Efficacy of Monocanaicular Intubation in Management of Proximal Versus Distal Lacrimal Canalicular Laceration

Abstract

Purpose: To detect the effect of laceration depth on the surgical outcomes of monocanalicular intubation in cases of lacrimal monocanalicular laceration and to detect the association between the distance of lacrimal canalicular laceration and other preoperative clinical characteristics.

Patient and Methods: A retrospective review was done for the medical records of 60 patients who underwent primary repair of lacrimal monocanalicular laceration by Mini-monoka monocanalicular lacrimal intubation. The patients were divided into two groups: Group I: included patients underwent repair of proximal canalicular laceration and group II: included patients who underwent repair of distal canalicular laceration. Demographic data were collected, etiology of injury, depth of laceration, interval between injury and surgical repair, duration to stent removal. Patients were followed regularly on 1st day, 1 week, and every month up to 6 months after the procedure and 3 months after stent removal. At the end of follow up period anatomical success was defined  as negative fluorescein dye disappearance test and patent canaliculus on irrigation of lacrimal passages. Functional success was defined as absence of tearing.

Results: Patients’ sex, age, etiology of trauma, time to stent removal, interval between trauma and surgical repair were not found to have a statistically significant difference between both groups. There was a significant difference between both groups regarding associated injuries (P< 0.001).Complete anatomical success was achieved in 30 patients (83.3%) in group I and 12 patients (50%) in group II. There was significant difference between studied groups regarding anatomical success (P=0.009). Complete functional success was achieved in 26 patients (72.2%) in group I and 14 patients (58.3%) in group II. There was a significant difference between studied groups regarding functional success (P=0.01). There was significant difference between studied groups regarding risk of granuloma formation and structural deformity of the medial canthal region (P=0.001) and (P=0.004) respectively.

Conclusions:     Surgical outcome of lacrimal canalicular laceration repair is affected by the depth of laceration. This study reported better anatomical and functional outcomes with minimal postoperative complications in proximal canalicular laceration compared to distal canalicular laceration. Associated injuries are more common in distal lacrimal canalicular lacerations than proximal lacrimal canalicular lacerations.