A custom-made lacrimal duct intubation snare and its clinical application for implanting a tube,a hanging suture or a dilator in the lacrimal duct is described

Objective To design a simple lacrimal duct intubation snare that can be used as a supplementary instrument for intubation,for a hanging suture or for the implantation of a dilator in the lacrimal duct.Methods One eye of each of 206 cases with an obstruction of the nasolacrimal duct with or without chronic dacry-ocystitis,laceration of the canaliculus or stroma stenosis after dacryocystorhinostomy were randomly selected for the study.Of the 206 cases,198 were diagnosed with chronic obstruction of the nasolacrimal duct or chronic dacryocystitisin,2 cases were diagnosed with stroma stenosis after dacryocystorhinostomy,and 6 cases were diagnosed with laceration of the canaliculus.The mean age of the 38 men and 168 women was(48.0±5.8)years(range 5 to 82 years).The operation to hang a line in the lacrimal duct was performed with a custommade lacrimal duct intubation snare.The amount of time needed,the success rate,and the complications were evaluated.The procedures were as follows:an epidural tube enclosing a steel wire was cut into two sections.The head of the epidural tube was scaled with lateral holes and used for the nasolacrimal duct intubation.The two ends of another piece of epidural tube were twisted and the extra section was cut off,creating an oval annular ring with a diameter of 5×7 cm(called a lacrimal duct intubation snare).The annular ring of the lacrimal duct intubation snare was inserted first from the anterior nares to the posterior nares nasal septum,setting it between the nasal cavity and nasopharynx nasalis.The epidural tube entered the lacrimal duct through the superior or inferior lacrimal punctum and was inserted into the nasolacrimal duct under the inferior nasal meatus.The annular ring of the lacrimal duct intubation snare was then inserted.With the traction of the twisted section of the snare,the epidural tube entered the annular ring of the lacrimal duct intubation snare and was pulled out of the anterior nares.After a silk suture was fixated to the head end of the epidural tube,the epidural tube was moved back toward the lacrimal punctum and the silk thread entered the lacrimal duct.The operation to hang a line was then completed.With the connection to the silk suture,the dilator can be implanted into the lacrimal duct.Results The one-time success rate of pulling out the epidural tube with the lacrimal duct intubation snare in 206 cases was 100%.The procedure took an average of 92 seconds.In some cases,there was a small amount of bleeding in the lacrimal duct and nasal cavity during the operation.No puncture or canaliculus tear or other complications occurred.Conclusion The lacrimal duct intubation snare effectively aids the intubation,hanging line and implantation of the dilator in the lacrimal duct,and deserves further clinical application.