Nasolacrimal duct intubation with Crawford tubes reduces severity of epiphora

Canada:  In a new study conducted by Karan Gandhi and team it was found that for the treatment of epiphora, nasolacrimal duct intubation with Crawford tubes done under direct endoscopic vision is routinely effective. The findings of this study were published in the Canadian Journal of Ophthalmology.

In pediatrics, silicone nasolacrimal stents are routinely used to treat epiphora. The most typical treatment length is three months, however, tubes are sometimes withdrawn mistakenly early and are still effective. There is no agreement on how long tubes should be left in place and what factors determine therapeutic effectiveness.

Over a 10-year period (2009–2019), a retrospective chart evaluation of patients who had Crawford tube implantation was performed for this study. Crawford tubes were implanted in patients above the age of 18 in collaboration with an otolaryngologist who conducted nasal endoscopy for direct visibility while recovering Crawford tubes and in fracture of the inferior turbinate. In all cases, bicanalicular intubation was tried; where this was not possible, monocanalicular intubation was performed.

The results of this study stated as follow;

1. In this study, 42 patients were enrolled, representing 50 eyes.

2. 54% of the eyes experienced spontaneous tube extrusion.

3. The tubes were left in place for an average of 17.1 weeks (0–113 weeks).

4. 86% of patients had their symptoms addressed, which is comparable to operations without endoscopy.

5. There were no difficulties throughout the procedure.

6. There was no link found between the frequency of persistent symptoms and the length of therapy.

In conclusion, although epiphora can resolve on its own, severe symptoms that last longer than a year after delivery require medical attention. Children who get Crawford tubes for epiphora frequently have spontaneous tube extrusion before the course of therapy is completed. However, the amount of time the tubes remained in place had no effect on treatment success. Intraoperative problems can be avoided using endoscopic visualization.

Reference:

Gandhi K, Dzioba A, Husein M, Makar I, Sharan S. Effectiveness of pediatric Crawford tube implants when endoscopically assisted by ENT surgeons. Can J Ophthalmol. Published online January 14, 2022. doi:10.1016/j.jcjo.2021.12.004

Keywords: epiphora, nasolacrimal duct intubation, tears, endoscopic surgery, otolaryngologist, Crawford tubes, Canadian Journal of Ophthalmology, implant, pediatric, tube implant