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John B. Miller, John D. Pemberton, Aaron Fay; Electronically-Assisted Nasolacrimal Duct Silicone Intubation. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1064.
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Nasolacrimal duct intubation (NLDI) is a moderately invasive procedure commonly performed by both general and subspecialty ophthalmologists. It has become standard of care for treatment of obstructive epiphora, adult and congenital nasolacrimal duct obstruction, and repair of canalicular lacerations. Several instrument designs are available to facilitate retrieval via the nasal passage. The widely used Crawford set and other metal probe devices can present challenges during both placement and retrieval of the probe from the inferior nasal meatus. The postero-inferior orientation of the nasolacrimal duct opening under the inferior turbinate of the nasal cavity, the narrow space, and delicate nasal mucosa contribute to poor visibility, bleeding, and difficulty in probe retrieval from the nose. The procedure can produce significant mucosal and structural trauma, occasionally with significant hemorrhage. We describe an electronic device that assists surgeons in localizing the metal probe intranasally. Upon contact, this device emits an audible alarm, guiding the surgeon in retrieval. This device will expedite retrieval, minimize trauma, and assist in surgical training.
Five consecutive adult patients requiring NLDI for nasolacrimal duct obstruction, punctal/canalicular stenosis, or canalicular laceration repair were enrolled in this prospective interventional surgical technique case series.
Electronically-assisted NLDI was performed on 5 patients. Intraoperatively, there was no evidence of electric shock, mucosal injury due to burns. In all cases, the electronic device buzzer was activated and helped localize the position of the Crawford probe.
Nasolacrimal duct intubation techniques and methods have advanced over the years as surgeons continually strive to make it easier, safer, and faster. This newly introduced Probuzz device expedites localization of the probe, decreases retrieval attempts, and minimizes chances of mucosal injury. It should also accelerate the learning curve for NLDI training, while decreasing operating times and complications rates. Combining the surgeon’s tactile sense with the auditory feedback of the electronic device improves a core ophthalmic procedure. Future series are planned to quantify operating time among attending surgeons and surgical trainees.
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