A review of bypass tubes for proximal lacrimal drainage obstruction

Proximal obstruction of the lacrimal drainage system is typically managed with conjunctivodacryocystorhinostomy and lacrimal bypass tubes, a technique first described in 1962 by Lester Jones. This initial approach utilizes a temporary stent to allow epithelialization of the fistula. Over the last 49 years numerous alterations to this technique have been described, including permanent intubation of the lacrimal bypass fistula, now the most common approach. We review the range of available lacrimal bypass tubes, indications for their use, and surgical techniques for their insertion and focus on improving success rates and minimising short and long-term complications.