Novel Surgical Procedure Treats Canalicular Obstruction

A new surgical procedure overcomes the disadvantages of conventional methods to treat epiphora resulting from intractable obstruction of the tear ducts.

The new procedure, developed at Toho University (Tokyo, Japan), is called conjunctivoductivo-dacryocystorhinostomy, and is designed to treat watery eyes (epiphora), which affects the quality of life of those suffering from it. Performed under general anesthesia (GA), the procedure includes exposure and elevation of the entire lacrimal duct and lacrimal sac. The lacrimal duct is then cut at the distal end, and the conjunctiva is incised at the medial canthus. The cut end of the lacrimal duct is withdrawn from the conjunctival incision and sutured to form a new lacrimal punctum.

Subsequently, the medial wall of the lacrimal sac is opened, resulting in the former lacrimal duct and lacrimal sac becoming the new lacrimal passage, allowing tear fluids to flow through the newly made passage. The new procedure can be used to enlarge the canaliculus whenever a Jones tube--a semi-permanent glass tube that connects the nasal cavity and medical canthus--or external surgery are being considered. Both of these options leave a scar of approximately two cm on the side of the nose. The study was published on October 1, 2021 in The Laryngoscope.

“The newly developed procedure, 'conjunctivoductivo-dacryocystorhinostomy' for the intractable canalicular obstruction does not leave any facial scarring or place foreign matter in the body. We believe that this procedure can help improve the quality of life of patients with epiphora,” concluded lead author Munetaka Ushio, MD, PhD, and colleagues of the departments of ophthalmology and otolaryngology.

Under normal conditions, tears in the eyes are drained into the lacrimal sac through the upper and lower puncta, which are located in medial canthus. The tears drain through the superior and inferior canaliculi and onto the lacrimal sac and the nasolacrimal duct, and finally into the nose. When both upper and lower canaliculi are obstructed, tears cannot drain into the nose, resulting in epiphora.

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