Figure 1: (a) A 2-cm long sleeve was prepared by cutting a polyvinyl chloride cutdown tube (2.5 mm in diameter, CoX600, KMS, Korea), and 4-0 black silk was passed through the distal end of the sleeve. (b) The two strands of the bicanalicular silicone tube were passed through the sleeve on each side of the black silk, and the black silk was tied. (c) The sleeve was pushed into the fundus of the lacrimal sac, surrounded by thick maxillary bone. (d) The two strands of the bicanalicular silicone tube were tied to each other at the distal end of the sleeve