The Effectiveness of Lacrimal Trephination for the Treatment of Canalicular Obstruction

Jeihoon Lee; Jung Bum Choi

doi:10.3341/jkos.2011.52.7.783

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Lee and Choi: The Effectiveness of Lacrimal Trephination for the Treatment of Canalicular Obstruction

Original Article

J Korean Ophthalmol Soc 2011;52(7):783-787.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.7.783

The Effectiveness of Lacrimal Trephination for the Treatment of Canalicular Obstruction

Jeihoon Lee, MD^1,², Jung Bum Choi, MD²

¹Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea

²Siloam Eye Hospital, Seoul, Korea

Address reprint requests to Jung Bum Choi, MD Siloam Eye Hospital #512-5, Deungchon 2-dong, Gangseo-gu, Seoul 157-836, Korea Tel: 82-2-2650-0880, Fax: 82-2-2650-0895, E-mail: jb-choi@hanmail.net

Received 22 July 2010 Revised 30 December 2010 Accepted 27 April 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To determine the effectiveness of lacrimal trephination to treat canalicular obstruction.

Methods

Silicone intubation following lacrimal trephination was performed in 38 eyes of 29 patients with epiphora due to canalicular obstruction between December 2005 and October 2009. Medical records were retrospectively reviewed and telephone interviews were performed. The severity of epiphora was graded by Munk's scale, and anatomical improvement was evaluated by postoperative probing and syringing.

Results

The procedure was successful in 73.7% of the cases (grade 0 or 1), and 68.4% of the eyes had complete resolution of epiphora (grade 0). The anatomical success rate was 81.6%.

Conclusions

Lacrimal trephination is a simple and effective treatment for canalicular obstructions. Therefore, lacrimal trephination could be performed prior to attempting an invasive conjunctivodacryocystorhinostomy.

Keywords: Canalicular obstruction, Lacrimal trephine, Munk's scale, Silicone tube intubation

References

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Figure 1.

Lacrimal trephine.

Figure 2.

Preoperative and postoperative Munk's scale. We used a reduction of epiphora to grade 0, or 1 as the criterion for success. On average, 73.7% of eyes had substantial improvement of epiphora.

Figure 3.

Improvement of epiphora according to the level of obstruction. We defined the improvement of epiphora as post-operative Munk's grade 0, or 1.

Figure 4.

Anatomical improvement according to the level of obstruction.

Table 1.

Munk's scale

Grade 0	No epiphora
Grade 1	Occasional epiphora requiring dabbing with a tissue or handkerchief less than twice a day
Grade 2	Epiphora requiring dabbing two to four times a day
Grade 3	Epiphora requiring dabbing five to ten times a day
Grade 4	Epiphora requiring dabbing more than 10 times a day or constant tearing

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