title: Silicone intubation with trans-sac fixation to prevent tube dislocation.
abstract: OBJECTIVE
  To report a new technique for silicone tube fixation, after successful intubation for congenital nasolacrimal duct obstruction, to minimize its lateral dislocation.
  
  
  METHODS
  Thirty patients (40 eyes) aged 20 months to 5 years (median, 28 months) were treated using the Ritleng bicanalicular lacrimal intubation system. After drawing the silicone stent out of the nose, a piece of 7-O Prolene suture was tied securely around one of its limbs. This limb was then pulled up, pulling the tied end of the Prolene suture to the medial canthal area. The same procedure was repeated with the other limb of the stent, pulling up the other Prolene suture end. This suture end was then un-tied. After adjusting the exposed silicone loop, the free end of the Prolene suture was tied securely to the corresponding part of the silicon stent. The nasally drawn two ends of silicone tube were tied in a single square knot. After 2 to 3 months, stents were removed in the medical office for all the patients.
  
  
  RESULTS
  This technique was used successfully for all the patients. Of the 40 tubes in this study, 39 did not displace and one tube was displaced laterally due to loosely tied Prolene suture. On follow-up, the trans-sac suture was well tolerated and no complications were noted.
  
  
  CONCLUSIONS
  The trans-sac fixation suture prevents lateral displacement of square-knotted silicone tube, which still can be removed easily at the physician's office.
authors.affiliation: Department of Pediatric Ophthalmology, Magraby Eye Center, Madina Munwara, Saudia Arabia. oshakim@hotmail.com
authors.forename: Ossama M
authors.initials: OM
authors.lastname: Hakim
authors.forename: Yasser Gaber
authors.initials: YG
authors.lastname: El-Hag
mesh_terms: D002675:Child, Preschool; D005260:Female; D005548:Foreign-Body Migration / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D007440:Intubation / Q000379:methods*; D007767:Lacrimal Duct Obstruction / Q000151:congenital / Q000628:therapy*; D008297:Male; D009301:Nasolacrimal Duct; D011126:Polypropylenes; D012826:Silicone Elastomers; D013536:Suture Techniques; D013537:Sutures
chemical_list: D011126:Polypropylenes; D012826:Silicone Elastomers