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Conjunctivoductivo‐Dacryocystorhinostomy: A Novel Surgery for Intractable Canalicular Obstruction

INTRODUCTION Tear fluid enters the lacrimal sac from the upper and lower punctum at the medial canthus through the superior and inferior canaliculi and then flows through the nasolacrimal duct into the nose. Obstruction in any part of the abovementioned lacrimal passage is the most common cause of epiphora, also known as excessive watering of the eye. Epiphora can be symptomatic of other underlying conditions and affects the quality of life (QOL) of patients. Canalicular obstruction can occur in either the upper or lower canaliculi; when both are obstructed, the tear fluid is not secreted from the nasolacrimal duct toward the nose, resulting in epiphora. Although the cause of canalicular obstruction is unknown in many cases, it may be influenced by aging, trauma, tumors, and oral anticancer medication. The first response is to enlarge the canaliculus by inserting a silicone tube, a surgical procedure commonly known as canaliculoplasty. However, the placement of a Jones tube or canaliculi-dacryocystorhinostomy with an external incision is only considered when the canaliculus is reoccluded or cannot be kept open. Jones tube placement was first reported in 1965 and is the gold standard for treating canalicular obstruction; it includes the semi-permanent placement of a glass tube through the medial canthus into the nasal cavity. One problem associated with this procedure is the need to implant a foreign body in semi-permanent detention. Lifelong hospital visits to clean and replace the tube are therefore required. In addition, complications such as eye pain, dry eye, foreign body sensation, infection, mechanical strabismus, diplopia, positional abnormalities, prolapse, and implantation may also occur in some cases. Canaliculo-dacryocystorhinostomy is performed with an external incision of approximately 2 cm on the side of the nose, thus leaving a scar. Additionally, the surgery is complicated and the infrastructure necessary to perform it is limited. The treatment of canalicular obstruction is essential in improving the QOL of patients. However, there is no nonexternal incisional surgery that does not require the insertion of a foreign body to treat intractable canalicular obstruction, as opposed to endoscopic dacryocystorhinostomy, which is a nonexternal incisional surgery for nasolacrimal duct stenosis. To address the aforementioned issues, we introduce a novel method, “conjunctivoductivodacryocystorhinostomy,” for anastomosis of the conjunctiva and nasolacrimal duct without leaving any facial scars or foreign bodies in semi-permanent detention.