Retrograde intubation dacryocystorhinostomy for proximal and midcanalicular obstruction

Objective: Retrograde intubation of canaliculi during dacryocystorhinostomy can restore canalicular patency in cases otherwise managed with bypass tub es. The surgical technique and success for this procedure are discussed. Design: A retrospective, noncomparative case series with clinic or telephon e interview for long-term follow-up of patients' symptoms. Participants: One hundred two patients who had undergone this particular la crimal 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 inc luded. There were 53 females and 49 males, with ages at surgery ranging fro m 6 to 83 years (mean, 49 years). The etiology was idiopathic (30%), herpet ic canaliculitis (24%), punctal agenesis (18%), and trauma (11%); less-comm on causes included dacryocystitis, Stevens-Johnson syndrome, eczema, and pr ior radiation therapy. Both upper and lower canalicular systems were involv ed in the majority (73%) of patients, and in 13 (11%) systems a dacryocysto rhinostomy had previously been performed. The silicone tube was placed for a mean of 2 months (range, 1 week-9 months); and the mean postoperative fol low-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 signific ant number of patients the long-term inconvenience of Jones tubes. Failure of this technique does not, however, compromise or complicate the future pl acement of a bypass tube.