Trephination and silicone tube intubation in the treatment of canalicular obstruction

Purpose To evaluate the efficacy of trephination and monocanalicular/bicanalicular silicone tube use depending on the number of affected canaliculi in patients with canalicular obstruction. Methods This retrospective study included 46 eyes of 36 patients who underwent trephination and silicone tube intubation performed by a single experienced oculoplastic surgeon due to canalicular obstruction between 2005 and 2020. Monocanalicular silicone tube was applied to patients with one canalicular obstruction, and bicanalicular silicone tube was applied to those with the upper and lower canalicular involvement of the same eye. Canalicular obstructions were divided into groups according to their localization as proximal, middle, and distal. The silicone tubes were kept in place for at least 5 months after the operation, and the follow-up duration of the patients was at least 12 months. Results Twenty (55.6%) patients were female and 16 (44.4%) were male. The mean age was 15.82 +/- 7.02 years in the treatment success group and 28.87 +/- 12.74 years in the treatment failure group (p = 0.001). While 67.6% of the eyes in the treatment success group had monocanalicular obstruction (monocanalicular silicone tube applied), 66.7% of those in the treatment failure group had bicanalicular obstruction (bicanalicular silicone tube applied) (p = 0.049). The most common distal obstruction was seen in the treatment success group, and the least distal obstruction and the most proximal obstruction were observed in the treatment failure group (p < 0.001). The mean duration silicone tube stay was 9.37 +/- 1.96 months in the treatment success group and 7.25 +/- 1.42 months in the treatment failure group (p = 0.003). Conclusion We consider that trephination with the use of a monocanalicular or bicanalicular silicone tube depending on the number of affected canaliculi can be the first choice of treatment in canalicular obstruction due to its high success rate, especially in distal obstruction.