Lacrimal bypass tube (Lester Jones tube)


What is a Lester Jones tube?
Made of highly polished pyrex, this tube measures about 1 cm long by 3.5 – 4mm wide and is used as a simple conduit between the tear film in the inner corner of the eye and the nasal space.
Although requiring an annual review in clinic, and periodic repositioning in some patients, a Lester Jones tube (LJT) can be highly effective where other lacrimal interventions have failed.

When is a Lester Jones tube used?
A Lester Jones tube is typically used in patients in whom previous lacrimal drainage operations (DCR) have not been successful (this more likely in those with prior canalicular disease).

How is this tube inserted?
As a DCR will already have been performed in most patients who require a tube, a LJT can be placed under a brief general or local anaesthetic by creating a track between the inner corner of the eyelids and the nasal passage, passing the tube over a blunt-tipped guide wire to lie within this track. This is usually undertaken with the use of an “endoscope” and instruments placed inside the nose so that no visible skin incisions are necessary.
Occasionally, where there is a significant deviation of the nasal septum, there may be insufficient nasal space to place a tube. A septoplasty may be required to improve the nasal space in such patients before a tube can be placed.

How long does the procedure take and when can I return to work?
The procedure itself takes between 30 – 45 minutes, and patients generally return home the same day. Administrative work can be recommenced within a day or two, with full return to work within a week.

What maintenance is required?
Regular ‘sniffing’ of saline or Hypromellose drops through the tube – several times daily – helps to keep it clear of mucus and debris. When sneezing, 2 fingers should be placed over the tube in the inner corner of the eyelids to minimise the chance of it becoming displaced.

How often will I need to come to clinic?
A fine suture (stitch) is usually placed around the neck of the tube and removed in clinic after a week or two. Thereafter, a review in clinic is required every 12months to ensure that the tube is clean and has not moved into an abnormal position.

What happens if the tube falls out?
If the tube does fall out at any time, it is perfectly safe to attempt to replace it into the fine track into the nose. Otherwise it should be brought without delay to a casualty department (with ophthalmic facilities) for it to be replaced. If this cannot be achieved as an outpatient, then a new tube will need to be inserted routinely under local or general anaesthesia.