Endoscopic conjunctivodacryocystorhinostomy with Jones tube placement

Objective: Conjunctivodacryocystorhinostomy (CDCR) with Jones tube placemen t as described by Jones has traditionally been performed as an "open" or ex ternal procedure by means of medial canthal incision, Application of endosc opic technique for ODOR with Jones tube placement has not been well describ ed in the peer-reviewed literature. Design: Retrospective nonrandomized comparative trial. Participants: Ten patients with epiphora secondary to canalicular stenosis, Methods: A total of 13 consecutive CDCR with Jones tube procedures were rev iewed, Five procedures (performed predominantly in the early study period) were done by means of a traditional external approach with a medial canthal incision. Eight procedures were performed with an intranasal endoscopic ap proach and instrumentation with Jones tube placement under direct endoscopi c visualization. Main Outcome Measures: Total operative time, estimated blood lost, intraope rative, and postoperative complications and need for secondary surgery were evaluated. Results: All procedures were successfully completed with no intraoperative complications. Average operative time was 59 minutes in the endoscopic grou p and 74 minutes in the external group, Average blood loss was 3.5 mi and 4 .4 mi in the endoscopic and external groups, respectively. Postoperative ad justment of tube size or position (performed as an office procedure with to pical/local anesthesia) was common: five of eight endoscopic and three of f ive external approach. Two patients in the endoscopic group required second ary surgery for anatomic reasons. Ultimately, all cases in both groups demo nstrated patent, retained Jones tubes and relief of epiphora. Conclusion: Endoscopic technique appears to be a reasonable approach for OD OR with Jones tube placement. Operative time and blood loss were comparable in the two groups, with the endoscopic group being slightly lower for each variable. Endoscopic Jones tube placement can be accomplished with readily available instrumentation. In this series, we did not find it necessary to use laser, radiofrequency, or monopolar devices for intranasal hemostasis. Ophthalmology 2000;107:1206-1209 (C) 2000 by the American Academy of Ophth almology.