Liat Attas-Fox1, François Codère. 1. Department of Ophthalmology, McGill University, Royal Victoria Hospital, Canada.
Abstract
PURPOSE: The aim was to describe a novel technique to retrieve retained stenting material from the lacrimal system. METHODS: In this consecutive case series, the authors reviewed charts of 4 children with retained silicone material in their lacrimal sac following intubation. In 2 children, the presence of the retained material was well documented. The other 2 children were examined for the following clinical triad: history of lacrimal intubation, obstructive symptoms characterized by mucopurulent discharge, and a patent nasolacrimal system on irrigation, highly suggesting retained stenting material in the lacrimal system. Retrieval of the foreign body is achieved by performing an intubation of the superior canaliculus with both arms of a Crawford silicone tube. This forms a loop of silicone tubing that can be retrieved from the nose. As the loop passes through the lacrimal sac and duct, the foreign body material is retrieved and extracted through the nose. RESULTS: In the 4 children on whom this procedure was attempted, it was successful in retrieving the retained piece of silicone on every occasion. In all children, there was complete resolution of the epiphora and chronic dacryocystitis without need for dacryocystorhinostomy. CONCLUSIONS: Retained stenting material can be responsible for persistent obstructive symptoms and chronic dacryocystitis. Patients examined for the clinical triad described should raise suspicion of the possibility of a foreign body in the lacrimal system. This technique should be considered in patients where a retained foreign body is known or suspected, prior to considering dacryocystorhinostomy. When successful, it will be both a diagnostic and therapeutic procedure, and will additionally serve to avoid unnecessary dacryocystorhinostomy.
PURPOSE: The aim was to describe a novel technique to retrieve retained stenting material from the lacrimal system. METHODS: In this consecutive case series, the authors reviewed charts of 4 children with retained silicone material in their lacrimal sac following intubation. In 2 children, the presence of the retained material was well documented. The other 2 children were examined for the following clinical triad: history of lacrimal intubation, obstructive symptoms characterized by mucopurulent discharge, and a patent nasolacrimal system on irrigation, highly suggesting retained stenting material in the lacrimal system. Retrieval of the foreign body is achieved by performing an intubation of the superior canaliculus with both arms of a Crawford silicone tube. This forms a loop of silicone tubing that can be retrieved from the nose. As the loop passes through the lacrimal sac and duct, the foreign body material is retrieved and extracted through the nose. RESULTS: In the 4 children on whom this procedure was attempted, it was successful in retrieving the retained piece of silicone on every occasion. In all children, there was complete resolution of the epiphora and chronic dacryocystitis without need for dacryocystorhinostomy. CONCLUSIONS: Retained stenting material can be responsible for persistent obstructive symptoms and chronic dacryocystitis. Patients examined for the clinical triad described should raise suspicion of the possibility of a foreign body in the lacrimal system. This technique should be considered in patients where a retained foreign body is known or suspected, prior to considering dacryocystorhinostomy. When successful, it will be both a diagnostic and therapeutic procedure, and will additionally serve to avoid unnecessary dacryocystorhinostomy.