Beyond dacryocystorhinostomy: our experience with the Jones tube for the treatment of epiphora.

Abstract

Introduction: Ocular epiphora is excessive tearing caused by an imbalance between tear production and drainage. In cases of lacrimal pathway obstruction, dacryocystorhinostomy (DCR) or conjunctivodacryocystorhinostomy (C-DCR) are the techniques commonly used for treatment. In complex cases, the Jones tube (JT) represents an effective surgical option, although not free of complications. The aim of this study was to describe the experience of the University Hospital of Torrejón with JT implantation and to analyze the factors associated with its patency.

Material and methods: A retrospective analytical study was conducted on patients who underwent DCR or C-DCR between 2017 and 2024. A total of 15 patients (23 eyes) with indication for JT placement were included. Variables analyzed included sex, age, laterality, previous diagnostic studies, site of obstruction, previous dilatation, number and type of surgeries, surgical technique, JT placement and size, reoperations, postoperative complications, and patency at 1, 3, 6, and 12 months. Statistical analysis was performed using SPSS software, applying Fisher´s exact test to assess the association between clinical factors and patency.

Results: Of the 15 patients, 14 were women (93.3%) with a mean age of 62 years. Left unilateral involvement was observed in 46.7% (7/15) of cases, while bilateral involvement was present in 53,3% (8/15). Previous lacrimal pathway dilatations had been performed in 26.1% of the 23 eyes (6/23). Technical placement of the Jones tube was successful in 16 of the 17 eyes in which implantation was attempted (94.1%). The surgical approach was external in 11 of 17 cases (64.7%) and endoscopic in 6 (35.3%). The median number of surgical interventions per eye was 2. Among the 16 implanted tubes, the most frequent complications were extrusion (7/16; 43.8%) and obstruction (4/16; 25.0%). Patency rates were 88.2% at 1 month, 52.9% at 3 months, and 23.5% at 6 and 12 months. A significant association was found between previous dilatation and greater patency at 6 and 12 months (Fisher's exact test, p* = 0.022).

Discussion and conclusion: DCR or C-DCR with a Jones tube may be considered an alternative in refractory lacrimal obstruction, although it carries a considerable complication rate, with progressive decline in patency comparable to that described in the literature. Previous dilatation may be associated with better outcomes. However, prospective studies with larger sample sizes are needed to obtain more conclusive results.