I appreciated the analysis, by Fan et al,1 of lacrimal surgery outcomes using the relatively new Medpor-coated Jones tube. My experience is much more limited than their 26 cases; nevertheless, I have noted a high likelihood of exuberant conjunctival overgrowth (‘granulation tissue’) arising from the caruncle and plica remnants, presumably a reaction to the Medpor material.

In the paper by Fan et al1, Table 2 cites conjunctival overgrowth severe enough to cause tube obstruction in 23% of cases. I was very enthusiastic about this Jones tube modification, which seemed to promise the elimination of tube extrusion; however, I am now less keen to implant further Medpor-coated Jones tubes.

With reference to the Discussion section of the paper, I recently removed one Medpor-coated tube that had failed due to recurrent conjunctival overgrowth. This was facilitated by passing a no. 11 blade tip down the tract and slitting the Medpor sheath by cutting down onto the tube—allowing the tube to slide out easily, leaving behind a Medpor tract that could then be snipped out with scissors.