A modified bicanalicular intubation procedure to repair canalicular lacerations using silicone tubes

Bicanalicular-nasal silicone stent for deep canalicular laceration management

We evaluated the efficacy and clinical outcomes of bicanalicular-nasal silicone stents for deep canalicular lacerations and their anatomical restoration advantages. This retrospective case series study included patients with deep canalicular lacerations who underwent bicanalicular-nasal silicone stent intubation between January 2010 and June 2021 at a Chinese tertiary hospital and two primary hospitals. Intra- and post-operative complications were recorded. Anatomical, functional, and cosmetic outcomes were evaluated as anatomical restoration assessments at the last follow-up. We defined anatomical success as a free passage with no reflux during irrigation. Functional success was evaluated using the Munk epiphora scale and fluorescein dye disappearance test. Cosmetic outcomes were evaluated by examining the eyelid, lacrimal punctum, and medial canthus for any structural abnormalities and recorded objectively using a grading scale. We evaluated 92 eyes of 92 patients (63 men and 29 women); the mean distance from the lateral lacerated end to the punctum was 7.74 mm (range 7-10 mm). Bicanalicular-nasal silicone stents were successfully used in all 92 eyes with no severe intra- or post-operative complications noted. The stent placement duration ranged from 12 to 16 weeks (mean, 13.18 weeks). The follow-up period after stent removal ranged from 3 to 12 months (mean, 6.04 months). The anatomical and functional restoration success rates were 96.74% (89/92) and 100% (92/92), respectively. Satisfactory eyelid position realignment was achieved in all patients. Bicanalicular-nasal silicone stent placement sufficiently relieved orbicularis muscle tension during deep canalicular laceration repair, providing good functional results and excellent cosmetic realignment and anatomical restoration of the eyelid.

Effect of Nasal Wall Fixation with Nonabsorbable Sutures during Nasolacrimal Silicone Intubation in Adults

Purpose: We explored the effects of silicone tube fixation using a nonabsorbable suture on the adult nasal wall during silicone tube intubation.Methods: The medical records of patients (50; 54 eyes) diagnosed with nasolacrimal duct stenosis and canalicular lacerations who underwent silicone tube fixation to the nasal wall (using nonabsorbable sutures) during silicone tube intubation from January 2019 to June 2021 and who were followed-up for more than 3 months after surgery were retrospectively investigated. We recorded the percentages of early silicone tube displacement and noted other complications.Results: We enrolled 22 males and 28 females of average age 65.28 ± 8.88 years. The silicone tubes were maintained for an average of 9.13 ± 1.77 weeks in the nasolacrimal duct stenosis group and 20.13 ± 3.36 weeks in the canalicular laceration group. Early tube displacement occurred in two of 46 eyes (4.4%) in the nasolacrimal duct stenosis group and in 0 of eight eyes (0%) in the canalicular laceration group. Overall, early displacement occurred in only two of 54 eyes (3.7%). Other complications included nasal irritation in four cases (7.4%), canaliculitis in three (5.6%), and loss of fixed nonabsorbable sutures in three (5.6%).Conclusions: Silicone tube fixation to the nasal wall using a nonabsorbable suture during silicone tube intubation simply and effectively prevents early tube displacement and loss, associated with minimal complications.

Bicanalicular Annular Stent Compared with Bicanalicular Nasal Intubation in Management of Traumatic Lower Canalicular Laceration

Purpose

To report the functional and anatomical results of bicanalicular annular stent compared to bicanalicular nasal intubation in the management of traumatic lower canalicular laceration.

Patients and Methods

A retrospective comparative, non-randomized interventional study. The study included consecutive patients suffering from traumatic lower canalicular laceration attended to ophthalmology department causality at Al Azhar University hospital Damietta branch, between December 2018 and August 2020.

Results

The study recruited eighty-five eyes of eighty-five patients admitted for treatment of traumatic lower canalicular laceration. In thirty-three patients, canalicular integrity was restored by bicanalicular annular stent (group 1) and in twenty five patients by bicanalicular lacrimal intubation (group 2). The affected patients were predominantly males (78.8% in the first group and 80% in the second group). Etiology of trauma was due to occupational hazards; 48.5% in the first group and 36% in the second group. Anatomical success in the first group was 93.9%, and 92% in the second group. Canalicular patency was achieved in 90.9% in the first group and in 80% in the second group.

Conclusion

There was no statistically significant difference between bicanalicular annular stent and bicanalicular nasal intubation regarding both anatomical and functional success. Both techniques represent a successful alternative to monocanalicular stent.

Multiple Approaches for Managing Complex Ophthalmic Blunt Trauma: A Case Report

Introduction

Ophthalmic trauma is defined as injuries affecting the ocular structures, including the globe, eyelid, lacrimal system, and surrounding orbital walls. Blunt trauma acts as the leading cause of injury and it may affect both the anterior and posterior parts of the globe. Prompt diagnosis, early management, and sustained follow-up are mandatory for an optimal outcome.

Purpose

This report presents a one-step surgery management process for an intricate case of blunt facial trauma with complex ophthalmic and nasal injury.

Patients and Methods

A 45-year-old male with blunt force trauma of the left eye from a wooden block, suffered from naso-orbital-ethmoidal fractures, eyelid laceration with canalicular, close-globe injuries of traumatic cataract and vitreous hemorrhage with retinal detachment. A simultaneous one-step surgery was performed by a trauma team of ophthalmological and ENT surgeons during the height of the COVID-19 pandemic to lessen the risk of cross-transmission. After ruling out the possibility of open-globe rupture, traumatic cataract extraction, retinal detachment surgery, the repair of an eyelid laceration with canalicular involvement, and septorhinoplasty were performed on concomitantly.

Results

Anatomical success was achieved for the repair of the nasoorbitoethmoidal (NOE) type II fracture and close-globe injuries, including the anatomical reattachment of the retina. However, the functional outcome remained unsatisfactory. Visual acuity failed to show further improvement at a later follow-up. Traumatic optic neuropathy was, at the final follow-up, considered to be the cause of the suboptimal visual acuity.

Conclusion

A single-step multi-procedure for a complex ophthalmic blunt trauma, as demonstrated in this case, may be beneficial for reducing the complications that might arise due to treatment delay. The complex nature of the injury, however, creates the higher possibility for residual post-operative complications. Risks of residual functional impairment should be considered in such complex trauma prior to surgery, to determine the surgical prognostic value and provide appropriate consent to the patient.

Eiology and prognosis of canalicular laceration repair using canalicular anastomosis combined with bicanalicular stent intubation

BACKGROUND

To evaluate the etiology of lacrimal canalicular laceration and explore the possible risk factors influencing prognosis.

METHODS

The data of 142 patients (142 eyes) with lacrimal canalicular lacerations who were surgically treated using canalicular anastomosis combined with bicanalicular stent intubation between March 2017 and March 2018 were reviewed. The analyzed data contained demographic information, types of trauma, injury locations, associated additional ocular injuries, and surgical outcomes at follow-up. The main outcome measures were anatomic success rate, functional success rate, and complications of surgery.

RESULTS

The mean patient age was 42.07 years (ranging from 1 to 75 years). Among the 142 patients, 112 (78.87%) were males. Upper and lower canalicular lacerations were found in 14 (9.86%) and 112 (78.87%) patients, respectively. Meanwhile, both upper and lower canalicular lacerations were found in 16 (11.27%) patients. Electric bike accidents comprised the leading cause of injury, accounting for 76 (53.52%) cases. There were 100 (70.42%) patients who had lid lacerations without tarsal plate fracture and 42 (29.58%) patients who had lid lacerations with tarsal plate fractures. The anatomic success rate was 98.59% and the functional success rate was 83.8%. The functional reconstruction failure rates were higher in patients with indirect injuries, lid lacerations with tarsal plate fractures, and those with punctum splitting (P < 0.05). Surgical complications were detected in the form of lacrimal punctum ectropion in 3 (2.11%) patients, punctum splitting in 2 (1.41%) patients, and stent extrusion and loss in 2 (1.41%) patients.

CONCLUSIONS

Electric bike accidents have become the leading cause of injury instead of motor vehicle accidents because of the changes in the lifestyles of people. Indirect injuries, lid lacerations with tarsal plate fractures, and those with punctum splitting were significantly more likely to lead to poor prognosis, as confirmed by the lower functional success rate of surgery.

Canalicular laceration repair using a self-retaining, bicanalicular, hydrophilic nasolacrimal stent

Purpose: To evaluate outcomes of primary eyelid and canalicular laceration repair using a self-retaining bicanalicular hydrophilic nasolacrimal stent.Methods: This study is a retrospective review of seven patients with canalicular laceration primarily repaired with a self-retaining bicanalicular nasolacrimal stent within 72 hours of initial injury. After lacrimal intubation, repair was performed by reapproximation of the lacerated tissues. Data collection included ophthalmic examination, mechanism of injury, involvement of upper/lower/common canaliculi, symptoms of epiphora, operative time, stent extrusion and canalicular irrigation.Results: Seven patients with monocanalicular laceration were repaired using the self-retaining bicanalicular nasolacrimal stent. The stent was left in place an average of 5 months. The average operative time was 29.3 minutes. None of the stents extruded prior to removal. After 5 months, the stent was removed successfully without difficulty. All patients reported subjective improvement in epiphora, with complete resolution of symptoms. Anatomic success was confirmed with irrigation in all cases. There were no complications associated with usage of the self-retaining bicanalicular nasolacrimal stent.Conclusions: Primary repair of canalicular lacerations can be successfully performed with a self-retaining bicanalicular nasolacrimal stent. This stent has several advantages, including potentially faster operative times, no need for intranasal fixation or retrieval, easier intubation in the lacrimal system, and improved anatomic reapproximation of lacerated tissues.

Repositioning a Prolapsed Tube After Bicanalicular Intubation of the Lacrimal System

OBJECTIVE

Prolapse of silicone tubes is one of the most common complications after bicanalicular intubation of the lacrimal system. This study describes a new method of repositioning prolapsed silicone tubes by using a suture-probe.

METHODS

This study was a retrospective chart review of 12 patients who experienced complete silicone tube prolapse after bicanalicular intubation. The silicone tube was repositioned by using a suture-probe; a double-stranded suture was placed in the lacrimal duct with a lacrimal probe with a hole in the front blunt tip, then interlocked with the prolapsed silicone tube. Subsequently, the suture loop was slowly stretched from the nasal cavity, and the silicone tube was repositioned. The silicone tube at the medial canthus was cut and loosened, then pulled out of the nasal cavity.

RESULTS

In all 12 cases, the silicone tube was restored with 100% success by using the suture-probe. Three patients were extubated immediately after the repositioning. For another 9 patients with an indwelling tube, extubation was performed after 3-4 months, and no patients experienced further tube dislocation during that time.

CONCLUSIONS

The suture-probe technique is a simple, low cost, and minimally traumatic method for repositioning a prolapsed silicone tube after bicanalicular intubation of the lacrimal system.A new technique, the suture-probe with thread interlocking the silicone tube ring can reposition the prolapsed silicone tube in lacrimal sac.

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.

The Study of a New Modified Bicanalicular Intubation for the Repairment of Traumatic Canalicular Laceration

Introduction

To investigate the efficacy and safety of a modified bicanalicular intubation (MBCI) used in canalicular laceration.

Materials and Methods

This study is a retrospective consecutive chart review. A total of 43 eyes from 43 patients (36 males and 7 females) who underwent canalicular intubation were enrolled. Success rate was determined at 6 months after the surgery. Anatomical success was determined by diagnostic probing and irrigation; functional success was determined by asking patients about tearing.

Results

Irrigation of the lacrimal passages in all 43 eyes showed that they were free from obstruction. The anatomical success was 100%, and 37 eyes (86%) achieved functional success. 6 eyes (14%) could not achieve functional success because there were some residual symptoms under irritating conditions, such as wind or winter weather, among which 2 eyes had bicanalicular lacerations and 4 eyes had lower canalicular laceration before surgery. There were no other complications observed in this study.

Conclusions

The MBCI was simple and safe for using in canalicular laceration.

Is the distance from punctum a factor in the anatomical and functional success of canalicular laceration repairs?

PURPOSE

The aim is to analyze the influence of the location of lacrimal canalicular laceration over the eventual anatomical and functional success after surgery.

METHODS

Retrospective, observational study of proximal canalicular laceration (PCL) and distal canalicular laceration (DCL) repairs by a single surgeon (MS). The distance between lacrimal punctum and the lateral canalicular lacerated end was defined as proximal (<6 mm) and distal (≥6 mm). The operation theater setup, microscopic magnified view, local adrenaline, and pigtail probe were used to locate the medial canalicular lacerated end. All patients underwent lacrimal stenting and the stents were removed after 3 months (12th week visit). After stent removal, a fluorescein dye disappearance test and lacrimal irrigation were performed to assess the anatomical and functional success of the operation.

RESULTS

Of 36 canalicular lacerations, 30 (83.33%) were monocanalicular lacerations which were repaired using monocanalicular stents. Of 6 (16.67%) bicanalicular lacerations, three were repaired using bicanalicular stents while in the remaining three, one monocanalicular stent was placed in each lacerated canaliculi. The medial cut end was identified by magnified visualization in 27 (75%), with adjunctive local adrenaline in four (11.11%) and pigtail probe in five (13.89%) patients. The mean post stent removal follow-up was 44 weeks. The DCL (n = 24, 66.67%) showed better functional and complete success as compared to PCL (75% vs. 33.33%, P = 0.03). Eight (22.22%) had spontaneous stent extrusion, two (5.56%) had loop prolapse, four (11.11%) had punctum granuloma, and three (8.33%) had medial canthus dystopia.

CONCLUSION

The location of canalicular laceration may help to prognosticate the functional and qualified success rate. We experienced better-qualified success in the distal canalicular laceration group.

A new method for locating the proximal lacerated bicanalicular ends in Chinese preschoolers and long-term outcomes after surgical repair

This report is to explore the long-term outcomes of surgical repair of bicanalicular lacerations in Chinese preschool patients. In this report, 12 patients with bicanalicular lacerations were studied between September 2010 and September 2015. The distance from the punctum to the distal canalicular lacerated end was recorded before surgery to classify different types of trauma. All patients underwent surgical repair of the lacerated canaliculi by 1 surgeon within 48 hours after the trauma occurred. After treatment, the lesions were divided into 3 types according to the distance from the punctum to the distal lacerated canalicular end as follows: lateral, medial, and the central. Based on this classification, each lacerated canaliculus was successfully repaired. Nearly half of the lesions (46%) were lateral, 42% were central, and 12% were medial. The average time for locating the proximal lacerated end of the canaliculus was 3.33 ± 1.52 minutes (range, 1.0-7.0 minutes). The follow-up time ranged from 6.0 months to 4.5 year (median, 25 months). Our study showed that 96% (23) of the canaliculi were completely patent. One lateral lesion presented with residual outdoor epiphora in cold weather secondary to left lower canalicular stenosis. All 12 patients had excellent cosmetic results. Our study displayed a surgical management based on the 3 types of lesions helped to find the proximal lacerated end of the canaliculus, and provided excellent long-term outcomes of drainage function.

Endoscopic endonasal dacryocystorhinostomy combined with canaliculus repair for the management of dacryocystitis with canalicular obstruction

Purpose. The aim of this study is to propose a simple and efficient combination surgery for the management of dacryocystitis with canalicular obstruction. Methods. A retrospective noncomparative case series of dacryocystitis with canalicular obstruction has been studied. Twelve patients with dacryocystitis and canalicular obstruction underwent a conventional endoscopic endonasal dacryocystorhinostomy (EE-DCR) combined with a modified canalicular repair. Postoperative observations included slit lamp, fluorescein dye disappearance test, lacrimal syringing, lacrimal endoscopy, and nasal endoscopy. Results. After 6-18 months of postoperative follow-up, the symptoms of epiphora and mucopurulent discharge disappeared completely in 10 patients, and occasional or intermittent epiphora remained in 2 patients. All of the twelve patients showed an opened intranasal ostium and normal fluorescein dye disappearance test. Patent bicanalicular irrigation was achieved in 9 patients. One patient had a partial and the other two had a complete reobstruction by lacrimal irrigation to their repaired lower canaliculus; however, all of them had a patent lacrimal irrigation to upper canaliculus. The functional success rate for the combination surgery is 83% (10/12), and anatomical success rate is 75% (9/12). Conclusion. EE-DCR combined with modified canalicular repair is a simple and efficient method for the management of dacryocystitis with canalicular obstruction.

Novel Pigtail Cannula for a Canalicular-Involving Eyelid Laceration

An 89-year-old woman presented with a canalicular-involving laceration/avulsion of the right lower eyelid after a fall. The inferior canaliculus was severed deep within the wound, and the ends were difficult to identify. Novel pigtail cannulas, designed by the authors, were used for lacrimal system intubation and suture passage. Satisfactory cosmetic and functional results were achieved. These cannulas facilitate repair by integrating multiple functionalities in a single instrument. Once a cannula has been inserted and rotated, the location of fluid egress provides important clues. If injected saline appears in the nasopharynx but not in the wound, absence of a common canaliculus can be suspected. Injection of viscoelastic, air or fluorescein-impregnated saline also permits easier identification of the cut end of the canaliculus within the wound and facilitates appropriate rotation of the pigtail.

Pediatric canalicular lacerations: epidemiology and variables affecting repair success

PURPOSE

To evaluate the epidemiology and outcomes of all pediatric canalicular lacerations at a high-volume urban tertiary eye care center. Variables of repair were evaluated in relation to age and success of repair.

METHODS

A retrospective review over a 10-year span of all primary pediatric canalicular laceration repairs was performed. Variables included patient demographics, repair setting, mechanism of injury, associated injuries, type of stent used, and success of repair.

RESULTS

Of 137 canalicular lacerations evaluated, 27.7% occurred in patients younger than 18 years. The majority of the children were male (73.7%) and white (68.4%), with a mean age of 10.8 years (range: 1.1 to 17.9 years). The mechanism of injury was significantly more likely to be due to dog bites in children when compared to adults (P < .0001), particularly those younger than 10 years (P = .0068). Repair was significantly more successful in the operating room than the minor procedure room, regardless of type of stent used (P = .0247). The majority of children did not have other injuries (60.5%). However, of the other injuries sustained, 52.6% required further monitoring or repair.

CONCLUSIONS

Pediatric canalicular lacerations are most common in young boys and dog bites are the most common etiology. Although many children may not have other injuries, full examination is warranted because other injuries may require intervention or more frequent monitoring.