September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Modified canaliculotomy with suture-fixed stent for treatment of canaliculitis
Author Affiliations & Notes
  • Tina H Chen
    Ophthalmology, University of Chicago, Chicago, Illinois, United States
  • Milap Mehta
    Eye and Vision, Northshore University, Chicago, Illinois, United States
  • Footnotes
    Commercial Relationships   Tina Chen, None; Milap Mehta, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 694. doi:
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      Tina H Chen, Milap Mehta; Modified canaliculotomy with suture-fixed stent for treatment of canaliculitis. Invest. Ophthalmol. Vis. Sci. 2016;57(12):694.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : The gold standard surgical treatment of canaliculitis is punctal dilatation and curettage, but may lead to recurrent disease if dacryoliths remain. Canaliculotomy allows direct access, but can lead to scarring, strictures, or dilatation of the canaliculi or punctum. In our study, we conducted a restrospective chart review of 2 patients undergoing modified canaliculotomy with suture-fixed stenting to evaluate its efficacy and ability to maintain patency of the lacrimal system.

Methods : Inclusion criteria included chronic canaliculitis with canalicular stenosis proven on probing and irrigation without nasolacrimal duct involvement. Patients with punctal plugs were excluded from the study. Our cohort included 2 patients (2 puncta), including 1 male (Patient 1) and 1 female (Patient 2), ages 71 and 22 years, respectively. Both presented with tearing and purulent discharge which failed conservative treatment. Intraoperatively, each patient received upper and lower punctal dilatation of the affected eyelid. A bowman probe #2 was then placed into the left lower punctum and canalicular system until a “hard stop” was engaged. A #11 blade was used to incise the canaliculus from the punctum towards the common canaliculus. A chalazion curette was then used to express any dacryoliths or foreign bodies. A chalazion clamp was used in a “milking” fashion to ensure no additional foreign bodies remained. Both patients had a lacrimal stent fixed into the punctum with a 6-0 prolene suture and externalized. The stent was then directed along the path of the previously incised canaliculus into the lacrimal sac. The skin was closed with 6-0 chromic sutures over the stent and re-formed canaliculus. The stents were removed after 6 weeks.

Results : Both patients underwent uncomplicated stent removal after 6 weeks. Both (100%) had complete resolution of symptoms and maintained patency of the lacrimal system. One patient (50%) developed a small pyogenic granuloma that resolved with conservative treatment. There were no cases of disease recurrence 6 weeks post-operatively.

Conclusions : The modified canaliculotomy with suture fixation of a lacrimal stent provides excellent surgical exposure and allows for easy removal of lacrimal foreign bodies. The suture-fixated lacrimal stent is easily placed with the wide surgical exposure. Fixation sutures prevent premature extrusion.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

Modified canaliculotomy

Modified canaliculotomy

 

Post op week 6

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