, 23% by violence, 20% by traffic accidents and 9% by job-related accidents. The canaliculus inferior was injured in 68% of all patients. We found 10 postoperative complications, e.g. ectropia, a too long silicon ring or granuloma. We found a positive anatomical readapted lacrimal system in 88% and 12% of our patients complained of distinct to severe epiphora.

CONCLUSIONS

The treatment of lacrimal laceration with a silicon intubation is an excellent method but special care should be taken with correct positioning of the lid margin.

Nasolacrimal duct injury from microscopic sinus surgery: preliminary report

Nasolacrimal duct injury is a well established complication of functional endoscopic sinus surgery. In 1992, Bolger reported an incidence of nasolacrimal duct injuries in endoscopic sinus surgery of up to 15 per cent, but there is no documentation in microscopic sinus surgery. Fluorescein instillation into the lacrimal system via the punctum was done to determine the incidence of nasolacrimal duct injuries in 16 patients who underwent 32 microscopic sinus procedures. Only one patient exhibited nasolacrimal duct injury intraoperatively on the left side (0.3%). He had complete healing of the nasolacrimal duct at 2 months and no postoperative epiphora developed.

[Prognosis of conjunctivo-dacryocystorhinostomy. Modification with different implant materials]

BACKGROUND

In cases of total canalicular occlusion or the total absence of the lacrimal apparatus the functional restoration requires the repair of a newly created lacrimal system. The intraoperatively reestablisted lacrimal drainage from the conjunctival sac will be maintained by a plastic tube. Beside other criteria the influence of the used inserted materials polyethylene or silicone should be evaluated.

PATIENTS AND METHODS

From 9/1978 to 2/1999 we have been treated and consecutive documented 37 cases of conjunctivodacryocystorhinostomy and its modifications in 36 patients (1mal both eyes). The patients (22 men, 14 women) ranged in age from 9-76 years (mean age of 35.2 years). In a retrospective review results were compared for the following two groups based on the type of used plastic tube: group I: (n = 23); insertion of a polyethylene tube (from 1976-1990); group II: (n = 14) insertion of a silicone tube (from 1991-1998).

RESULTS

Causes of lacrimal drainage system obstruction were trauma (n = 21), malformation (n = 8), chronic inflammation (n = 5) and tumor (n = 2). The following different surgical techniques were performed: conjunctivodacryocystorhinostomy (cdr, n = 23), conjunctivodacryocystostomy (cd, n = 10) and conjunctivorhinostomy (cr, n = 4), (right eye: n = 21, left eye: n = 16). In group I 14 of 23 operations (61%) had successful functional results, in group II 10 of 14 operations (72%), respectively. The polyethylene tubes on the average were maintained for 15 months after surgery (4mal spontaneous removal) and the silicone tubes for 12 months, respectively (4mal spontaneous removal).

CONCLUSION

Traumatic disturbance and congenital defects of canaliculi and surrounding tissue require in the case of any symptoms the surgical reconstruction of the lacrimal pathway. With the introduction of the silicone tube the success rate could be further advanced.

[Foreign body granuloma after lower eyelid avulsion and surgical revision with silicone tube splint]

BACKGROUND

Foreign-body-reactions with granulomas after use of silicone-containing biomaterials are of clinical importance [4].

HISTORY AND SIGNS

A 4-year old patient entered our hospital with a reddish vascularised tumor. The tumor's origin was in the conjunctiva of the nasal lid-angle of the right eye.

THERAPY AND OUTCOME

After a traumatic disconnection of the canaliculus lacrimalis inferior, a bicanalicular silicon-tube intubation had been performed with the patient in the age of one year. Only 3 years after this intervention a secondary clinical examination could be performed. At this time, an extended solid conjunctival-tumor appeared at the operated eye. After removal and histological examination it could be classified as a foreign body granuloma.

CONCLUSIONS

The blood- and tissue compatibility of silicone is only insufficiently guaranteed on the basis of the hydrophobic material-surface. After reconstructive lacrimal surgery postoperative care and the removal of the stabilizing silicone material is necessary.

Lacrimal duct injuries revisited: a retrospective review of six patients

This is a retrospective review of 6 patients treated for lacrimal duct injuries between December 1994 and October 1997. Four patients had inferior canalicular lacerations, one had a superior laceration, and one had a combined inferior and superior laceration. Associated injuries included facial fractures (1 patient), multiple facial lacerations (2 patients), and avulsion of the medial canthus (1 patient). All patients were repaired with Crawford tubes using a semicircular technique. The mean time of lacrimal intubation was 4.2 months (range, 3.6-4.5 months). One tube fell out at an undetermined time during the follow-up period. Visible anatomic restoration was considered excellent in all patients. There were no instances of persistent epiphora or other complications. Although there are several techniques available for treating lacrimal duct injuries in the course of dealing with general facial trauma, the semicircular technique using a Crawford intubation system yielded consistently reliable results with minimal or no complications.

Monocanalicular lesions: to reconstruct or not

OBJECTIVE

To evaluate the success rate of a simple surgical method for the treatment of a monocanalicular lacrimal lesion.

DESIGN

Retrospective noncomparative case series.

PARTICIPANTS

Thirteen consecutive patients with monocanalicular trauma who were seen from August 1995 to March 1998. In six patients, the canaliculus was lacerated as a result of an external injury and in seven patients as a result of tumor removal (iatrogenic injury).

INTERVENTION

Reapproximation of the orbicularis muscle and skin overlying the torn canaliculus without reanastomosis of the lacerated canaliculus. In those patients in whom the canaliculus was sacrificed as part of the removal of an eyelid tumor, no attempt was made to reconstruct the canaliculus.

MAIN OUTCOME MEASURES

Symptomatology, patency of the lacrimal passage, fluorescein dye disappearance test, and patient satisfaction.

RESULTS

In all patients the injured canaliculus was totally blocked, but despite this none of the patients complained of inconvenient tearing either indoors or outdoors. The ipsilateral unharmed canaliculus was functioning normally in such a way that the fluorescein dye instillation test showed residual dye in six patients after 2 minutes and in none of the patients after 5 minutes. All patients were satisfied with the functional and cosmetic result.

CONCLUSION

Nonrepair of a monocanalicular lesion is a valid approach that results in little or no morbidity.

[Anatomical consideration for the injury of dacryocyst and nasolacrimal duct during intranasal sinus surgery]

Based on dissection and measurement on 20 adult head cadavers, there is the close relationship between lacrimal duct and lateral wall of the nasal cavity. The cells of anterior ethmoid sinus were classified into three degrees, according to the relationship between the anterior ethmoid sinus and the lacrimal sac fossa. The average distance is 6.74 +/- 1.72 mm between the nasolacrimal duct and the upper part of the uncinate process, 3.44 +/- 0.75 mm and 5.50 +/- 3.73 mm from the nasolacrimal duct to ethmoidal infundibulum and the maxillary ostium. The orifice of the duct most commonly opens under the insertion of the inferior turbinate anteriorly. To perform intranasal sinus surgery, the safest area and key operation approach were discussed.

The 'swing-door' technique for uncinectomy in endoscopic sinus surgery

Uncinectomy is an important step in endoscopic sinus surgery. The traditional method of performing uncinectomy has the risk of penetration of the lamina papyracea with orbital fat exposure. If the orbital penetration is not recognized, major complications may follow. In this study the authors used historical consecutive controls to compare the incidence of orbital penetration, identification of the natural ostium and lacrimal apparatus injury by the traditional surgical technique and a new technique of uncinectomy. Six hundred and thirty-six uncinectomies have been performed using the 'swing-door' technique. The 636 uncinectomies performed prior to changing techniques were used as historical controls. The incidence of orbital penetration (six compared to 0; p < 0.05) and ostium non-identification (42 not identified as compared to 0; p < 0.001) was significantly less with the new technique. One lacrimal injury occurred with the 'swing-door' technique compared to zero with the standard technique (p > 0.05). The techniques are described and the complications discussed. The authors recommend this technique as it is easy to learn, allows removal of the uncinate flush with the lateral nasal wall and allows easy identification of the natural ostium of the maxillary sinus.

The extended Jones tube

Conjunctivo-dacryocystorhinostomy with a Jones glass tube serving as a conduit for tear flow is used in patients with epiphora resulting from obstructed canaliculi. The glass tube runs from the medial canthus into the nose. The author describes the use of an extended Jones tube in a patient without a nose.

The bubble test: an atraumatic method for canalicular laceration repair

Canalicular lacerations need to be correctly identified before surgical repair. Methods to find the medial cut end are numerous. With the use of direct sight or the bubble test or both, the identification and repair of the medial cut end of the lacerated canaliculus should be achievable in the majority of cases.

An animal model studying reconstruction techniques and histopathological changes in repair of canalicular lacerations

We designed an animal model using sheep to evaluate three methods of canalicular reconstruction after laceration: direct sutured reapposition of the canaliculus without silicone intubation (4 eyelids), silicone intubation of the canalicular system without mucosal anastomosis (14 lids) and silicone intubation with mucosal anastomosis (10 lids). We also wished to determine the appropriate time of silicone tube removal. In the canaliculi repaired using silicone intubation the tubes were removed at 4, 8 or 12 weeks. Patency of the canalicular system was assessed at 16 weeks by probing. Sections of eyelid tissue were examined histopathologically to confirm patency and to compare the tissue alteration caused by the various methods of repair. We found that silicone intubation was necessary to reestablish patency of the canaliculus and that silicone intubation with and intubation without mucosal anastomosis were equally efficacious in restoring canalicular patency. The optimum time for removal of the tube was 12 weeks. Histopathologically, all canaliculi found to be patent by probing demonstrated mucosal continuity along the canalicular lumen.

[Reconstruction of lacrimal ducts]

For reconstruction of lacrimal drainage after injury of tumour resection indications, surgical technique and results of five surgical procedures are presented: primary suture with splinting, conjunctivorhinostomy, endonasal dacryocystorhinostomy, Heermann tube and mobilisation of nasolacrimal duct. Performing these techniques, solitary or in combination, one achieves almost a good lacrimal drainage. The results of our retrospective study are based upon a combination of subjective and objective findings. Success rate was 96% for direct suturing of the tear ducts with intubation, 100% for conjunctivorhinostomy, 96% for endonasal dacryocystorhinostomy in case of postsaccal stenosis, 83% for Heermann/Jones tube and 100% for relocation of the nasolacrimal duct.

[Causes, surgical methods and results of primary management canaliculus injuries]

A retrospective study of the results obtained from surgical treatment after canaliculus injuries during the period 1981 to 1987 at the Munich University Eye Hospital. The surgical treatment involved a ring intubation of both canaliculi with a silicone rod inserted with a pigtail probe (Kellnar probe). In 45 patients with an average follow up period of 2.1 years we found a 91% success rate with anatomical reconstruction of the injured canaliculus. Although the lacrimal passages were patent, 4% of these patients complained of epiphora. We analyse the circumstances of the injury, the age of the patient and complications. The discussion includes a review of relevant literature.

Nasolacrimal injuries. Evaluation and management

The tear drainage system is disrupted in 17% to 21% of nasoethmoidal fractures and, to a lesser degree, other midfacial fractures. When epiphora or dacryocystitis occurs, evaluation should include the Jones dye tests, probing of the ductal system, or dacryography. Dacryocystorhinostomy is the treatment of obstruction distal to the common canaliculus.

[A monocanalicular stent with self-stabilizing meatic fixation in surgery of excretory lacrimal ducts. Initial results]

Our experience of 49 cases with a new monocanalicular silicone stent is described. This is a stent with a "auto-stable" meatic plug which respects the canalicular anatomy. There is no stopping-knot, no palpebral ring as in the bicanaliculo-nasal-intubation. The risk of accidental exteriorization is less important, the risk of stricturotomy is absent. Two types of intubation can be used: monocanaliculo-nasal intubation: the way of putting it in place is the same as the bicanaliculo-nasal one, with a metallic probe. The range of it's use widdens from distal canalicular wounds (2 cases) to common canalicular stenosis (15 cases) and to lacrimo-nasal imperforations (12 cases). In the two last instances, the intubation is made through the superior canaliculus, so that the inferior one is left free. In 13 cases, an intubation was made bilaterally for the same disorder, and a comparison could be done between monocanalicular and bicanalicular intubation. The true monocanalicular intubation, for proximal injuries: grasping the metallic probe inside the nose is no longer necessary. The length of the silicone probe is adaptated intra-operatively. The functional results of monocanalicular intubation are comparable to the results of bicanalicular intubation, especially for monocanalicular injuries (in addition with canalicular sutures) and the lacrimo-nasal imperforation. Incidents were observed especially with the first patients; a strict method is mandatory for avoiding accidents. The use of monocanalicular intubation should be used only for short duration and monocanalicular disorders. In other cases, bicanalicular intubation remains the good choice.

[Repair of recent canalicular wounds using a monocanalicular stent]

A new monocanalicular stent is described, which is used in cases of lacrimal canalicular injuries, associated with direct sutures of the canalicular wall. When injuries occur on proximal portion (2/3) of the canaliculus, a true monocanalicular stent is used, without intubation of the vertical part of lacrimal system. When the distal portion (1/3) of the canaliculus and/or the sac are involved, a complete monocanalicular probe is placed. First results of this method are exposed (5 cases) and are suggestively good.

Locating cut medial canaliculi by direct injection of sodium hyaluronate into the lacrimal sac

Locating the cut medial ends of canaliculi after trauma or surgery can be difficult. In cases of double canalicular or common canalicular lacerations, injection of sodium hyaluronate (Healon) directly into the lacrimal sac may help pinpoint the medial openings.

A method of monocanalicular silicone intubation

A method for silicone intubation of a single canaliculus is described. A lacrimal stent has been crafted from a short segment of silicone tubing and a punctal plug. The distal end of the stent is fixed in the punctum with a punctal plug. The silicone stent, which is attached to the punctal plug, bridges the canalicular laceration. Because the punctal plug remains fixed in the punctum, no sutures are needed to fixate the stent to the eyelid.

Single silicone intubation for repair of single canaliculus laceration

A method is described and illustrated for managing the surgical problem that occurs when intubation of the canalicular system is desired, but for various reasons only single intubation is to be performed as opposed to double intubation. To provide the necessary fixation of the single tube (fixation is usually provided with a double-tube system by knotting it in the nose), and at the same time to avoid unsightly scars and difficulties that result from fixation to the skin, it is suggested that the end of the tube be buried and sutured into the inferior fornix or alongside the caruncle. At this site, it is possible to maintain the tube's position for the necessary three- to six-month period without the problems associated with other methods of fixation.

Silicone intubation for lacerated lacrimal canaliculi

Twenty-two cases of lacerated canaliculi were repaired with the use of silicone tube stents. Of the 18 patients having early repair, 17 (94%) had a good result and one (6%) fair. The four patients with late repair yielded three (75%) with a poor result and one (25%) fair. Primary repair of lacerated canaliculi by this method has a good prognosis. Secondary repair is more difficult, and the outcome is likely to be poor.

Gentle, technically simple repositioning of displaced lacrimal tubing

Lateral displacement at the medial canthus is the most common complication following lacrimal intubation. Current procedures for dealing with this situation involve the removal of the tubing, and are either technically difficult or else involve retrograde passage of the knotted silicone through one of the canaliculi. By passing both probes of a second intubation set through the same punctum, the loop of the displaced tubing can be captured and gently repositioned without removal. This is particularly useful with early displacement of the tubing following microsurgical repair of a canalicular laceration.

Silicone intubation in children with nasolacrimal obstruction

Silicone tube intubations were performed on 36 cases of congenital nasolacrimal obstruction and on three children with traumatic canalicular lacerations. The success rates of 84% in congenital nasolacrimal duct obstructions, 54% in congenital punctal-canalicular obstructions, and 100% in canalicular lacerations and the minimal complications encountered suggest that silicone intubations in the pediatric population are useful in avoiding dacryocystorhinostomy and conjunctivo-dacryocystorhinostomy.

Pediatric nasolacrimal pigtail probes

This paper describes two nasolacrimal probes designed for pediatric use. Patterned after the Beyer probe, the first has a diameter that is smaller by 25%. The second has the smaller diameter and also a curvature radius that has been reduced by 25%. Other features of the instruments are unchanged. These probes seem safer and easier to use with pediatric patients.

Trauma to the lacrimal system in children

We repaired damage to the lacrimal drainage system in a series of 393 children who had lacrimal obstruction caused by congenital obstruction or facial injuries. Delayed surgery for traumatic obstruction of the nasolacrimal duct in children, including infants, was successful in all cases.

Repair of the lacerated canaliculus

There are various techniques used to repair a lacerated canaliculus. Successful functional results are obtained with the use of soft silicone tubing as a canalicular stent. One such technique used by the authors is described.

[A new lacrimal intubation set (author's transl)]

The authors report a new lacrimal intubation set made with two very malleable metal probes and with a silicone tube. The system can be used during the repair of the nasolacrimal duct injuries, during dacryorhinocystostomy, and also for the repair of canaliculus injuries with the little set.