Conjunctivodacryocystorhinostomy is a procedure by which a fistula is
created between the medial commissural conjunctiva in to the nasal
cavity. A Pyrex glass tube (Jones tube) is placed within the fistula to
keep it functioning.
1. Canalicular agenesis
2. Canalicular obstruction
3. Common canalicular obstruction
4. Lacrimal pump dysfunction (e.g. facial palsy)
is ideally performed under general anesthesia. It can also be performed
under local anesthesia if the condition warrants.
incision and conjunctival dissection: A self retaining eye lid speculum
is used to provide adequate exposure of the medial conjunctiva.
Anterior half of the caruncle is excised using 15 blade. The posterior
portion of the caruncle is left intact to protect the medial
conjunctiva from inflammation that is associated with contact with the
Figure showing transcanalicular incision
The anterior edge of the incision is
retracted using a fine double hook retractor. The soft tissues
overlying the lacrimal bone are spread using blunt dissection. This
procedure reveals the underlying lacrimal bone.Step II:
Bone removal and catheter placement:
opening is created in the lacrimal gland with the help of high speed
drill. The window created should be approximately 8 mm in diameter. A
14 gauge iv catheter that contains an internal trocar is introduced at
a 45 degree angle through the window created in the lacrimal bone,
penetrating the nasal mucosa to enter the nasal cavity. This procedure
is ideally completed under endoscopic guidance.
Figure showing opening being created in the lacrimal bone
Figure showing 14 gauge catheter being introduced
Jones tube insertion and placement:
measuring the approximate length of the cannula inserted, a Jones tube
with 4 mm diameter is inserted via the cannula which is then removed
after successful insertion. This step again is endoscopically guided.
Picture showing Jones tube in position
tube is anchored in position using Vicryl sutures. The functioning of
this tube is checked by instilling fluorescein dye impregnated solution
in to the conjunctiva. Its clearance is checked using an endoscope and
seeing it drain into the nose through the Jones tube.