title: Retrograde intubation dacryocystorhinostomy for proximal and midcanalicular obstruction.
abstract: OBJECTIVE
  Retrograde intubation of canaliculi during dacryocystorhinostomy can restore canalicular patency in cases otherwise managed with bypass tubes. The surgical technique and success for this procedure are discussed.
  
  
  METHODS
  A retrospective, noncomparative case series with clinic or telephone interview for long-term follow-up of patients' symptoms.
  
  
  METHODS
  One hundred two patients who had undergone this particular lacrimal drainage surgery at Moorfields Eye Hospital between 1992 and 1997.
  
  
  METHODS
  All patients underwent a dacryocystorhinostomy and retrograde canaliculostomy while under general anesthetic.
  
  
  METHODS
  Relief or reduction of epiphora and discharge.
  
  
  RESULTS
  One hundred twenty-three lacrimal systems of 102 patients were included. There were 53 females and 49 males, with ages at surgery ranging from 6 to 83 years (mean, 49 years). The etiology was idiopathic (30%), herpetic canaliculitis (24%), punctal agenesis (18%), and trauma (11%); less-common causes included dacryocystitis, Stevens-Johnson syndrome, eczema, and prior radiation therapy. Both upper and lower canalicular systems were involved in the majority (73%) of patients, and in 13 (11%) systems a dacryocystorhinostomy had previously been performed. The silicone tube was placed for a mean of 2 months (range, 1 week-9 months), and the mean postoperative follow-up was 8 months (range, 2-24 months). Epiphora subjectively improved in 90 (73%) of 123 systems, of which 27 (22%) of 123 were asymptomatic. In 33 systems (27%) in which epiphora persisted, 14 (11%) have undergone closed placement of a Jones canalicular bypass tube with control of symptoms.
  
  
  CONCLUSIONS
  Retrograde canaliculostomy and intubation can spare a significant number of patients the long-term inconvenience of Jones tubes. Failure of this technique does not, however, compromise or complicate the future placement of a bypass tube.
authors.affiliation: Moorfields Eye Hospital, London, England.
authors.forename: M J
authors.initials: MJ
authors.lastname: Wearne
authors.forename: B
authors.initials: B
authors.lastname: Beigi
authors.forename: G
authors.initials: G
authors.lastname: Davis
authors.forename: G E
authors.initials: GE
authors.lastname: Rose
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003608:Dacryocystorhinostomy / Q000379:methods*; D005260:Female; D006801:Humans; D007440:Intubation / Q000379:methods*; D007765:Lacrimal Apparatus / Q000378:metabolism; D007767:Lacrimal Duct Obstruction / Q000209:etiology / Q000378:metabolism / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012826:Silicone Elastomers; D013666:Tears / Q000378:metabolism; D016896:Treatment Outcome
chemical_list: D012826:Silicone Elastomers