Under normal conditions, tears in the eyes drain into the tear sac through small openings called upper and lower tear points located in the inner corner of the eye (called the medial canthus). Tears pass through small ducts called the upper and lower canaliculi, then flow through the lacrimal sac and lacrimal nasal duct, and finally into the nose (Figure 1a). Obstruction in any part of the passage mentioned above is the most common cause of tearing or epiphora. Epiphora affects the quality of life (QOL) of patients. When the upper and lower canaliculi are blocked, tear fluid cannot be drained into the nose, resulting in epiphora. Although the cause of canalicular obstruction cannot be identified in many cases, it is believed to be associated with aging, trauma, tumors, and oral cancer drugs.
Minor surgery to enlarge the canaliculus by inserting a silicone tube is the common treatment to remove blockages. When the canaliculus is re-occluded or cannot be kept open, a Jones tube placement is considered, which semi-permanently places a glass tube that directly connects the nasal cavity and the medical canthus. Otherwise, surgery with an external incision may be considered, leaving a scar of about 2 cm on the side of the nose.
To overcome the drawbacks of these conventional surgical methods, a team of otolaryngologists and ophthalmologists from Toho University Sakura Medical Center have developed a new procedure called “conjunctivoductivo-dacryocystorhinostomy”.
All surgical procedures are performed under general anesthesia. First, the entire tear duct and tear sac are exposed and elevated, then the tear duct is cut at the lower end (Fig 1b). At the medial canthus, the conjunctiva is incised (Fig 1b). The end of the cut tear duct is removed from the conjunctival incision and sutured to form a new tear point (Fig 1c). Then the medial wall of the lacrimal sac is widely opened (Fig 1c). Now, the old tear duct and tear sac become the new tear passage, and tear fluid flows into this newly created passage.
The newly developed procedure, “conjunctivoductivo-dacryocystorhinostomy” for intractable canalicular obstruction leaves no facial scars or place of foreign objects in the body. We believe this procedure can help improve the quality of life of patients with epiphora, ”said Dr. Munetaka Ushio, lead author of the study. The study was published in The Laryngoscope on October 1, 2021.
Title of the article: Conjunctivoductivo-Dacryocystorhinostomy: a new surgery for refractory canalicular obstruction
Authors: Munetaka Ushio1, Hidetaka Masahara2, Masashi Sakamoto2, Yasushi Ohta1, Takatoshi Maeno2, Mitsuya Suzuki1
1Department of Otolaryngology, Toho University Sakura Medical Center
2Department of Ophthalmology, Toho University Sakura Medical Center