Endoscopic Placement of Jones Lacrimal Tubes with the Assistance of Holmium YAG Laser

Introduction: The aim of this paper is to highlight the use of the Holmium YAG laser in the endoscopic placement of Lester Jones tubes in patients with a blocked canaliculus or failed lacrimal pump function. Materials and methods: Sixteen cases with a non-functional canaliculus were included over a one-year period. Following caruncle excision, a 19G needle is inserted through the medial canthal tissues into the nasal space. Nasal endoscopy confirms the accurate positioning in relation to the nasal anatomy. With the Holmium YAG laser, a tissue channel is fashioned around the guide needle through the structures of the lateral nasal wall to facilitate an accurate and secure placement of the Jones tube. Results: The endoscopic, laser-assisted placement reduces the operating time to less than 20 minutes, minimizes tissue trauma and does not require the initial surgical steps of an open DCR procedure. There were 14 cases (87.5%) with securely retained tubes and two cases (12.5%) that required tube replacement. The advantage of the procedure is especially great in revision surgery where the ostium is opened through scar tissue. Conclusions: Nasal endoscopy with the assistance of the Holmium YAG laser offers simplicity and precision in the placement of Jones tubes. It minimizes tissue trauma and increases the surgical success rate.