Korean J Ophthalmol.  2019 Apr;33(2):138-141. 10.3341/kjo.2018.0077.

Outcome of External Dacryocystorhinostomy and Monocanalicular Intubation in Patients with Total Obstruction of One Canalicus

• Buttanri I
• Buttanri B
• Serin D

• KMID: 2442618
• DOI: http://doi.org/10.3341/kjo.2018.0077

Abstract

PURPOSE
We sought to evaluate the outcomes of external dacryocystorhinostomy (DCR) and mono-canalicular intubation in patients with total obstruction of one canalicus.
METHODS
Sixteen eyes of 16 patients with nasolacrimal duct obstruction and a single canaliculus obstruction who had undergone external DCR and monocanalicular intubation of the intact canaliculus were retrospectively included in the present study. The monocanalicular tube (Mini Monoka) was left in place for at least two months. Munk epiphora grading for the evaluation of epiphora and irrigation was performed both preoperatively and at 6 months postoperatively.
RESULTS
Mean patient age was 46 ± 14.2 (range, 18 to 76) years. The inferior canaliculus was obstructed in nine eyes (group A) and the superior canaliculus was obstructed in seven eyes (group B), respectively. Eight eyes had chronic dacryocystitis and two of these eyes also had a history of acute dacryocystitis attack. Mean preoperative Munk scores were 3.89 in group A and 4.0 in group B. Ocular surface irritation occurred in one eye in group A. Artificial eye drops were prescribed and early tube removal was not performed. Spontaneous tube dislocation was recorded in one eye in group B. No other corneal, punctal, or canalicular complications were found. At six months, irrigation of intact canaliculus was patent in all eyes. Mucoid discharge, conjunctival hyperemia, and chronic conjunctivitis were also resolved. Postoperative Munk scores were 1.11 ± 0.9 in group A and 0.86 ± 0.9 in group B. Of note, preoperative and postoperative Munk scores were significantly different in both groups (group A, p = 0.006; group B, p = 0.017). The postoperative Munk scores were not statistically different between the two groups (p = 0.606).
CONCLUSIONS
In patients with nasolacrimal duct obstruction and a total of one canaliculus obstruction, external DCR and monocanalicular intubation of the intact canaliculus is an effective surgical option.

Keyword

Dacryocystorhinostomy; Lacrimal apparatus diseases; Lacrimal duct obstruction

MeSH Terms

Conjunctivitis
Dacryocystitis
Dacryocystorhinostomy*
Dislocations
Eye, Artificial
Humans
Hyperemia
Intubation*
Lacrimal Apparatus Diseases
Lacrimal Duct Obstruction
Nasolacrimal Duct
Retrospective Studies

Reference

1. Tarbet KJ, Custer PL. External dacryocystorhinostomy. Surgical success, patient satisfaction, and economic cost. Ophthalmology. 1995; 102:1065–1070.

2. Buttanri IB, Serin D, Karslioglu S, et al. The outcome of silicone intubation and tube removal in external dacryocystorhinostomy patients with distal canalicular obstruction. Eur J Ophthalmol. 2012; 22:878–881.

3. Munk PL, Lin DT, Morris DC. Epiphora: treatment by means of dacryocystoplasty with balloon dilation of the nasolacrimal drainage apparatus. Radiology. 1990; 177:687–690.

4. Lim C, Martin P, Benger R, et al. Lacrimal canalicular bypass surgery with the Lester Jones tube. Am J Ophthalmol. 2004; 137:101–108.

5. Fein W. Cautery applications to relieve punctal stenosis. Arch Ophthalmol. 1977; 95:145–146.

6. Kaynak P, Karabulut GO, Ozturker C, et al. Comparison of botulinum toxin-A injection in lacrimal gland and conjunctivodacryocystorhinostomy for treatment of epiphora due to proximal lacrimal system obstruction. Eye (Lond). 2016; 30:1056–1062.

7. Lee H, Chi M, Park M, Baek S. Effectiveness of canalicular laceration repair using monocanalicular intubation with Monoka tubes. Acta Ophthalmol. 2009; 87:793–796.

8. Detorakis ET, Mavrikakis I, Ioannakis K, Pallikaris IG. Monocanalicular intubation in external dacryocystorhinostomy. Ophthalmic Plast Reconstr Surg. 2011; 27:439–441.

9. Delaney YM, Khooshabeh R. External dacryocystorhinostomy for the treatment of acquired partial nasolacrimal obstruction in adults. Br J Ophthalmol. 2002; 86:533–535.

10. Yen MT, Pflugfelder SC, Feuer WJ. The effect of punctal occlusion on tear production, tear clearance, and ocular surface sensation in normal subjects. Am J Ophthalmol. 2001; 131:314–323.

11. Simsek I, Yabas Kiziloglu O, Ziylan S. External dacryocystorhinostomy for the treatment of functional nasolacrimal drainage obstruction. Turk J Ophthalmol. 2015; 45:208–212.