Silicone stent intubation with pigtail probe







Table 62.1

Indications for surgery











After removal of lesion overlying punctum
For reconstruction of the eyelid after removal of the proximal lacrimal system from cancer surgery
To promote healing of the lacrimal system after repair of eyelid laceration involving the canalicular system
Prophylaxis against canalicular stenosis while on chemotherapy (docetaxel)


Table 62.2

Preoperative evaluation





















Detailed history of tearing – frequency, mucoid discharge, dacryocystititis
Medication history – chemotherapy for breast cancer (docetaxel), radioactive iodine for thyroid carcinoma, glaucoma medications, anti-herpes simplex/zoster virus drops
History of prior lacrimal surgery – nasolacrimal duct probing, stent placement, DCR (external/endonasal)
History cutaneous malignancies, prior photographs of eyelid lesion at punctum
History of trauma to eyelid involving canalicular system, timing and associated symptoms
Probing and irrigation of canaliculi
Presence of punctal stenosis
Presence of lower eyelid malposition – ectropion, entropion, punctal ectropion, eyelid retraction
Workup for dry eye (pseudoepiphora)


Introduction


Silicone stent intubation of the proximal lacrimal system is typically done as a prophylactic measure to prevent scarring from a variety of causes. As the nasolacrimal duct (NLD) is not intubated in this technique, there is no role for proximal intubation for epiphora secondary to NLD obstruction. Common indications include reconstruction of the puncta and canaliculi after excision of cutaneous malignancies and during eyelid laceration repair involving the canaliculus. Excision of lesions at the punctum may cause scarring and prophylactic stent placement is protective. Canalicular stenosis induced by chemotherapeutic medications such as docetaxel may be prevented by proximal stenting but bicanalicular stent placement through the NLD is more advisable ( Chapter 60 ).


The pigtail catheter is used to facilitate proximal intubation of the lacrimal system. The primary complication with the pigtail catheter is iatrogenic damage to the common canalicular system. Care is taken to minimize lateral traction with the catheter in place. Finally, certain manufacturers have erroneously created large diameter pigtail probes. These should be completely avoided as they induce a high rate of common canalicular disinsertion that may necessitate Jones tube placement ( Chapter 59 ).

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May 16, 2019 | Posted by in Reconstructive surgery | Comments Off on Silicone stent intubation with pigtail probe
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