[Prognosis of conjunctivo-dacryocystorhinostomy. Modification with different implant materials]

In cases of total canalicular occlusion or the total absence of the lacrimal apparatus the functional restoration requires the repair of a newly created lacrimal system. The intraoperatively reestablisted lacrimal drainage from the conjunctival sac will be maintained by a plastic tube. Beside other criteria the influence of the used inserted materials polyethylene or silicone should be evaluated.

From 9/1978 to 2/1999 we have been treated and consecutive documented 37 cases of conjunctivodacryocystorhinostomy and its modifications in 36 patients (1mal both eyes). The patients (22 men, 14 women) ranged in age from 9-76 years (mean age of 35.2 years). In a retrospective review results were compared for the following two groups based on the type of used plastic tube: group I: (n = 23); insertion of a polyethylene tube (from 1976-1990); group II: (n = 14) insertion of a silicone tube (from 1991-1998).

Causes of lacrimal drainage system obstruction were trauma (n = 21), malformation (n = 8), chronic inflammation (n = 5) and tumor (n = 2). The following different surgical techniques were performed: conjunctivodacryocystorhinostomy (cdr, n = 23), conjunctivodacryocystostomy (cd, n = 10) and conjunctivorhinostomy (cr, n = 4), (right eye: n = 21, left eye: n = 16). In group I 14 of 23 operations (61%) had successful functional results, in group II 10 of 14 operations (72%), respectively. The polyethylene tubes on the average were maintained for 15 months after surgery (4mal spontaneous removal) and the silicone tubes for 12 months, respectively (4mal spontaneous removal).

Traumatic disturbance and congenital defects of canaliculi and surrounding tissue require in the case of any symptoms the surgical reconstruction of the lacrimal pathway. With the introduction of the silicone tube the success rate could be further advanced.