|Year : 1972 | Volume
| Issue : 1 | Page : 16-19
Intubation of nasolacrimal duct with polythene tube
PK Mukherjee, PC Jain
Department of Opthalmology, Medical College, Jabalpur, (M. P.), India
P K Mukherjee
Department of Opthalmology, Medical College, Jabalpur, (M. P.)
Source of Support: None, Conflict of Interest: None
|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
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. , Mehra  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  who used polythene tube in 15 cases with but one failure. Dejean  achieved uniformly good result by using a tube 2.5 mm. in diameter and 15 mm. in length. Results of Legranda  were not so encouraging as those of the former two. He had poor results in 5 out of 16 cases. Vicencio  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 ,, and success with intubation ,, 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|| |
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|| |
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|| |
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|| |
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|| |
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|| |
Beard C.: Annual review - Lids, Lacrimal apparatus and Conjuctiva. A.M.A. Arch. Ophthal. (Chicago) 57. 119-120 (1957).
Dejcan C. : Causes of Failure in Lacrimal Intubation. Arch. Ophthal. 15, 474-478 (1955).
Dayal Y. : Corticosteroid and Enzyme Therapy in Treatment of Epiphora. J. All-India Ophthal. Soc. 10, 61-63 (1962).
LeGrand : Quoted by Beard C. Annual Review - Lids, Lacrimal Apparatus and Conjunctiva. A.M.A. Arch. Ophthal. (Chicago) 57, 119-120 (1957).
Mehra K.: Role of Visine in Treatment of Epiphora. Amer. J. Opthal. 59, 498-499 (1965).
Mehra K.: Dacryocystostomy Probing. J. All-India Ophthal. Soc. 15, 98-99 (1967).
Reese G : Method of Anchoring Polythene Tube and Reestablishing Tear Drainage. Amer. J. Ophthal. 41, 10631066 (1956).
Valantin-Gomazo I. : Quoted by Beard C. Annual Review - Lids, Lacrimal Apparatus and Conjunctiva. A.M.A. Arch. Ophthal. (Chicago) 57, 119-120 (1957).
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).
[Figure - 1], [Figure - 2], [Figure - 3]
[Table - 1]