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ARTICLES
Year : 1972  |  Volume : 20  |  Issue : 1  |  Page : 16-19

Intubation of nasolacrimal duct with polythene tube


Department of Opthalmology, Medical College, Jabalpur, (M. P.), India

Correspondence Address:
P K Mukherjee
Department of Opthalmology, Medical College, Jabalpur, (M. P.)
India
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Source of Support: None, Conflict of Interest: None


PMID: 4668543

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How to cite this article:
Mukherjee P K, Jain P C. Intubation of nasolacrimal duct with polythene tube. Indian J Ophthalmol 1972;20:16-9

How to cite this URL:
Mukherjee P K, Jain P C. Intubation of nasolacrimal duct with polythene tube. Indian J Ophthalmol [serial online] 1972 [cited 2019 Aug 21];20:16-9. Available from: http://www.ijo.in/text.asp?1972/20/1/16/34679

Table 1

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Table 1

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Numerous methods of surgical reconstruction of lacrimal passage are but proof of absence of one universally accepted method to treat chronic dacryocystitis surgi­cally.

With improved surgical techni­ques and advances in instruments, dacryocystorhinostomy has be­come the most successful opera­tion for chronic dacryocystitis, capable of achieving over 90% of successes in competent hands. Inadequate instruments, improper selection of cases and poor surgi­cal skill compels the surgeon to fall back upon dacryocystectomy leaving the patient with annoying and persistent epiphora.

The procedure which is less mutilating than removal of sac is probing. [3],[5] Mehra [6] used probing in adults after dacryocystostomy with good results in six out of ten cases. Intubation of the nasolacri­mal duct with a suitable tube seems to be better than dacryocy­stostomy with probing especially when surgical trauma is not grea­ter in the former. Intubation with polythene tube has the added ad­vantage over dacyocystostomy that in case of failure its removal fol­lowed by one of the modifications of dacryocystorhinostomy can be applied.

The idea of keeping the nasola­crimal duct patent with a tube is not new. From time to time vari­ous metalic, plastic and acrylic tubes have been used without uni­form satisfactory result.

In recent years the procedure was revived by Valantin-­Gomazo [3] who used polythene tube in 15 cases with but one fail­ure. Dejean [8] achieved uniformly good result by using a tube 2.5 mm. in diameter and 15 mm. in length. Results of Legranda [8] were not so encouraging as those of the former two. He had poor results in 5 out of 16 cases. Vicencio [9] reported 100% failure in intubation. Beard appreciated the usefulness of intubation in certain instances but was not convinced that it was an answer to nasolacrimal duct block. At the same time he ex­pressed the hope that improve­ment in technique and more care­ful selection of cases may result in better and long lasting results. He advocated the method of Reese for intubation.

Satisfactory results with pro­bing [3],[5],[6] and success with intuba­tion [2],[4],[8] led the authors to try intu­bation in chronic dacryocystitis. In the begining this was limited to cases where dacryocystectomy was planned, but was later used as a routine in all cases of chronic da­cryocystitis because the initial re­sults were unexpectedly good.

The procedure was tried in 33 patients, 25 adults and 8 children amounting to 44 sacs, all cases of acquired chronic dacryocystitis. In all the cases, block of the nasola­crimal ducts was diagnosed by epiphora and regurgitation on pres­sure over the sac. It was confirmed by syringing. The cases with acute dacryocystitis, block in lower cana­liculus and with nasal pathology were not included.

The polythene tube used was 15 mm. long with 2.5 mm. dia­meter. It was sterilised by boiling in water for twenty minutes.

Adults were operated under lo­cal infiltration anaesthesia. Child­ren were operated under general anaesthesia.


  Operative Technique Top


The sac is exposed by the usual method of dacryocystostomy. A vertical incision 3 mm. long is given on the anterior sac wall. Through this the nasolacrimal duct is dilated passing Bowman's probes beginning with no. 1 and gradually increasing to no. 6. [Figure - 1].

One end of the sterilised poly­thene tube is dilated by passing a Nettleship punctum dilator for about 5 mm. The dilated end prevents the tube from slipping into the nose when passed through the nasolacrimal duct. The tube is mounted on no. 6 probe and the probe is passed in the already dila­ted nasolacrimal duct with the tube covering it like a sleeve

Once the whole of the tube is inside the duct, the probe is pul­led out gradually leaving the tube in place. Additional anchorage to the tube is given by passing a 00000 chromic catgut suture through the lateral wall of the tube and then attaching this to the lower part of the sac wall.

The sac wall is then closed by interrupted chromic cat gut sutu­res. The skin is sutured with a continuous suture with cotton thread. [Figure - 3] .

The skin suture is removed on the sixth postoperative day. The first postoperative syringing is done on the tenth postoperative day. The syringing is repeated every 15 days for 3 months. Ab­sence of epiphora and regurgitation of fluid on pressure, and free flow of fluid by syringing for 3 months is considered a cure. Patient is advised to report if there is epi­phora, any time after 3 months.


  Observations Top


Out of 33 patients, 11 had bila­teral involvement. In these patients both nasolacrimal ducts were in­tubated. In 22 patients there was unilateral intubation. Thus a to­tal of 44 sacs were intubated.


  Complications Top


In 37 cases the duct was patent from the first postoperative syring­ing and remained patent through­out the follow-up period. The two complications met with in the series were slipping of the tube in the nose in 3 cases i.e. 6.8% and postoperative inflammation of the sac wall and the pericystic tissue in 4 cases i.e. 9%.

In the 3 cases of "slipped tubes", in 1 case, the sac remained patent in spite of the mishap, in 1 case patency was maintained by repea­ted syringing, whereas in the third case the block could not be re­moved.

In the four cases that developed pericystitis, when treated with broad spectrum antibidics, in two the block was removed partially, whereas in the other two, the block could not be removed.

From [Table - 1] it is seen that in 86"0 of cases the duct was patent from the first postoperative syringing and has remained patent since then and these cases have been labelled as cured. Though in 7% of cases there was symptoma­tic relief i.e. no epiphora or re­gurgitation, they had partial block on syringing. They have not been included in the list of cured as obstruction may occur later on. They have been labelled as partial­ly successful. In the remaining 7% of cases the duct was blocked com­pletely and were labelled as fail­ures.


  Conclusion Top


From the above observations it is concluded that intubation of the nasolacrimal duct with 2.5 mm dia­meter of polythene tube restores normal flow of lacrimal fluid in 86% of cases. This percentage of success is less than that in dacry­ocystorhinostomy which is as high as 90-95%. Keeping in mind that tubation of nasolacrimal duct does not require any special instrument, is done in a short time of 10-15 minutes without much skilled te­chnique and can be done with ease even by a beginner also, it is ad­vocated to be tried in those cases where dacryocystectomy is other­wise planned or where there is no facility to do dacryocystorhino­stomy.


  Summary Top


Literature on the subject has been reviewed and a method of intubation of nasolacrimal duct has been described. There were only two complications in the series i.e. slipping of the tube and postoperative inflammation. Suc­cess has been achieved in 86% cases, in 7% complete failure and in 7% partial success in 44 lacri­mal sacs of 33 patients.

 
  References Top

1.
Beard C.: Annual review - Lids, Lacrimal apparatus and Conjuctiva. A.M.A. Arch. Ophthal. (Chicago) 57. 119-120 (1957).  Back to cited text no. 1
    
2.
Dejcan C. : Causes of Failure in Lacri­mal Intubation. Arch. Ophthal. 15, 474-478 (1955).  Back to cited text no. 2
    
3.
Dayal Y. : Corticosteroid and Enzyme Therapy in Treatment of Epiphora. J. All-India Ophthal. Soc. 10, 61-63 (1962).  Back to cited text no. 3
    
4.
LeGrand : Quoted by Beard C. Annual Review - Lids, Lacrimal Apparatus and Conjunctiva. A.M.A. Arch. Ophthal. (Chicago) 57, 119-120 (1957).  Back to cited text no. 4
    
5.
Mehra K.: Role of Visine in Treat­ment of Epiphora. Amer. J. Opthal. 59, 498-499 (1965).  Back to cited text no. 5
    
6.
Mehra K.: Dacryocystostomy Probing. J. All-India Ophthal. Soc. 15, 98-99 (1967).  Back to cited text no. 6
    
7.
Reese G : Method of Anchoring Poly­thene Tube and Reestablishing Tear Drainage. Amer. J. Ophthal. 41, 1063­1066 (1956).  Back to cited text no. 7
    
8.
Valantin-Gomazo I. : Quoted by Beard C. Annual Review - Lids, Lacrimal Apparatus and Conjunctiva. A.M.A. Arch. Ophthal. (Chicago) 57, 119-120 (1957).  Back to cited text no. 8
    
9.
Vicencio A. B. : Use of Nylon Thread and Polythene Tubing in Nasolacrimal Duct Stenosis - Report of 16 Cases. A.M.A. Arch. Ophthal. (Chicago) 55, 267-268 (1956).  Back to cited text no. 9
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]
 
 
    Tables

  [Table - 1]



 

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  In this article
Operative Technique
Observations
Complications
Conclusion
Summary
References
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