Repair of the lacerated canaliculus

Canalicular laceration repair using a novel bicanalicular silicone stent versus traditional bicanalicular stent with nasal fixation

PURPOSE

To compare the clinical effects of two types of lacrimal stents in the repair of canalicular lacerations.

METHODS

A retrospective analysis was conducted on patients with canalicular lacerations between January 2017 and December 2022. The canalicular reconstruction was performed using either the Runshi-RS bicanalicular silicone stent or the traditional bicanalicular silicone stent with nasal fixation, under a surgical microscope. The stent was placed for 3 months, and patients were followed up for more than 3 months after extubation. The anatomical and functional success rates were compared between the two groups. Anatomical success was assessed through diagnostic probing and irrigation of lacrimal passage, while functional success was determined by the patient's subjective symptoms of epiphora.

RESULTS

The study included 315 patients (315 eyes) undergoing canalicular laceration repair. The Runshi-RS stent was utilized in 147 patients (46.7%), while the traditional stent with nasal fixation was employed in 168 patients (53.3%). The anatomical success rates (99.3% vs 98.8%, P = 0.642) and functional success rates (87.2% vs 88.1%, P = 0.926) were similar between the RS group and the traditional stent group. Postoperative complications were fewer (4.1% vs 10.1%, P = 0.04) and the operation time was shorter (67.1 ± 35.3 min vs 86.1 ± 43.4 min, P < 0.001) in the RS group.

CONCLUSION

The Runshi-RS tube demonstrates favorable surgical outcomes for the repair of canalicular lacerations. Compared to the traditional stent with nasal fixation, the RS stent allows for shorter operation times and fewer postoperative complications in the repair of canalicular lacerations.

Innovative cost-effective method to repair lacrimal cannaliculi laceration - finding proximal end and stent

Purpose: To explore a new technique to find out the proximal end of lacerated canaliculi and a new material for the stent.

Methods: Surgery was performed on 9 eyes of 9 patients using a 5/0 prolene suture needle as a modified probe. Prolene suture was inserted as a stent and left in place for two months. All the data were analyzed.

Results: The surgery was successful in all cases and the prolene were removed after two months. The mean follow-up time after the tube removal was 3.8 months (range 3–6 months). No other complications associated with the prolene sutures were noticed except for epiphora and corneal irritation in three cases. All the tubes were removed successfully without any difficulty. No iatrogenic injuries occurred during prolene removal.

Conclusions: The reported surgical technique is a very cost-effective option for lacrimal canalicular laceration repair.

Early Versus Late Canalicular Laceration Repair Outcomes

PURPOSE

To determine whether delayed repair of traumatic canalicular laceration affects the final outcome.

DESIGN

Retrospective case series.

METHODS

The medical records of 334 patients who underwent primary traumatic canalicular laceration repair were retrospectively reviewed. Patients were divided into 2 groups according to the surgical timing within 48 hours (early) or after 48 hours (delayed). The anatomic results were compared between these 2 groups. The causes of delayed repair and the mean operation time were also analyzed.

RESULTS

There were 23 failed cases among 301 patients (7.6%) who had a repair within 48 hours and 3 failed cases among 33 patients (9.1%) who had a repair after 48 hours (P = .732). The mean operation time was 62 minutes in the early group and 66.3 minutes in the delayed group, which showed no significant difference (P = .371). The major cause of delayed surgery was traumatic brain injury, followed by facial or orbital fracture, long bone fracture, and chest injury.

CONCLUSIONS

Delayed canalicular repair in unstable patients did not lead to poor results. An elective scheduling surgery, instead of an urgent repair, is feasible for an experienced surgeon.

National survey on the management of lacrimal canalicular injury in the United Kingdom

PURPOSE

The management of lacrimal canalicular injury is controversial. It is believed that practice varies widely among surgeons.

METHODS

One hundred and twenty National Health Service-based Consultant Ophthalmologists with oculoplastic interest across the United Kingdom (UK) were identified via the website http://www.specialistinfo.com, which is a website that asks UK consultants to identify their areas of subspecialty interests. Questionnaires were sent out to them to determine caseload, intraoperative techniques (magnification, suture and stents) and postoperative management (antibiotic use, stent placement and replacement and secondary lacrimal surgery) of patients with canalicular injuries.

RESULTS

Eighty-nine (74%) completed questionnaires were returned and analysed. Most (63%) of the respondents treated between one and five canalicular injuries over the past year. Thirty-eight (43%) of them would repair a monocanalicular injury only if the lower canaliculus was involved and 36 (40%) respondents would always repair a monocanalicular injury. Eighty-two (92%) respondents used magnification during surgery. Fifty-one (57%) respondents would never consider using the pigtail probe. Eighty-five (96%) would use the bubble test and/or fluorescein dye to locate the severed medial canalicular end. Vicryl or dexon was the suture of choice for 76 (85%) and 63 (71%) respondents for repairing pericanalicular and canalicular tissues, respectively. Thirteen (14.6%) respondents did not stent their canalicular repairs. Forty-seven (53%) routinely used prophylactic antibiotics. Sixty-eight (76%) respondents would wait between 3 and 12 months before undertaking further lacrimal surgery.

CONCLUSION

This study confirmed that management of lacrimal canalicular injury varies widely among surgeons in the UK.

Mini Monoka silicone monocanalicular lacrimal stents: Subjective and objective outcomes

BACKGROUND. Canalicular injuries and anomalies are relatively common. Despite this, controversy still exists regarding the indications for surgery and best surgical methods. The most favourable intervention would be one that is simple, associated with a high level of subjective and objective outcome, and does not threaten the uninjured or unaffected part of the lacrimal drainage system. This study assesses outcomes of intervention with the Mini Monoka silicone monocanalicular lacrimal stent. METHOD. A single cohort, hospital-based study with retrospective and prospective components. Participants were all identifiable patients at Bristol Eye Hospital in whom the Mini Monoka silicone monocanalicular stent was used for any indication. Retrospective analysis of patient records for all related pre-operative, operative and postoperative data was performed. Prospective analysis of subjective outcome via confidential patient questionnaire and objective outcome via clinical examination was performed. RESULTS. Complete data were obtainable in 13 patients (14 canaliculi) of the identified 22 patients (23 canaliculi). Follow-up was from 12 to 70 months (mean 39 months). A high level of subjective outcome was noted with no patients experiencing significant or disabling symptoms. In terms of objective outcome, 79% achieved canalicular patency. The main complications with this technique were premature stent loss (29%) and stent migration (14%). CONCLUSIONS. The Mini Monoka monocanalicular stent is a safe, effective and simple surgical technique that, unlike bicanalicular procedures, does not threaten the uninjured / unaffected part of the lacrimal drainage system.

Monocanalicular lesions: to reconstruct or not

OBJECTIVE

To evaluate the success rate of a simple surgical method for the treatment of a monocanalicular lacrimal lesion.

DESIGN

Retrospective noncomparative case series.

PARTICIPANTS

Thirteen consecutive patients with monocanalicular trauma who were seen from August 1995 to March 1998. In six patients, the canaliculus was lacerated as a result of an external injury and in seven patients as a result of tumor removal (iatrogenic injury).

INTERVENTION

Reapproximation of the orbicularis muscle and skin overlying the torn canaliculus without reanastomosis of the lacerated canaliculus. In those patients in whom the canaliculus was sacrificed as part of the removal of an eyelid tumor, no attempt was made to reconstruct the canaliculus.

MAIN OUTCOME MEASURES

Symptomatology, patency of the lacrimal passage, fluorescein dye disappearance test, and patient satisfaction.

RESULTS

In all patients the injured canaliculus was totally blocked, but despite this none of the patients complained of inconvenient tearing either indoors or outdoors. The ipsilateral unharmed canaliculus was functioning normally in such a way that the fluorescein dye instillation test showed residual dye in six patients after 2 minutes and in none of the patients after 5 minutes. All patients were satisfied with the functional and cosmetic result.

CONCLUSION

Nonrepair of a monocanalicular lesion is a valid approach that results in little or no morbidity.

Management of canalicular laceration

Although canalicular injuries are relatively common, controversy persists regarding indications for repair and the surgical methods that should be employed. In this review, these various treatment philosophies and techniques are analyzed in an historical and a contemporary context. The surgical anatomy, epidemiology and clinical presentation of canalicular injuries are discussed. Inconsistencies in current nomenclature regarding the surgical anatomy of canalicular lacerations are analyzed. Recent studies of lacrimal drainage in systems with monocanalicular obstruction are cited. Various surgical techniques in the repair of canalicular injuries are reviewed, including methods of identifying the medial lacerated lacrimal passages and the various lacrimal stents that have been used. The current popularity of silicone tubing as a lacrimal stent is reviewed. The various methods of stent placement and fixation are systematically categorized. Case series of canalicular repair reported in the literature are reviewed, and the results and complications are compared.

The pathogenesis of canalicular laceration

Canalicular lacerations are seen commonly in ophthalmic practice, but the pathogenesis of canalicular lacerations has not been explored. The authors retrospectively reviewed 25 cases of canalicular laceration seen at their institutions. Only 4 patients (16%) had injuries attributable to direct trauma; the remaining 21 patients (84%) had diffuse trauma or trauma to the eyelid remote from the canaliculus. The authors postulate that, in many of their cases, canalicular "lacerations" resulted from indirect trauma, where the eyelid was ruptured when it was stretched acutely to the point of avulsion. Two experimental models were derived to test this hypothesis. The results suggest that the canalicular portion of the eyelid is a particularly vulnerable location, and that injuries morphologically similar to canalicular "lacerations" occur predictably if the eyelid is traumatized indirectly or diffusely to the point of rupture.