|Year : 1975 | Volume
| Issue : 3 | Page : 30-32
Canaliculus repair by a simplified method
AS Mehrotra, Suresh T Rai
S.N. Medical College, Jodhpur-342001, India
A S Mehrotra
Department of Ophthalmology, S.N. Medical College, Jodhpur
|How to cite this article:|
Mehrotra A S, Rai ST. Canaliculus repair by a simplified method. Indian J Ophthalmol 1975;23:30-2
Canaliculus cut is not uncommon in face injuries involving lid. Lower canaliculus is more frequently injured as compared to upper one. Restoration and maintenance of canaliculus function is dependent upon accurate end to end anastomosis of the severed channel. Failure of perfect coaptation of the divided ends and contracture of fibrous tissue around the site of injury causes occlusion of duct  .
Most of the surgeons agree that some type of non-irritating device should be left in the channel until healing is complete  . A number of materials are used for this purpose, viz. heavy suture materials and small metallic rods  , metallic wire  , hollow probe  , spiral probe, , etc.
In present series, use of hollow polyethylene tube of 1-2 mm. diameter has been advocated in repair of severed canaliculus. It has been found to be very convenient and with good advantages as discussed below.
| Material and Methods|| |
Canaliculus repair of 14 cases was done by this method in two years time. All cases, except one, were admitted in the hospital indoor wards. These cases had lacerated injury of lid/lids, medial to puncta and no other associated injury of eye or face.
A brief history of the case was taken about the mode of injury, time duration etc. and the case was taken for operation at the earliest. The cases were operated under local or general anaesthesia depending upon age and the cooperation of the patient.
The cut ends of the canalictlus were searched and a hollow polyethylene tube of 1-2 mm diameter was passed through puncta and lateral end of cut canaliculus to sac. It's position in the sac was confirmed by pushing 0.5 to I ml. of normal saline through the lateral free end of the tube. Stiching of the cut ends was done 1 yer by layer. Muscle was stitched by 4(o) chromic catgut and lid margin and conjunctiva by 6(o) silk with atraumatic needle. Care was taken for exact approximation of cut lid margins. 3-4 stitches were applied on lid margins to ensure better healing and good approximation.
After stitching was complete, about 2.0 cm of polyethylenc tube was left outside the puncta and the free end was fixed, to skin of cheek or lid, by a stay suture [Figure - 1]. Veseline gauge was applied over it and bandage was done. First dressing and syringing was done after 48 hours. The syringing was done through the hollow tube to confirm its position in sac. Sutures were removed on 7th or 8th day as soon as it was felt that the wound is well healed. Tube was removed after 2 weeks. Subsquent probing was done at an interval of one week. A follow up of 4-6 months was done in 10 cases. Observations are recorded in [Table - 1],[Table - 2].
A follow up of 4-6 months was possible in ten cases. In one case only there was gaping of wound for which resuturing was done, but still exact approximation could not be achieved and finally there was notching and closure of canaliculas. In all other cases recovery was uneventful and passage remained patent,
In two cases there was bead of pus at the place where the outer end of polyethylene tube was fixed to skin and lower lid. The skin stitches were removed and free end of tube was fixed to skin by adhesive plaster till it was removed after two weeks.
| Discussions|| |
Repair of canalicular tear remains an unrewarding experience for both doctor and patient. The one possible hopeful fact which has emerged from this mass of discouraging literature is that the best, perhaps the only, chance for restoration of canalicular integrity lies in early repair  , and leaving some non irritating devise  in the channel. If surgery is delayed there is oedema of tissue and chances of exact approximation of margins are less, thereby increasing the percentage of failure.
In the present series these factors were fully kept in mind. The patient was taken for operation at an earliest possible opportunity. This helped in finding the canaliculus ends due to less tissue reaction. In case where patient reached hospital after 10 to 12 hours of injury there was difficulty in finding the cut ends of canaliculus as well as suturing it. The failure to get good result in one case was due to the delay in reaching the hospital.
Hollow polyethylene tube was preferred in all these cases due to the fact that it is an inert as well as flexible material, so that there is ease in keeping it in the canaliculus and is easier in passing and tying external ends, as compared to metallic wires etc. Secondly, we can always be sure about its position by pushing the saline through it in the sac, which comes to nose and pharynx, if the tube is in right passage.
| Summary|| |
Experiences of repair of lower canaliculus by putting a hollow polyethylene tube are given. Stress is laid on early operation which gives best results. Putting a hollow tube confirms its correct position in the canaliculus by syringing.
| References|| |
|1.||Aichman, H. 1967, Klin. Mbl. Augen. 150, 298. |
|2.||Byron Smith, Chrubini, T.D., 1970, Oculoplastic Surgery, P. 12, C. V. Mosby & Co. St. Louis. |
|3.||Fox, Sidney A., 1972, Lid Surgery, P, 154, Newyork, Grune & Shatton. |
|4.||Jain M.R. and Makhija J., 1970, Orient. Arch. Ophth., 8, 254. |
|5.||Korchmaros, 1967, Acta Ophth., 45, 209. |
|6.||Rodenhanser J.H., 1967, Quoted by Excerpta Ophth. 8, 608. |
|7.||Stallard H.B., 1965, Eye Surgery, P. 294. John Wright & Sons, London. |
[Figure - 1]
[Table - 1], [Table - 2]