97th DOG Annual Meeting 1999



H. G. Struck, D. Ehrich

In cases of total canalicular occlusion or the total absence of the lacrimal apparatus the functional restoration requires the repair of a newly created lacrimal system. The intraoperatively re-establisted lacrimal drainage from the conjunctival sac will be maintained by a plastic tube for a long period. Beside other criteria the influence of the used inserted materials polyethylene or silicone should be evaluated.

Patients and Methods: From 1976 to 1998 we have been treated and consecutive documented 37 cases of conjunctivodacryocystorhinostomy and its modifications in 36 patients (1x both eyes). The patients (22 men, 14 women) ranged in age from 9 - 76 years (mean age of 35,2 years). In a retrospective review results were compared for the following two groups based on the type of used plastic tube: group I: n = 23; insertion of a polyethylene tube (from 1976 - 1990); group II: n = 14; insertion of a silicone tube (from 1991 - 1998).

Results: Causes of lacrimal drainage system obstruction were trauma (n = 21!), malformation (n = 8), chronic inflammation (n = 5) and tumor (n = 2). The following different surgical techniques were performed: conjunctivodacryocystorhinostomy (cdr, n = 23), conjunctiv-odacryocystostomy (cd, n = 10) and conjunctivorhinostomy (cr, n = 4), sometimes with the correction of lidmalposition (right eye: n = 21, left eye: n = 16). In group I 14 of 23 operations (60%) had successful functional results, in group II 10 of 14 operations (71%), respectively. The polyethylene tubes on the average were maintained for 15 months after surgery (2x spontaneous removal) and the silicone tubes for 12 months, respectively (4x spontaneous removal).

Conclusion: Traumatic disturbance and congenital defects of canaliculi and surrounding tissue require in the case of any symptoms the surgical reconstruction of the lacrimal pathway. With the better microsurgical technique and the introduction of the new silicone tube the success rate could be further advanced.

University Eye Hospital, Martin-Luther-University, Magdeburger Str. 8, D-06097 Halle/Saale