Effectiveness of Primary Monocanalicularnasal Intubation With Monoka Tubes and Nasal Endoscopic Findings for Congenital Nasolacrimal Duct Obstruction With Enlarged Lacrimal Sac and Chronic Dacryocystitis

Backgrounds: We report successful outcomes of monocanalicularnasal intubation with Monoka tubes and endoscopic findings for Hasner valve area. This method is presented as a primary treatment modality in congenital nasolacrimal duct obstruction (CNLDO) with an enlarged lacrimal sac and chronic dacryocystitis. Methods: In a prospective noncomparative consecutive case series, 23 eyes of 18 patients with CNLDO with an enlarged lacrimal sac and chronic dacryocystitis underwent endoscopic probing and monocanalicularnasal intubation under general anesthesia. Demographic information, including age, sex, duration of preoperative symptoms, operative endoscopic findings, timing of silicone tube removal, follow-up periods, complications, and outcomes, was analyzed. Results: The study included 23 eyes of 18 patients. Mean (SD) age was 19.7 (12.2) months (range, 9-48 mo). Under nasal endoscopic view, the probe tip protruded through a balloon-like nasal mucosa around the Hasner valve. In all cases, tubes were removed in an office setting under topical anesthesia. Mean follow-up period was 24.6 (5.4) weeks. Complications, such as punctal slitting and corneal abrasion, were not observed. All patients showed successful results until the final follow-up. Conclusions: In cases of CNLDO with an enlarged lacrimal sac and chronic dacryocystitis, monocanalicular intubation is recommended rather than simple probing. Monoka tube intubation has the advantages of technical ease of insertion and tube removal. Moreover, the tubing does not threaten the unprobed part of the lacrimal drainage system. Endoscopic findings revealed that the probe tip protruded through a balloon-like nasal mucosa with pus around the Hasner valve.