|Year : 1970 | Volume
| Issue : 4 | Page : 173-175
Canaliculo-dacryocysto-rhinostomy- A simple technique
Dept. of Ophthalmology, King George Medical College, Lucknow, India
R C Saxena
Dept. of Ophthalmology, King George Medical College, Lucknow
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Saxena R C. Canaliculo-dacryocysto-rhinostomy- A simple technique. Indian J Ophthalmol 1970;18:173-5
Canalicular block in lacrimal passages always poses a difficult problem to the Ophthalmologists. JONES in 1960 has discussed his technique of canaliculodacryocystorhinostomy to treat cases of obstruction in the common lacrimal canaliculus. He dissected out the common canaliculus, removed the obstruction and anastomosed it to the lateral wall of the sac. This operation. though quite time consuming, carried high incidence of success in his hands.
In our hispital, the cases of chronic dacryocystitis with canalicular block, specially of lower ones, were treated by Dacryocystectomy in the past. Recently I have come across a case having bilateral chronic dacryocystitis with lower canalicular block on one side. This case on the side of canalicular block has been operated for "Canaliculo-dacryocystorhinostomy" by much quicker and simpler technique.
The purpose of this paper is to demonstrate the operative technique used in this patient along with its results.
| Case Report|| |
Patient `S', a female, aged 12 years, was admitted to the Ophthalmic Section of G. M. & Associated Hospitals, Lucknow, on 2nd March, 1969 as a case of one year old bilateral chronic dacryocystitis which she got after small-pox. On pressure moderate amount of mucopurulent regurgitation could be seen through both puncta in the right eye and only through upper punctum in the left eye. On flushing through the right lower punctum, the fluid with mucopurulent discharge regurgitated from the upper punctum. Fluid could not be pushed through the lower canaliculus of left eye although a lacrimal needle passed easily upto a distance of 5 mm. Fluid, however, could be pushed through the upper canaliculus but the fluid with mucopurulent discharge regurgitated from the same punctum.
Paranasal sinuses and nose were normal. Plane skiagram of orbit did not show any abnormality of the lacrimal bone. Dacryocystography, with 50% Diaginol injected through lower punctum in right eye and upper punctum in left eye showed clear blockage of the neck of the sac in both eyes. Left lower canaliculus was not visualised.
The patient, under general anaesthesia was operated on her right eye for dacryocystorhinostomy by classical description of Dupuy-Dutemps and Bourgeut.
Her left eye, again under general anaesthesia, was operated after ten days. The left eye had a block at the neck of sac and in the distal part of lower canaliculus. Hence Dacryocystorhinostomy was decided upon. Two flaps each from sac and nasal mucosa were dissected out. Posterior flaps were stitched by catgut. Now a lacrimal probe was passed through the lower canaliculus and inner aspect of the lateral wall of sac was well exposed after reflecting its anterior flap. The opening of the common canaliculus was determined. Then the lacrimal probe was pushed further to cause indentation on inner aspect of lateral wall of the sac. This indentation was manipulated to occupy the centre of the hole of the common canaliculus. Now a small incision with the tip of Grace's Knife was made on the central part of the indentation. Immediately the tip of the probe appeared which could be pushed easily in front of the stitched posterior flaps, with slight pressure. Now thicker lacrimal probes were passed to dilate the opening further. After this a doubled nylon thread was prepared by keeping two free ends on one side and joined with the rounded end on the other side. This rounded end was crushed with artery forceps. The crushed end was then passed through the lower canaliculus which emerged easily in front of posterior flaps. A tenotomy hook was passed through the left nostril and the nylon thread was hooked and pulled out through the bony opening made in nasal wall. Now the anterior flaps of the sac and nasal mucosa were stitched and the wound was closed. The two ends of doubled nylon thread were tied together [Figure - 1] .
The patient was given tetracyclin orally for 5 days. The dressings with G. Penicillin 10,000 units/cc., ung. Terramycin and mercurochrome in aqua were done on alternate days for seven days. On each dressing the nylon thread was rotated. The skin stitches were removed on 7th day and nylon thread was taken out after 6 weeks. After this syringing with penicillin lotion was done twice a day for one week and then weekly for another three weeks. After this period this patient was discharged with patent left lower canaliculus and dry eyes.
| Discussion|| |
After treating many clinical conditions of sac inflammation by anastomotic surgery (SAXENA AND GARG - 1969) in past four years I am left with few cases which show obstruction in the canaliculi with or without obstruction at the neck of sac. The proce dune of dacryocystectomy in present era of anastomotic surgery is unjustifiable. The efforts of Barrie R., Jones in 196o in solving the problems of common canalicular block are quite encouraging. His technique. however, consumes far too much of time and shortens the length of the canaliculus. The case which I have dealt herewith had a thin obstruction at the end of lower canaliculus which could easily be indented by a lacrimal probe and severed by Graefe's knife. The opening thus created was maintained by keeping a doubled nylon thread for six weeks and later by frequent syringings. It was easy to pass the doubled nylon thread through the nose with the help of tenotomy hook.
This procedure being very simple does not need much skill. It takes less time, and avoids shortening or kinking of canaliculi. The nylon thread used here could also be replaced by a polythene tubing. This method, however, carries its own limitations. In my opinion only a thin block at the distal end of canaliculi or common canaliculus can be well treated by this method. Encysted mucoceles should also find a favourable place in this technique.
| Conclusion|| |
A case of chronic dacryocystitis in both eyes after small-pox with left lower canalicular block has been demonstrated. A simple technique of canaliculo-dacryocystorhinostomy with its possible indications has been discussed.
| References|| |
Jones, B. R. - Trans. Ophthal. Soc. U.K., 80, 343-356 (1960).
Dupuv-Dutemps and Bourgeut - An d'oc., Clviii, 241 (1921).
Saxena, R. C. and Gar-, K. C. All India Ophth. Soc., 17, 55-58 (1969)
[Figure - 1]