To evaluate long-term outcomes of maintenance of lacrimal silicone stent for the management of functional epiphora after anatomically patent external dacryocystorhinostomy (DCR).
We retrospectively reviewed the medical records of 101 eyes of 75 patients who were diagnosed to have functional epiphora after external DCR from 2005 to 2014. Functional epiphora was defined as epiphora that persisted or recurred even after patent DCR confirmed by a lacrimal irrigation test. Secondary silicone intubation was indicated when the patients wanted a further intervention. The stent was intended to be kept in situ unless there was a stent-related complication or the patient wanted removal.
In total, 34 of 75 patients (45.3%, 52 eyes) who agreed to the intervention underwent secondary silicone intubation. The success rates at 1, 3, and 5 years after surgery were 96.2%, 75.5%, and 70.2%, respectively. At the final follow-up (mean 72.7 ± 26.4 months), 32 (61.5%) eyes chose to retain the silicone tube: silicone stent was well maintained without epiphora and complications once inserted in 18 eyes (34.6%), whereas tube replacement was needed in 14 eyes (26.9%) because of nasal crust or whitish plaque formation on the tube surface. In 13 cases (25.0%), silicone stent was removed because of tube-related complications, and the most common complication was canaliculitis (n = 8, 15.4%).
Secondary intubation and maintenance of the stent is an effective and simple procedure for functional epiphora. The main obstacle to long-term maintenance is tube-associated canaliculitis.
Subscribe to Journal
Get full journal access for 1 year
only $41.58 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
Beshay N, Ghabrial R. Anatomical and subjective success rates of endonasal dacryocystorhinostomy over a 7-year period. Eye. 2016;30:1458–61.
Coumou AD, Genders SW, Smid TM, Saeed P. Endoscopic dacryocystorhinostomy: long-term experience and outcomes. Acta Ophthalmol. 2016;95:74–8.
Lee MJ, Khwarg SI, Kim IH, Choi JH, Choi YJ, Kim N et al. Surgical outcomes of external dacryocystorhinostomy and risk factors for functional failure: a 10-year experience. Eye. 2017;31:691–7.
Sahlin S, Rose GE. Lacrimal drainage capacity and symptomatic improvement after dacryocystorhinostomy in adults presenting with patent lacrimal drainage systems. Orbit. 2001;20:173–9.
Shams PN, Chen PG, Wormald PJ, Sloan B, Wilcsek G, McNab A, et al. Management of functional epiphora in patients with an anatomically patent dacryocystorhinostomy. JAMA Ophthalmol. 2014;132:1127–32.
Kim NJ, Kim JH, Hwang SW, Choung HK, Lee YJ, Khwarg SI. Lacrimal silicone intubation for anatomically successful but functionally failed external dacryocystorhinostomy. Korean J Ophthalmol. 2007;21:70–73.
Hwang SW, Khwarg SI, Kim JH, Choung HK, Kim NJ. Bicanalicular double silicone intubation in external dacryocystorhinostomy and canaliculoplasty for distal canalicular obstruction. Acta Ophthalmol. 2009;87:438–42.
Choung HK, Khwarg SI. Selective non-intubation of a silicone tube in external dacryocystorhinostomy. Acta Ophthalmol Scand. 2007;85:329–32.
Delaney YM, Khooshabeh R. Fluorescein transit test time and symptomatic outcomes after external dacryocystorhinostomy. Ophthalmic Plast Reconstr Surg. 2002;18:281–4.
Detorakis ET, Drakonaki E, Papadaki E, Pallikaris IG, Tsilimbaris MK. Watery eye following patent external DCR: an MR dacryocystography study. Orbit. 2010;29:239–43.
Kaliki S, Ali MJ, Honavar SG, Chandrasekhar G, Naik MN. Primary canaliculitis: clinical features, microbiological profile, and management outcome. Ophthalmic Plast Reconstr Surg. 2012;28:355–60.
Lee MJ, Choung HK, Kim NJ, Khwarg SI. One-snip punctoplasty and canalicular curettage through the punctum: a minimally invasive surgical procedure for primary canaliculitis. Ophthalmology. 2009;116:2027–.e2022.
Zaldivar RA, Bradley EA. Primary canaliculitis. Ophthalmic Plast Reconstr Surg. 2009;25:481–4.
Freedman JR, Markert MS, Cohen AJ. Primary and secondary lacrimal canaliculitis: a review of literature. Surv Ophthalmol. 2011;56:336–47.
Huang YY, Yu WK, Tsai CC, Kao SC, Kau HC, Liu CJ. Clinical features, microbiological profiles and treatment outcome of lacrimal plug-related canaliculitis compared with those of primary canaliculitis. Br J Ophthalmol. 2016;100:1285–9.
Kim DJ, Park JH, Chang M. Species-specific characteristics of the biofilm generated in silicone tube: an in vitro study. BMC Ophthalmol. 2018;18:85.
Kim SE, Lee SJ, Lee SY, Yoon JS. Clinical significance of microbial growth on the surfaces of silicone tubes removed from dacryocystorhinostomy patients. Am J Ophthalmol. 2012;153:253–.e251.
Kim SH, Park CY, Hwang SW, Chang M. Clinical significance of biofilm on silicone tubes removed from patients with nasolacrimal duct stenosis. J Craniofac Surg. 2018;29:462–5.
Samimi DB, Ediriwickrema LS, Bielory BP, Miller D, Lee W, Johnson TE. Microbiology and biofilm trends of silicone lacrimal implants: comparing infected versus routinely removed stents. Ophthalmic Plast Reconstr Surg. 2016;32:452–7.
Conflict of interest
The authors declare that they have no conflict of interest.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Lee, M.J., Park, J., Yang, M.K. et al. Long-term results of maintenance of lacrimal silicone stent in patients with functional epiphora after external dacryocystorhinostomy. Eye 34, 669–674 (2020). https://doi.org/10.1038/s41433-019-0572-2