[Lacrimal surgery].

Abstract

Tear drainage may be disturbed due to the lack of a connection between the drainage system and the lacus lacrimalis or an obstruction within the drainage system. The connection to the drainage system may be reconstructed by surgery of the puncta. The one-snip and two-snip procedures described by L. T. Jones and the plasty of the punctum by Bangerter are mentioned. A torn canaliculus is repaired by internal splinting with silastic tubing which is inserted as a small, continuous loop. As the upper canaliculus may be of greater importance for the transportation of tears, a reconstruction of the upper canaliculus should also be attempted. Canalicular obstruction may be treated by intubation of the drainage system with silastic tubing. The following complications of this treatment have been observed: ulcera of the cornea and conjunctiva, slitting of the punctum, expression of the intubated silastic loop, closure of the nasal ostium after dacryocystorhinostomy as a result of a chronic irritation by the silastic tube. If reconstruction of the canalicular system is no longer possible, a direct anastomosis between conjunctiva, lacrimal sac and nose may be performed. The dacryocystorhinostomy remains the first choice operation for obstructions below the lacrimal sac. Treatment of the connatal lacrimal obstruction is performed in three steps: conservative treatment with compression of the lacrimal sac, hydraulic pressure flushing and probing.