Conjunctivodacryocystorhinostomy with Jones tube

Abstract

One hundred and eight patients (111 eyes) underwent conjunctivodacryocystorhinostomy with a Jones tube for treatment of epiphora resulting from canalicular obstruction. Sixty-nine patients (63.9%) were females and thirty-nine (36.1%) were males. Their ages ranged from 9 to 64 years, the mean age being 30.1 years. The causes of lacrimal drainage abnormalities included idiopathy (76 cases, 68.5%), trauma (15 cases 13.5%), tumors (8 cases, 7.2%) congenital abnormalities (6 cases, 5.4%) and conjunctival inflammation (6 cases, 5.4%). Twenty-eight (36.8%) eyes in the idiopathic group had previous failed dacryocystorhinostomies. The operation was successful in 90.1% of the eyes with relief of epiphora. Fifty-one out of 111 (45.9%) eyes had complications. Extrusion of the tube was the most frequent complication occurring in 20 (18%) eyes. Malposition (12 eyes 10.8%), infection (12 eyes, 10.8%) and obstruction of the tube (7 eyes, 6.3%) were the other major complications. Of the 20 eyes with tube extrusion, 11 experienced recurrent tube losses. Five of 11 eyes were free of epiphora after tube loss. Four out of five had the tube in place for 2 to 5 years and one had the tube, in place for one year. The remaining 6 eyes which had the tubes for 6 months to 3 years were complicated by epiphora. Our experience confirms the general belief that the tube should stay in place forever. The large majority of our patients could wear their tubes successfully and have done so in our practice for as long as 10 years.

Comparison of botulinum toxin-A injection in lacrimal gland and conjunctivodacryocystorhinostomy for treatment of epiphora due to proximal lacrimal system obstruction

“…3,6,17 Lim et al 3 reported that the cause of obstruction was mostly idiopathic and trauma was the most common cause where the etiology was known. Consistent with previous studies, 3,6,[18][19][20] idiopathic obstruction, trauma, and unsuccessful lacrimal surgery were the most common causes of obstruction in our study as well. Lichen planus, congenital agenesis, systemic lupus erythematosus, Stevens-Johnson syndrome, and herpetic infection were the other less common causes.…”

“…2,3,6,[17][18][19][20][21][22][23] Extrusion rate was 50% in this study, which had been reported as 18-51% 2,3,6,18,20 in the literature. To overcome this problem PuttermanGladstone tubes with additional flange, 3,6,21 frosted Jones pyrex tubes with textured outer surface, 2,3,22 and porouspolyethylene-coated tubes 3,23 were introduced to increase the stability in the surgical fistula.…”

The use of Medpor coated tear drainage tube in conjunctivodacryocystorhinostomy

“…Although the pyrex tube is successful in the majority of patients in relieving tearing, the main shortcoming of a Jones tube is extrusion, with extrusion rates reported as high as 18-51%. 2,10,11 Using the Medpor tube as bypass tube, an improvement or complete relief of epiphora was achieved in 23 cases (88.5%), and the tube extrusion or displacement was not seen in this study. It demonstrates that the inner glass core-coated HDPP to the outer surface retains all the benefits of the glass tube and the added advantage of tube stability and retention.…”

Lacrimal drainage obstruction and dacryocystorhinostomy in children

“…10,13 Previous reports of Jones tubes in adults have shown a 45-50% complication rate. 30,34 These included malposition (18.0%), infection (10.8%), and obstruction (6.3%). 30 In a recent study performed by our group, complications occurred eventually in most cases following Jones tube placement in adults such that the tube required replacement, repositioning, or cleaning, with thirty-five percent of the patients reporting tube maintenance to be troublesome.…”

“…30 In a recent study performed by our group, complications occurred eventually in most cases following Jones tube placement in adults such that the tube required replacement, repositioning, or cleaning, with thirty-five percent of the patients reporting tube maintenance to be troublesome. 34 It has been reported that patients who have had radiation therapy to the medial canthal area, or those with a history of medial canthal trauma, and resulting scarring, have a higher rate of Jones tube displacement. Radiation therapy slows or prevents the normal tissue contraction that occurs around the Jones tube, and extensive trauma or scar tissue can cause the tube to be hyper mobile for a prolonged period of time.…”