Pushed monocanalicular intubation: an alternative stenting system for the management of congenital nasolacrimal duct obstructions

Abstract

Purpose: To present our experience with a "pushed" monocanalicular nasolacrimal intubation device in the management of nasolacrimal duct obstruction in children.

Methods: The cases of consecutive patients with nasolacrimal duct obstruction who were treated with primary probing and intubation with the Masterka were reviewed retrospectively. The Masterka includes a metal guide placed inside a silicone tube for "pushed" intubation as opposed to material attached at the distal end of the silicone for intranasal retrieval ("pulled" intubations). All procedures were accomplished with the patients receiving masked airway anesthesia; neither laryngeal mask airway nor endotracheal intubation was necessary. Only patients noted to have a membranous (mucosal) obstruction were considered for treatment with the Masterka. The duration of operation, duration of stent intubation, and severity of symptoms on follow-up were noted. Success was defined as absence of symptoms after stent removal or loss.

Results: A total of 110 eyes of 88 patients were included (average age, 2.4 years; range, 1-8 years). The average operating time was 3 minutes (range, 2-9 minutes). Persistent tearing on follow-up with the stent in place was noted in 26 eyes (24%); tearing resolved after stent removal in 19 eyes (73%). Success was achieved in 94 eyes (85%). with an average follow-up of 33.7 weeks (range, 4-139). Keratitis was noted in 2 eyes (2%). Early stent loss occurred in 17 ducts (15%).

Conclusions: The Masterka was an effective primary treatment for nasolacrimal duct obstruction associated with mucosal obstructions in this small series of patients.