Canalicular blockage

More complex surgical procedures are necessary if intubation is not successful. The micro-surgical repair of canaliculi has been proposed with a canaliculo-DCR being reserved for distal canalicular blockage. Retrograde intubation of the canaliculi combined with DCR is used for proximal canalicular obstruction and punctal agenesis, with a success rate of 60-70%13 . During a standard DCR the inner opening of the common canaliculi is identified and probed towards the blocked canaliculi. On reaching the site of the blockage a pseudo punctum is fashioned. A silicone tube is then inserted through the same route.

Canalicular stenosis

Silicone tube insertion during DCR is necessary. Alternatively canaliculoplasty by closed technique bicanalicular silicone tube insertion can be performed. A success rate of up to 70% has been reported14, 15. Early anecdotal reports indicate that endocanalicular Erbium laser, used prior to intubation, has an arguably (but as yet unproven) better outcome.

In cases of failure of the above procedures, a by-pass operation is the only remaining option. Conjunctivo-DCR with a Lester-Jones tube can be performed as a closed technique in the presence of a previous osteotomy.

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