Locating the Medial Cut End of Lacerated Canaliculus
Our technique is a simplified one-step air-injection procedure to locate the medial cut end of a lacerated canaliculus. The round tip was used to form a relatively closed system. The cut end could be easily identified by visualising the air bubble exit. Typically, the more medial the laceration, the more difficult the location of the cut edge would be. With this novel probe, the more medial the laceration, the easier the injected air will reflux (figure 1E).
Our data showed that the efficiency of our technique was equal to that of the traditional technique. The traditional air-injection technique originally described by Morrison in 1964 was reported in many studies and appears to be practiced by experienced lacrimal surgeons. The technique requires the cooperation of the patient and is not suitable for those under systemic anaesthesia or who are unable to blow air during the operation.
The injection of coloured agents through the intact canaliculus is another technique reported in the literature. The technique described here is similar to our recently reported technique that uses a soft side port probe to inject oculentum into the lacrimal sac, with the nasolacrimal duct blocked by the closed tip. Given the great viscosity and resistance of the oculentum, it takes a much longer time to fill up the lacrimal sac and achieve reflux. We prefer injecting air rather than viscous agents because air is easy to obtain, could emerge quickly and does not obscure the operative field. Injected coloured agents might possibly infiltrate into the eyeball in cases with concurrent open globe injuries.
This cannula is different from that termed the 'last resort' or pigtail probe. There were no complications using a straight probe in our procedure. Some authors suggested that there is risk of creating iatrogenic trauma when passing a curved pigtail probe around the tight turn of the common canaliculus.
Our technique is simple, safe and efficient in our mono-canalicular case series. It should not be used in patients with concurrent nasal bone fracture to avoid secondary injury. The efficiency of this novel technique in bicanalicular tears, paediatric patients and delayed cases requires further evaluation.
Discussion
Our technique is a simplified one-step air-injection procedure to locate the medial cut end of a lacerated canaliculus. The round tip was used to form a relatively closed system. The cut end could be easily identified by visualising the air bubble exit. Typically, the more medial the laceration, the more difficult the location of the cut edge would be. With this novel probe, the more medial the laceration, the easier the injected air will reflux (figure 1E).
Our data showed that the efficiency of our technique was equal to that of the traditional technique. The traditional air-injection technique originally described by Morrison in 1964 was reported in many studies and appears to be practiced by experienced lacrimal surgeons. The technique requires the cooperation of the patient and is not suitable for those under systemic anaesthesia or who are unable to blow air during the operation.
The injection of coloured agents through the intact canaliculus is another technique reported in the literature. The technique described here is similar to our recently reported technique that uses a soft side port probe to inject oculentum into the lacrimal sac, with the nasolacrimal duct blocked by the closed tip. Given the great viscosity and resistance of the oculentum, it takes a much longer time to fill up the lacrimal sac and achieve reflux. We prefer injecting air rather than viscous agents because air is easy to obtain, could emerge quickly and does not obscure the operative field. Injected coloured agents might possibly infiltrate into the eyeball in cases with concurrent open globe injuries.
This cannula is different from that termed the 'last resort' or pigtail probe. There were no complications using a straight probe in our procedure. Some authors suggested that there is risk of creating iatrogenic trauma when passing a curved pigtail probe around the tight turn of the common canaliculus.
Our technique is simple, safe and efficient in our mono-canalicular case series. It should not be used in patients with concurrent nasal bone fracture to avoid secondary injury. The efficiency of this novel technique in bicanalicular tears, paediatric patients and delayed cases requires further evaluation.
SHARE
