|Year : 1970 | Volume
| Issue : 4 | Page : 170-172
Conjunctivo - rhinostomy
LK Trivedi, R Rohatgi
L K Trivedi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Trivedi L K, Rohatgi R. Conjunctivo - rhinostomy. Indian J Ophthalmol 1970;18:170-2
When both the canaliculi and naso lacrimal duct are so obstructed that drainage is not possible and also when lachrimal sac is either absent or destroyed or has become extensively enmeshed in dense fibrous tissue, it is necessary to attempt a communication between the conjunctiva at the lacus lacrimalis and the nasal mucosa.
This is an established procedure practised by many surgeons, but the results described so far are disappointing (Stallard). Cases of this type are found in those in whom no other plastic procedure is possible to make a patient symptom-free. A simplified method of conjunctivo-rhinostomy has been tried in cases, and its results assessed.
1. Dacryocystitis with sinus : Chronic cases of long duration, in which canaliculi are blocked and hardly a trace of lachrimal sac is available.
2. Lachrimal abscess : Cases of lachrimal abscess in whom abscess has been drained.
3. Injury of the face : Fractures of middle-third of the face in which laclirimal passage is involved.
| Material & Method|| |
The cases selected were, in whom on probing, the canaliculi seem to be blocked with long standing lachrimal sinus. The other set of cases were in whom acute lachrimal abscess had been drained in the hospital. These cases were admitted for operation when inflammation subsided.
Anaesthesia : The operation can be performed either under general or local anaesthesia, depending upon the age of the patient.
The usual preoperative measures and medications are given.
Incision, Exposure, and Removal of Sac and Bone:
The steps are the same as in dacryocystorhinostomy operation. The remnant of sac with the sinus is excised.
A stab incision is then made with a Barde-Parker knife through the lacus lacrimalis downward and medially, the point of the knife being aimed at the centre of the nasal mucosa. The knife is withdrawn and the points of a closed blunt-pointed scissor are introduced in this incision. These are then spread in the vertical and horizontal planes. The maximum separation is about to mm.
A rubber tube with an inner diameter of 3 mm and an outer one of 5 mm and 20 cm long with one end bevelled is passed through the conjunctiva) stab incision and then through the nasal mucosal opening into the nostril and taken out. The other end is anchored with the conjunctiva in the lacus lacrimalis with 3-4 sutures. The anterior flaps of conjunctiva and nasal mucosa are sutured by chromic catgut, allround this tube except on the posterior surface and thus a tunnel is formed. The tunnel is covered by spongoston. The medial palbebral ligament is replaced in position, the orbicularis and skin incision is closed as usual. The nasal end of the tube is stitched at the ala of the nose, and the tail end is fixed by an adhesive tape on the forehead.
The first dressing is done on the 4th day and then on alternate days. The stitches are removed on the 8-loth day. The tube is removed after 3 weeks. Streptopenicillin ½ gm is given once daily for 7 days. The patient is discharged with "visin" eye drops thrice a day in eye and nose.
| Discussion|| |
Conjunctivo-rhinostomy operation is an established procedure, but the results obtained by others have been disappointing. The reason may be improper technique, closing down of the passage by clot and discharge by fibrosis of the formed channel.
Stallard  described two methods of forming the channel joining the conjunctiva and nasal mucosa, one by venous graft and the other by buccal mucous membrane. The technique of the operation is not simple and results are not encouraging.
The type of cases selected in this series were unfavourable for any plastic procedure, the technique is simple, takes about 45 mts, but the results are encouraging. As many as 66% got relieved from symptoms of ephiphora in such cases where excision of sac was the only alternative.
Rubber tubing of a slightly bigger diameter has been taken, so that after removing it, even if some fibrosis results, the lumen of the channel may be reduced but not blocked. This is left in situ for about two weeks, so that granulation formation around the channel is complete.
The advantage of this operation is even if the purpose of conjunctivorhinostomy is defeated, no harm to the patient has been done as the excision of the sac is part of operation. The main cause of the failure seems to be local infection. This can be avoided and better results can be obtained if the operation is done after doing bacterial culture and sensitivity tests, putting antibiotic powder locally and putting the patient under cover of antibiotic in the post operative period.
| Summary|| |
A simplified method of conjunctivo-rhinostomy is described in detail with its indications. Its results are discussed in relation to symptoms and compared with other techniques. The possibilities of failure are reviewed.
| References|| |
Srallard. H. B.: Eye Surgery. ed. 4. PP. 334-336.
[Table - 1], [Table - 2]