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T. M. Haller, C. B. Haller, M. L. Haller; Bicanaliculus Intubation as a Means of Avoiding Dacryocystorhinostomy. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3150.
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The current treatment for epiphora caused by obstruction in the lacrimal excretory system at the common internal punctum is dacryocystorhinostomy. Although highly successful, dacryocystorhinostomy is an invasive and medically stressful procedure, performed under general anesthesia with the accompanying medical and surgical risks. The purpose of our study was to attempt to find a simple, office based procedure that may be used as an alternative.
The study examined 6 patients with complaints of severe tearing caused by obstruction at the level of the common internal punctum as it enters the lacrimal sac. Under topical anesthetic, the obstruction was punctured with Bowman probes. Ordinarily, this puncture alone would close within days and tearing would return. To maintain the patency of the newly formed opening, we then intubated both canaliculi with self-retaining bicanaliculus silicon stents. The patients were then monitored to follow their progress.
100% of the patients extruded their stents within three weeks. However, 2 of the 6 (33%) patients were no longer symptomatic and patency was demonstrated by free irrigation into the nose. These patients remained patent and asymptomatic and were able to avoid invasive surgery. The remaining 4 patients required and underwent a dacryocystorhinostomy.
Bicanalicular intubation should be attempted in those patients who demonstrate common internal punctum stenosis or obstruction. It is a simple, office-based procedure with minimal risk. A significant percentage of patients could be cured by this procedure and avoid major surgery. This would be a significant benefit to patients who are either afraid or unwilling to undergo dacryocystorhinostomy or are poor medical candidates for the surgery.
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