ONE-STITCH CANALICULAR REPAIR - A SIMPLIFIED APPROACH FOR REPAIR OF CANALICULAR LACERATION

Background: It has been widely believed that direct microsurgical re-a nastomosis of the canalicular epithelium is necessary for satisfactory repair of canalicular lacerations. However, because repair is carried out in conjunction with placement of an indwelling silicone stent, th is stent should keep the canalicular edges adequately approximated wit hout the need for suturing. The authors report their results in repair ing canalicular lacerations using a single, fine, horizontal, mattress suture to re-approximate the overlying pericanalicular orbicularis mu scle and eliminate direct microsurgical re-anastomosis of the canalicu lar epithelium. Methods: The authors retrospectively reviewed the char ts of 67 patients who underwent repair of lacerated canaliculi with on e-stitch re-approximation of the overlying orbicularis muscle in conju nction with bicanalicular silicone tube intubation. Stents were left i n place for 3 months postoperatively and then removed. Probing across the lacerated portion of the canaliculus was carried out at the time o f stent removal to ensure patency. Dye disappearance testing with 2% f luorescein and irrigation through the canaliculus then was performed 6 weeks to 3 months after stent removal. Results: Of the 67 patients, 5 9 were followed to stent removal. Probing with a 00 probe showed canal icular patency in all 59 patients. Irrigation resulted in reflux in tw o patients, indicating unrelated nasolacrimal duct obstruction, Of the se 59 patients, 45 complied with scheduled follow-up 6 weeks to 3 mont hs after stent removal. Dye disappearance testing using 2% fluorescein demonstrated delay in lacrimal outflow in 6 of the 45 patients. Only two patients had symptomatic epiphora, and in both patients there was an underlying nasolacrimal duct obstruction confirmed by irrigation. C onclusions: Simple re-approximation of the lacerated overlying soft ti ssue combined with bicanalicular silicone intubation proved highly suc cessful in managing canalicular lacerations. Probing through the lacer ated canaliculus demonstrated patency in 100% of the 59 patients follo wed to stent removal. Only 4% of patients had symptomatic epiphora pos toperatively, and 13% demonstrated some delay in outflow with dye disa ppearance testing. This compares very favorably with previous reported series in which lacerated canaliculi were microsurgically re-anastomo sed.