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Abstract ID: 24-162
A case of different Jones Tubes types simultaneously in a patient to resolve longstanding nasolacrimal duct obstruction after multiple failed surgeries
Mumta Kanda
Purpose
In patients with epiphora from canalicular obstruction or with failed dacryocystorhinostomy (DCR), insertion of a transconjunctival lacrimal bypass tube may be effective. Traditionally, this is done with a Lester Jones Tube (LJT). An important complication is extrusion. The StopLoss Jones Tube (SLJT) is a newer variety with an internal silicone flange that reduces extrusion. We present a case of bilateral, likely congenital, nasolacrimal duct obstruction (NLDO) with multiple previous surgeries managed with simultaneous LJT in one eye and SLJT in the other.
Methods
A case report from a district general hospital eye unit in London, UK.
Results
A 50-year-old female attended our adnexal clinic 6 months post bilateral endoscopic dacryocystorhinostomy (DCR) done abroad. She had a 30-year history of bilateral NLDO with multiple repeat nasolacrimal surgeries, including rhinal surgery for previous trauma. Bilateral O’Donoghue tubes had been left in and were removed due to local irritation. She developed repeat epiphora and lacrimal syringing showed complete obstruction of superior and inferior canaliculi bilaterally. CT orbit/sinuses showed chronic rhinosinusitis and post-surgical changes to the anteromedial orbital walls bilaterally. Endoscopic NLD exploration showed bilateral scarred tissue and distorted anatomy. During exploration, O’Donaghue tubes were placed on the right but not the left as the canaliculi were completely obstructed and no common canaliculus was observed. Return of right epiphora led to further surgery with bilateral LJTs. Post-operatively, the right LJT was displaced and causing conjunctival irritation. We replaced the LJT with a SLJT (the only tube available in the correct size). 6 months post-operatively, there have been no complications and patient symptoms are much better with no difference between eyes.
Conclusion
In a patient with multiple failed DCR surgery for NLDO, LJT can be an effective solution. In such cases, both eyes may behave differently and require a different approach and careful selection of JT types, including simultaneous insertion of different tubes in each eye.
Additional Authors
Anna Gkountelia – Queen’s Hospital, Romford