Retrograde circular intubation for the failed passage of a pigtail lacrimal probe in the management of non-specific inflammatory punctum occlusion.

Abstract

Purpose: to describe the role of Retrograde Circular Intubation (RCI) technique in the management of non-specific inflammatory punctum occlusion (NIPO).

Methods: patients with NIPO who failed conservative treatment underwent 3-snip mini rectangular punctoplasty with adjunctive use of circular canalicular intubation. When the use of the pigtail lacrimal probe was not safely possible, circular intubation was accomplished by the RCI technique. A loop of 6/0 polypropylene suture was introduced into the upper lacrimal drainage system in a retrograde manner from the nose by pulling its two ends up from the puncta with 2/0 polypropylene sutures. The latter were placed between the punctum and the nose by a canulated probe or a Ritleng lacrimal probe (https://youtu.be/n31NKdWIUJM).

Results: Thirty-two patients (64 eyes) underwent circular intubation as an adjunct to the 3-snip mini rectangular punctoplasty. In 9 eyes (14%) the pigtail lacrimal probe couldn't pass safely across the upper lacrimal drainage system. Circular tube insertion was still possible with the RCI technique. Circular tubes were removed after two months. Over two years of follow-up, 27 patients (84%) maintained a patent punctum.

Conclusion: NIPO not responding to conservative measures can be managed surgically under an umbrella of medications. Circular canalicular intubation with its excellent stability and low morbidity is a valuable adjunctive to the 3-snip mini rectangular punctoplasty. When the passage of the pigtail lacrimal probe fails, circular tubes can be inserted with the RCI technique.