Debates in Dacryology: The Intubation Dilemma

  • Edwin C. Figueira
  • Andrea Zarkovic
  • Simon N. Madge
  • Marcus M. Marcet
  • Dinesh Selva
Chapter

Abstract

The use of stenting in dacryocystorhinostomy (DCR) for primary acquired nasolacrimal duct obstruction (PANDO) in the absence of canalicular disease is controversial. There is no definitive evidence to support the routine use of intubation in DCR for PANDO [1–3]. Advocates for stenting report an increased patency rate, due to presumed maintenance of canalicular and ostial patency [4, 5]. However, recent meta-analyses have not found a significant benefit from routine intubation. In addition, there are reports of a higher failure rate in DCR patients who had routine intubation for PANDO [6]. It has been suggested the higher failure rates are possibly a result of intubation-related granulomatous inflammation. Stenting of the nasolacrimal system is also associated with complications including punctal erosion and “cheese-wiring” of the canaliculi [7].

References

  1. 1.
    Vicinanzo M, McGwin G, Long JA. The consequence of premature silicone stent loss after external dacryocystorhinostomy. Ophthalmology. 2008;115:1241–4.PubMedCrossRefGoogle Scholar
  2. 2.
    Madge S, Selva D. Intubation in routine dacryocystorhinostomy: why we do what we do. Clin Experiment Ophthalmol. 2009;37:620–3.PubMedCrossRefGoogle Scholar
  3. 3.
    Madge S, Selva D, ANZSOPRS DCR Intubation Study Group. Canalicular intubation in routine dacryocystorhinostomy. Clin Experiment Ophthalmol. 2009;37:533–44.PubMedCrossRefGoogle Scholar
  4. 4.
    Griffiths J. Nasal catheter use in dacryocystorhinostomy. Ophthal Plast Reconstr Surg. 1991;7:177–86.PubMedCrossRefGoogle Scholar
  5. 5.
    Mäntynen J, Yoshitsugu M, Rautiainen M. Results of dacryocystorhinostomy in 96 patients. Acta Otolaryngol Suppl. 1997;529:187–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Allen K, Berlin AJ. Dacryocystorhinostomy failure: association with nasolacrimal silicone intubation. Ophthalmic Surg. 1989;20:486–9.PubMedGoogle Scholar
  7. 7.
    Anderson R, Edwards JJ. Indications, complications and results with silicone stents. Ophthalmology. 1979;86:1474–87.PubMedCrossRefGoogle Scholar
  8. 8.
    Boboridis KG, Bunce C, Rose GE. Outcome of external dacryocystorhinostomy combined with membranectomy of a distal canalicular obstruction. Am J Ophthalmol. 2005;139:1051–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Smirnov G, Tuomilehto H, Terasvirta M, et al. Silicone tubing after endoscopic dacryocystorhinostomy: is it necessary? Am J Rhinol. 2006;20:600–2.PubMedCrossRefGoogle Scholar
  10. 10.
    Zolli C, Shannon GM. Dacryocystorhinostomy: a review of 119 cases. Ophthalmic Surg. 1982;13:905–10.PubMedGoogle Scholar
  11. 11.
    Mann B, Wormald PJ. Endoscopic assessment of the dacryocystorhinostomy ostium after endoscopic surgery. Laryngoscope. 2006;116:1172–4.PubMedCrossRefGoogle Scholar
  12. 12.
    Chong K, Lai FHP, Ho M, et al. A randomized trial on silicone intubation in endoscopic mechanical dacryocystorhinostomy (SEND) for primary nasolacrimal duct obstruction. (Report). Ophthalmology. 2013;120:2139–45.PubMedCrossRefGoogle Scholar
  13. 13.
    Allen K, Berlin AJ, Levine HL. Intranasal endoscopic analysis of dacryocystorhinostomy failure. Ophthal Plast Reconstr Surg. 1988;4:143–5.PubMedCrossRefGoogle Scholar
  14. 14.
    Rosen N, Sharir M, Moverman DC, et al. Dacryocystorhinostomy with silicone tubes: evaluation of 253 cases. Ophthalmic Surg. 1989;20:115–9.PubMedGoogle Scholar
  15. 15.
    Chan W, Selva D. Ostium shrinkage after endoscopic dacryocystorhinostomy. Ophthalmology. 2013;120:1693–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Linberg J, Anderson RL, Bumsted RM, et al. Study of intranasal ostium external dacryocystorhinostomy. Arch Ophthalmol. 1982;100:1758–62.PubMedCrossRefGoogle Scholar
  17. 17.
    Older JJ. Routine use of a silicone stent in a dacryocystorhinostomy. Ophthalmic Surg. 1982;13:911–5.PubMedGoogle Scholar
  18. 18.
    Pandya VB, Lee S, Benger R, et al. External dacryocystorhinostomy: assessing factors that influence outcome. Orbit. 2010;29:291–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Callejas C, Tewfik MA, Wormald PJ. Powered endoscopic dacryocystorhinostomy with selective stenting. Laryngoscope. 2010;120:1449–52.PubMedCrossRefGoogle Scholar
  20. 20.
    Walland M, Rose GE. The effect of silicone intubation on failure and infection rates after dacryocystorhinostomy. Ophthalmic Surg. 1994;25:597–600.PubMedGoogle Scholar
  21. 21.
    Rosser P. There is no use crying over spilt tears: the surgical management of primary acquired nasolacrimal duct obstruction. Aust N Z J Ophthalmol. 1999;27:95–100.PubMedCrossRefGoogle Scholar
  22. 22.
    Choung H, Khwarg SI. Selective non-intubation of a silicone tube in external dacryocystorhinostomy. Acta Ophthalmol Scand. 2007;85:329–32.PubMedCrossRefGoogle Scholar
  23. 23.
    Saeed B. Endoscopic DCR, without stents: clinical guidelines and procedure. Eur Arch Otorhinolaryngol. 2012;269:545–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Pittore B, Tan N, Salis G, et al. Endoscopic transnasal dacryocystorhinostomy without stenting: results in 64 consecutive procedures. Acta Otorhinolaryngol Ital. 2010;30:294–8.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Ananth L, Hosamani P, Chary G. Efficacy of endonasal dacryocystorhinostomy, using ‘cold steel’ instruments without stenting, in treatment of distal nasolacrimal duct obstruction. J Laryngol Otol. 2011;125:590–4.PubMedCrossRefGoogle Scholar
  26. 26.
    Unlu H, Gunhan K, Baser EF, et al. Long-term results in endoscopic dacryocystorhinostomy: is intubation really required? Otolaryngol Head Neck Surg. 2009;140:589–95.PubMedCrossRefGoogle Scholar
  27. 27.
    Smirnov G, Tuomilehto H, Teräsvirta M, et al. Silicone tubing is not necessary after primary endoscopic dacryocystorhinostomy: a prospective randomized study. Am J Rhinol. 2008;22:214–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Gu Z, Cao Z. Silicone intubation and endoscopic dacryocystorhinostomy: a meta-analysis. Head Neck Surg. 2010;39:710–3.Google Scholar
  29. 29.
    Unlu H, Aslan A, Toprak B, et al. Comparison of surgical outcomes in primary endoscopic dacryocystorhinostomy with and without silicone intubation. Ann Otol Rhinol Laryngol. 2002;111:704–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Feng YF, Cai JQ, Zhang JY, et al. A meta-analysis of primary dacryocystorhinostomy with and without silicone intubation. Can J Ophthalmol. 2011;46:521–7.PubMedCrossRefGoogle Scholar
  31. 31.
    Cannon P, Chan WO, Selva D. Incidence of canalicular closure with endonasal dacryocystorhinostomy without intubation in primary nasolacrimal duct obstruction. Ophthalmology. 2013;120:1688–92.PubMedCrossRefGoogle Scholar

Copyright information

© Springer India 2015

Authors and Affiliations

  • Edwin C. Figueira
    • 1
  • Andrea Zarkovic
    • 2
  • Simon N. Madge
    • 2
  • Marcus M. Marcet
    • 3
  • Dinesh Selva
    • 4
  1. 1.Ophthalmic Plastics SurgeryRoyal Adelaide HospitalAdelaideAustralia
  2. 2.Department of OphthalmologyWye Valley Trust, NHSHerefordUK
  3. 3.Department of OphthalmologyUniversity of Hong KongCyberportHong Kong
  4. 4.Ophthalmology and Visual SciencesUniversity of AdelaideAdelaideAustralia

Personalised recommendations