|Year : 1957 | Volume
| Issue : 4 | Page : 107-108
Surgical treatment of epiphora
DV Sethi, NS Jain
Dept. of ophthalmology, Irwin Hospital, New Delhi, India
D V Sethi
Dept. of ophthalmology, Irwin Hospital, New Delhi
|How to cite this article:|
Sethi D V, Jain N S. Surgical treatment of epiphora. Indian J Ophthalmol 1957;5:107-8
Since the publication of our paper on Dacryocystorhinostomy in the July 1955 issue of the journal of the All-India Ophthalmological society we have had the opportunity of treating surgically four cases of epiphora where Dacryocystorhinostomy had either failed or was not indicated due to cicatricial closure of the lower or both the canaliculi following a lacerating injury.
Both the cases with damaged canaliculi (Group A) were treated by Stallard's operation and in the other two (Group B) where dacryocystorhinostomy had failed twice in one case and in the other where the sac had been excised, a saphenous vein graft was done. Experiences from these four cases thus treated are discussed in this paper.
| Group A-2 cases|| |
C. R., male aged 40 years developed epiphora after lacerating injury following a dog bite and B. J., female aged 32 years sustained injury from a pen knife
Both these cases were operated tinder local anaesthesia. After the usual incision for dacryocystectomy, the upper half of the lacrimal sac was mobilised from all sides. A stab wound was then made through the lower fornix close to the inner canthus and the fundus of the sac pulled out through this opening. With four interrupted sutures, the sac wall was stitched to the conjunctiva and the upper portion of the sac snipped off, thus establishing a direct communication between the lacrimal and the conjunctival sacs. The stitches were removed on the 4th day. One of these cases has been followed for about six months and the other for about three weeks.
| Group B-2 cases|| |
S. L., male aged 20 years and S. G. male aged 24 years had epiphora for several months. They had their sacs excised somewhere else before they came to us. Dacryocystorhinostomy was tried on the first case twice with no effect, the passage getting closed with fibrous tissue both the times.
Both the cases were finally operated upon by a saphenous vein graft by the following technique: An incision 1" long and i cm: medial to the inner canthus was made in the skin deep down to the bone. In the second case since no dacryocystorhinostomy had been attempted, the making of a bony window and the two flaps from the nasal mucous membrane by the technique described by Jain, Sethi and Prakash was easy. In the first case the bony window was enlarged by nibbling as much as possible anteriorly thus obtaining an adequate portion of the underlying nasal mucous membrane to form an anterior flap. A stab wound was then made through the lower fornix near the inner canthus as in Stallard's operation and a portion of the saphenous vein about ¾ long previously excised and preserved in sterile warm saline was laid in the wound. The wider end was pulled out through the stab wound in the conjunctiva and four interrupted sutures were applied to secure the venous end to the conjunctiva. The narrow end of the vein was then sutured by two stitches each in the anterior and the posterior flaps of the nasal mucous membrane.
Postoperative recovery was normal and uneventful. The passage was probed and syringed at weakly interval for about two months.
| Results|| |
Group A:-Of the two cases treated by Stallard's operation one was a complete failure, showing neither patency on syringing nor relief of epiphora. At the end of three weeks there was a certain amount of fibrosis at the conjunctival opening of the lacrimal sac. The patient was lost sight of thereafter. The second case was followed for about six months and showed a patent passage on syringing and a fair amount of relief of epiphora.
Group B:-Both the cases wherein a venous graft was put in showed patency on syringing after a week and fortnight respectively. Surprisingly enough we found that there was hardly any relief in epiphora during the first few weeks but there was an appreciable relief 3-4 weeks after the operation.
| Comments|| |
1. Both the operations are quite easy to perform.
2. The reason for complete failure of one of the cases treated by Stallard's operation appears to be due to improper handling and suturing which gave rise to fibrous stricture.
3. Both the cases wherein a saphenous vein graft was done remained patent on syringing and showed appreciable relief in epiphora 3-4 weeks after the operation.
On the whole we feel that although the surgical result has been excellent in so far as the patency of the passage is concerned, except in one case, yet the physiological improvement though not perfect is quite encouraging.
| Summary|| |
Four cases of epiphora treated by Stallard's operation and saphenous vein graft are described. The results though based on 4 meagre experience are encouraging.
| References|| |
|1.||Jain, N. S., Sethi, D. V., Om Prakash (1955)-J. All-India Ophth. Soc., 3, 37-44. |