Proper instrumentation helps target canalicular disease

Key Points

Las Vegas-Diseases of the canaliculus can be managed successfully by surgeons with an accurate knowledge of the canalicular anatomy and training in the latest techniques to clear the obstructions, according to Don O. Kikkawa, MD, who spoke at the American Academy of Ophthalmology annual meeting.

Several tools are available for treating obstructions associated with canalicular disease. The pigtail probe, he explained, can be utilized with an apposing intact canaliculus. One side of the probe is used for the right upper and left lower eyelids and the other side for the left upper and right lower eyelids. Dr. Kikkawa is professor of clinical ophthalmology, and chief of Division of Ophthalmic Plastic and Reconstructive Surgery, Shiley Eye Center, University of California, San Diego, in La Jolla.

A microtrephine, composed of a 0.81-mm cutting tip and an easily removable stylet, can be used for some obstructions of the canaliculus.

Diseases of the canaliculus

"The diseases of the canaliculus are broadly defined as developmental and acquired. Regarding the former, atresia, an absence of the upper system including the canaliculus and the puncta, is typically seen," Dr. Kikkawa said.

Occasionally, in young children, he said, he has tried to re-establish a mucosal line drainage using multiple silicone stents with a mucosal line track. The prognosis is poor for maintaining a mucosal line conduit, Dr. Kikkawa said. "The gold standard for these patients continues to be the conjunctival dacryocystorhinostomy (DCR), and we typically use the endoscopic approach," he said.

Canalicular trauma can be divided into two categories, the avulsion type involving medial canthal degloving or a laceration that is typically from a penetrating injury, Dr. Kikkawa said.

Bicanalicular intubation remains the gold standard; the monocanalicular stents, however, are ideal for isolated, single lid lacerations, he said. These stents can be used in the office with local anesthesia. One complication associated with the stents is extrusion; also, the tip of the stent can rise and cause a foreign body sensation. In addition, Dr. Kikkawa said, when the plug is in place, there is no flow through the segment that was repaired.