title: Refractory medial conjunctival inflammation associated with jones tubes.
abstract: OBJECTIVE
  To report an uncommon complication of refractory medial conjunctival inflammation associated with Jones tubes in 2 patients.
  
  
  METHODS
  " Complete ophthalmic and nasal examinations were performed on 2 patients in whom medial conjunctival injection developed after conjunctivodacryocystorhinostomy (cDCR) with Jones tube placement that persisted despite aggressive medical treatment.
  
  
  RESULTS
  The medial conjunctival inflammation, which resembled episcleritis, persisted despite removal of the Jones tube in the first patient. The other patient had a "pterygium-like" lesion and ultimately underwent excision of the medial granulation tissue with amniotic membrane graft and exchange of the Jones tube. Histopathologic examination revealed conjunctival tissue with inflammation and fibrosis.
  
  
  CONCLUSIONS
  Medial conjunctival inflammation is an uncommon complication of cDCR with Jones tubes. Based on our experience and a thorough review of the literature, medial conjunctival injection and thickening usually resolves once Jones tubes are removed. There have been no previous reports indicating the persistence of medial conjunctival inflammation after Jones tube removal, as was the case in our first patient. These cases suggest that some chronic effect initiated by the Jones tubes and/or surgical manipulation may induce inflammation and scarring of the medial conjunctiva. Multiple surgeries may also predispose to this inflammatory response.
authors.affiliation: Department of Opthalmology, Albany Medical Center, Allbany, New York, USA.
authors.forename: Ari D
authors.initials: AD
authors.lastname: Abel
authors.forename: Dale R
authors.initials: DR
authors.lastname: Meyer
mesh_terms: D000328:Adult; D000368:Aged; D003228:Conjunctiva / Q000473:pathology; D003231:Conjunctivitis / Q000209:etiology* / Q000601:surgery; D003608:Dacryocystorhinostomy / Q000009:adverse effects*; D020878:Device Removal; D005260:Female; D005355:Fibrosis; D006099:Granuloma / Q000209:etiology / Q000601:surgery; D006801:Humans; D007440:Intubation / Q000009:adverse effects*; D007766:Lacrimal Apparatus Diseases / Q000601:surgery*; D008297:Male; D015423:Scleritis / Q000209:etiology