Journal List > J Korean Ophthalmol Soc > v.57(1) > 1010322

Kim, You, and Min: The Clinical Outcome of Endoscopic Endonasal Silicone Tube Intubation According to Nasolacrimal Duct Resistance



To evaluate the clinical result of silicone tube intubation through Hasner’s valve according to nasolacrimal duct resist-ance under intranasal endoscopic guidance in partial acquired nasolacrimal duct obstruction patients.


The present study enrolled a total of 50 eyes from 31 patients diagnosed with partial acquired nasolacrimal duct ob-struction in the Department of Ophthalmology, Chonbuk National University Hospital from 2012 January to 2012 December. Silicone tube intubation was done through the Hasner’s valve and confirmed by intranasal endoscopy and the nasolacrimal duct resistance was measured. Success was defined as the disappearance of epiphora, and failure was defined as the maintenance of epiphora after silicone tube intubation.


There were 8 male patients and 23 female patients, ages between 32 to 80 and the average age was 61.4 years old. 3 eyes of 3 patients (6%) had no resistance, 26 eyes of 17 patients (52%) had mild resistance, 17 eyes of 15 patients (34%) had moderate resistance and 4 eyes of 3 patients (8%) had severe resistance. The success was 44 eyes (88%) and the failure was 6 eyes (12%). In the no resistance and mild resistance groups the success rates were both 100%, while an 82% of success rate in the moderate resistance group and 25% success rate in the severe resistance group were observed. The success rates showed clear distinction between severe, moderate and mild resistance patients.


Ensuring the passage of a silicone tube through Hasner’s valve increases the success rate in the functional aspect; however, the resistance of the nasolacrimal duct can highly influence the success rate. Therefore, if a patient has severe nasola-crimal duct resistance, dacryocystorhinostomy should be considered earlier.


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Figure 1.
Intraoperative findings. (A) Intranasal endoscopic observation of Hasner's valve. (B) Ensuring the passage of probe by intranasal endoscopy.
Table 1.
Demographic data of the patients
Factor N = 31 (eye = 51) %
 Male 8 (10) 25
 Female 23 (40) 75
 31-40 years old 1 3.1
 41-50 years old 3 9.7
 51-60 years old 10 32.3
 61-70 years old 10 32.3
 71-80 years old 7 22.6
 Mean ± SD (years old) 61.4 ± 10.8
 Right (24) 48
 Left (26) 52
 Both 19
 No resistance (3) 6
 Mild resistance (26) 52
 Moderate resistance (17) 34
 Severe resistance (4) 8

Values are presented as mean ± SD unless otherwise indicated.

Table 2.
Success rate of endoscopic endonasal silicone tube in tubation
N Success rate (%)
No resistance 4 100
Mild resistance 26 100
Moderate resistance 17 82
Severe resistance 4 25
Total 51 88
Table 3.
ANOVA between resistance groups
Sum of square Degree of freedom Root mean square F S Significance probability
Between groups 2.059 3 0.686 9.805 0.000*
Within groups 3.221 46 0.070
Total 5.280 49

ANOVA = one-way analysis of variance.

* p<0.05 statistically significant.

Table 4.
Post-hoc analysis between resistance groups
Resistance N Subset for alpha = 0.05
1 2
Severe resistance 4 0.25
Moderate resistance 17 0.82
No resistance 3 1.00
Mild resistance 26 1.00
Significance probability 1.000 0.288

Means for groups in homogenous subsets are displayed. Duncan.*,† * Uses Harmonic Mean sample size = 6.697; The group sizes are unequal. The harmonic mean of the group sizes is used. Type I er-ror levels are not guaranteed.

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