The Surgical Outcome of two Different Tear Drainage Tube in the Proximal Obstruction of Lacrimal System

Abstract

Volume 3 | Issue 2 is traditionally treated by a lacrimal bypass surgery named conjunctivodacryocystorhinostomy (CDCR). Other indications for this surgery are lacrimal pump failure associated with facial palsy and epiphora despite a patent dacriocystorinostomy (DCR) [1].In the management of proximal obstruction of the lacrimal drainage system, performing a new drainage system between the conjunctiva and the nasal cavity with the insertion of a tear drainage tube, is an accepted treatment technique [2][3][4][5]. It was first described by Von Hoffman in 1904, and later by Kraupa and Goar [2]. Lester Jones in 1962, described various procedures for the management of proximal obstruction and noted a high rate of closure of the fistula in cases of CDCR with anastomosis of the lacrimal sac to the conjunctiva and nasal mucosa [2]. To overcome this problem, he tried different stents before developing a Pyrex glass tube [2]. Thin Pyrex tubes provided excellent capillary attraction, low irritation to surrounding tissues, and a low risk of blockage; but as complication rates were still unacceptably high for some surgeons, new materials and techniques were developed [2]. Although these developments, in patients with CDCR, the most common complications associated with tear drainage tube, are tube extrusion, malposition, obstruction, and diplopia [3].The purpose of this study is to evaluate and compare the efficiency of CDCR surgery with the use of tear drainage tubes with different material, such as silicone and Medpor coated. Materials and Methods13 eyes of 13 patients; who underwent CDCR surgery with a tear drainage tube placement between September 2009 and November 2014 years were included in this retrospective study. The study was conducted in accordance with the ethical standards stated in the 1964 Declaration of Helsinki. The study was approved by the Local Ethics Committee of the participating center. All patients were informed about the purpose of the study and provided their consent.The patients had grade 4 symptomatic epiphora according to Munk scale. The mean duration of symptom was 10.07 ± 1.7 months. All patients underwent preoperative lacrimal irrigation for detecting the patency of the lacrimal system. Functional obstruction secondary to external DCR surgery was seen in 8 of 13 (61.5%) eyes, traumatic upper lacrimal system damaged was seen in 4 of 13 (30.8%) eyes, and punctal atrezia was seen in 1 of 13 (7.7%) eyes. Patients with evidence