|Year : 1981 | Volume
| Issue : 3 | Page : 239-241
Daljit Singh, Narinder Singh, Arun Verma
Department of Ophthalmology, Medical College, Amritsar, India
Department of Ophthalmology, Medical College, Amritsar
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh D, Singh N, Verma A. Conjunctivo-vestibular anastomosis. Indian J Ophthalmol 1981;29:239-41
Persistent and troublesome epiphora occurs in conditions : like after dacryocystectomy, damage to the lacrimal passages, beyond surgical repair, and congenital absence of the punctum and the canaliculus. The methods currently advocated for intractable epiphora are :
1. Partial dacryo-adenectomy, 2. Injection of alcohol into the lacrimal gland, (3) Cutting the nerve supply to the lacrimal gland, 4. Conjunctivodacryo-cystostomy, 5. Conjunctivorhinostomy.
The first three methods giving attention to the lacrimal gland are likely to cause paucity of the tears, with consequent adverse effects on the integrity of the eye. The two anastomosing procedures are not easy to perform and the results are not predictable.
A simple procedure of connecting the lower fornix of the conjunctiva with the vestibule of the mouth, at the site of reflection of the upper lip has been designed to overcome annoying epiphora [Figure - 1]
| Case reports|| |
R.K., 30 yrs. old female had undergone dacryocystectomy operation on the left side 5 years earlier and had been suffering from severe epiphora ever since.
Under general anaesthesia, the communication between the lower conjunctival fornix and the vestibule of the mouth was established with the help of a suitable length of a leg vein. The length of the vein used was approximately one cm. longer than the distance between the conjunctival sac and vestibule of the mouth. The patient was operated upon in the year 1973 and was followed for over four years, during which period she remained symptom free.
B.K, 45 years old, had been suffering from severs epiphora in the right eye for nearly 10 years, during which period repeated probing had been unsuccessfully tried by a number of ophthalmic surgeons.
We also tried syringing and probing. It was found that the lower canaliculus as well as the nasolacrimal duct had been severely scarred and appeared beyond repair.
Conjunctivo-vestibular anastomosis in this patient was performed as follows:
The surgery was done under local anaesthesia. The upper lip was everted. A point was marked in the vestibule directly below the medial third of the lower lid. The distance between this point and the lower fornix was approximately measured. A mucous membrane strip, 5 mm wide and about 1½ cm. in excess of the required length was dissected from under the upper lip. The dissection was started at the marked point and went laterally. The lateral end of the strip was cut free. The mucous membrane of the lip was rapaired by interuppted stitches.
With the help of a blunt scissors, a track was made vertically between the lower fornix and the vestibule. The free end of the dissected mucous membrane strip was passed through the track and the end brought out of the lower fornix. The free end of the strip was stitched to the conjunctiva away from the opening in the fornix.
The mucous membrane strip adhered to the opening in the fornix while the excess distal part was shed off in about 10 days. The track containing the mucous membrane strip remained tender for about 5-6 days. An antibiotic cover was given during this period.
The patient who was operated upon in October 1976 has remained under observation ever since and is completely free from epiphora. Saccharine solution put in the conjunctival sac arrives in the mouth in less than 30 seconds.
A probe in [Figure - 2] shows the position of the upper opening. The probe has not been pushed further for fear of damaging the drainage passage.
In [Figure - 3] the upper lip has been retracted to expose the opening in the vestibule.
| Discussion|| |
The long range study of two operated cases has proved entirely satisfactory. Conjunctivovestibular anastomosis may therefore, be considered as yet another technique, in the armamentarium of the ophthalmic surgeon, when dealing with cases of intractable epiphora. The new technique is probably the simplest out of all the methods currently available for the purpose. The use of mucous membrane under the lip for effecting a channel formation appears to us easier and more. promising out of the two different methods used in the two cases described.
With conjunctivo-vestibular anastomosis, the conjunctival sac is connected to the cleanest part of the mouth. The drainage of the tears occurs by gravity and also possibly by capillary attraction.
[Figure - 1], [Figure - 2], [Figure - 3]