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Seanna R Grob, Michael Yoon; Lacrimal tubes in external dacryocystorhinostomy: a method for placement and removal and the incidence of prolapse. Invest. Ophthalmol. Vis. Sci. 2016;57(12):689.
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© ARVO (1962-2015); The Authors (2016-present)
To report a method of lacrimal tube placement and removal, and the incidence of lacrimal tube extrusion after external dacryocystorhinostomy (DCR).
A retrospective review of 88 patients (96 eyes) that underwent external DCR from 2011-2015 by one surgeon at Massachusetts Eye and Ear Infirmary was conducted. For placement, the Crawford tube was secured using 20 square knots and replaced in the nose. For removal, a 50:50 mix of 0.05% oxymetoxalone and 4% lidocaine was sprayed into the nose and the stent was cut between the puncta. After 5 minutes, the patient blew the affected side of the nose, while occluding the contralateral nare. Endonasal forceps were used to remove the stent if this was unsuccessful.
88 patients (96 eyes) were identified (mean 61 years, 54 female). 15 eyes had one or more episodes of tube extrusion (15.6%). Two eyes had two episodes and three eyes had 3 episodes of extrusion. The mean time after surgery until the first tube extrusion was 34.2 days (median 17 days). The tube was unable to be replaced after extrusion in 4 patients after the first extrusion, 1 patient after the second, and 2 patients after the third extrusion. A total of 21 patients had their tubes removed prior to the usual 3-month period (only 6 were from tube extrusion or 6.2%). Of the six patients whose tubes were out before the 3 months from tube extrusion, only 1 patient did not have post-operative symptom relief. Forty patients were observed using the nose blowing technique. 83% achieved success using this technique with a mean of 1.6 attempts. Of these patients, 30 of them exerted adequate effort with nose blowing. The remainder required forceps for removal, either due to poor effort or failure of the technique. There were no instances of slit puncta or inability to locate/remove the stent.
Our method of tube placement and removal showed successful results. Although lacrimal tube extrusion occurred, over half of the displaced tubes were replaced without requiring early tube removal. The success rate of surgery was still high despite tube extrusion and early removal. Forceps and endoscope tube removal was avoided in the majority of patients and no damage to the puncta occurred.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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