View 2019 Abstracts

To assess the feasibility and outcome for trans-canalicular trephination and silicone intubation for late medial common canalicular obstruction after uncomplicated open lacrimal surgery.

A retrospective case-note review for patients in whom membranous obstruction of the common canaliculus had occurred after prior open lacrimal surgery, and who had undergone nasal endoscopy with trans-canalicular trephination and silicone intubation. The surgery was performed under general or local anaesthesia, the tubes removed after about 4 months and success judged by the subjective relief of “flow” symptoms (epiphora) and the free passage of tear-film fluorescein into the nasal space.

Seventy-one patients (51 female; 72%) had attempted trans-canalicular trephination and intubation in 85 systems, the procedure being completed in 81/85 (95%) cases. Trephination could not be completed in 4 patients. Of those, 3 were cured with later open revisional surgery and one became asymptomatic after attempted trephination.
Although a patent anastomosis was established in 59/81(73%) systems at a mean follow-up of 59 months (median 19; range 1-266 months), symptomatic relief was achieved in 47/81 (58%). Twenty-six systems with continued symptoms underwent successful secondary procedures – 5 patients underwent repeat trephination and intubation, 1 had 4 months of re-stenting with a silicone tube, 10 had repeated open lacrimal surgery and 10 had closed placement of a Lester Jones canalicular bypass tube.

Endoscopically-guided trans-canalicular trephination and silicone intubation is an efficient method for revision of failed lacrimal surgery where a thin membranous common canalicular obstruction forms at the Valve of Rosenmuller. Where completed, the technique provides a symptomatic cure in a majority of cases and may, if necessary, be repeated.