Aric Vaidya , Tushar Sarbajna , Hirohiko Kakizaki & Yasuhiro Takahashi
A 35-year-old woman complained of an unpleasant odor for a few days after a change in foundation cream. The patient had previously undergone conjunctivo-dacryocystorhinostomy with a Jones tube fixed with non-absorbable suture. Slit-lamp examination revealed an orange-colored discharge in the tube. A culture test of the discharge showed Corynebacterium kroppenstedtii (1+), Aspergillus versicolor (1+), and Mycobacterium chelonae (1+). After medical treatment and suture removal, the discharge completely disappeared. This is the first reported case of a Jones tube infection following conjunctivo-dacryocystorhinostomy with multiple microorganisms, including C. kroppenstedtii.
Excessive tearing caused by blocked tear ducts is a condition often encountered by the lacrimal surgeon. When the obstruction is due to canalicular damage, the most common management approach is conjunctivodacryocystorhinostomy (CDCR). This surgical technique, introduced by Jones in 1962,1 consists of inserting a Pyrex® tube (Lester Jones tube; Gunther Weiss, Portland, OR) into the nasal cavity to bypass the blocked canaliculi completely.1,2
Ilse Mombaerts, Elodie Witters
Background/aims Although a Jones tube is considered the mainstay for epiphora in patients with total blockage of the canalicular system, it has been discouraged in children for reasons of inadequate self-care and maintenance. The purpose of this study is to compare the long-term outcome of Jones tube surgery in paediatric versus adult patients.
Methods Retrospective, interventional case series of a single academic institution. The medical records of all children (≤16 years old) and adults (>16 years old) who underwent conjunctivorhinostomy with placement of a 130° angled extended Jones tube were reviewed. The outcome measures were patency and anatomical position of the tube, type and frequency of complications and subjective relief of epiphora.
Results The study included 10 children (11 eyes) (range, 5.1–16.0 years old) and 102 adults (127 eyes) (range, 19.7–82.4 years old). The success and complication rate did not differ between the two age groups. Tube dislodgement and obstruction occurred in 4 (36.4%) of the paediatric tubes with an incidence rate of 6.1%/year and in 47 (37.0%) of the adult tubes with an incidence rate of 9.3%/year (p=0.3867). Two adults required routine self-irrigation of the tube. The median follow-up was 6.7 years for the children and 8.7 years for the adults (p=0.3430).
Conclusion With a similar outcome profile and minimal self-care, young age is not a prognostic nor limiting factor for surgery with angled Jones tubes. Exchange with tubes of a longer length is not required during growth.
Yongwei Guo, Konrad, R. Koch, Ludwig M. Heindl
For more than 50 years, the Lester Jones tube—a bypass between the conjunctiva and the nasal cavity—is the gold standard for managing epiphora secondary to upper lacrimal outflow obstructions . However, these Pyrex glass tubes are often considered to have tube migration or extrusion in up to 50% of the cases . Recently, the StopLoss Jones tube (SLJT), an innovation in Pyrex glass tubes with an internal silicone flange bonded, was reported to reduce the risk for tube extrusion [3, 4]. Tube insertion requires a bony ostium, which in some cases might preexist due to previous dacryocystorhinostomy (DCR). However, in patients without previous DCR, an external transcutaneous approach is needed for correct tube placement. Herein, we describe—to the best of our knowledge for the first time—a novel transcaruncular diode laser-assisted, StopLoss Lester Jones tube procedure without any skin incisions for the treatment of lacrimal canalicular obstructions……
Henriksen, Brad; Perry, C. Blake; Ng, John D.
Conjunctivodacryocystorhinostomy with placement of a Jones tube (JT) is the gold standard for upper lacrimal system dysfunction. However, traditional JT have been associated with various complications. In their practice, the authors have encountered challenges with postoperative dry eye in a select group of patients, with recurrence of epiphora following tube occlusion, suggesting a need for decreasing the rate of tear drainage while maintaining a patent JT. To address this issue, the senior author (J.D.N.) introduced a modified JT with a narrow lumen (reduced-flow JT) for patients who experience significant dry eye symptoms after placement of a JT. The authors describe 3 patients who experienced improvement in dry eye symptoms after the placement of reduced-flow JT.
R L Scawn, D H Verity and G E Rose
Lester Jones described canalicular bypass tubes 50 years ago. We present a cohort of patients with Jones’ tubes first placed between 1969 and 1989, and who were reviewed within the last 15 years.
Patients and methods
Retrospective case-note review for living patients identified as having had Jones’ tube placement prior to 1990. The duration of Jones’ tube usage was noted and the number of replacements recorded.
Twenty-nine patients (33 eyes) had maintenance of their Jones’ tube(s) within the last 15 years, and had first tube placement before 1990. The average follow-up was 29.5 years (median 28.8 years, range 17–45.7 years). The original tube was present in 8/33 (24%) of eyes, at a mean survival of 34 years (33.3 years; range 29.4–44.4 years). The number of tube replacements during follow-up ranged from 0 to 9 (mean 1.7; median 1). When considering the initially placed tube in all 33 eyes, however, the survival ranged between 18 days and 44.4 years (mean 13.6 years; median 6.9 years). At last follow-up, 11/33 (33%) of eyes had lost their tubes, with 9 having minimal or no symptoms.
These patients with Jones’ tube placement before 1990 provides the first recorded evidence that the device can be tolerated for at least four decades, and that some patients will—with appropriate outpatient maintenance—retain their originally placed tube. This information may be useful in counselling patients about the lifetime expectation for bypass tubes.
Jung Hye Lee, Stephanie Ming Young, Yoon-Duck Kim, Kyung In Woo, Jung-Hoon Yum
To report the surgical results of canaliculorhinostomy for patients with distal canalicular obstruction and lacking a structurally functional lacrimal sac who would otherwise require a conjunctivodacryocystorhinostomy (CDCR) with Jones tube placement.
Retrospective observational case series.
Setting: Single tertiary institution. Period: November 1994 to June 2011. Patient Population: Sixteen patients with canalicular obstruction at or beyond 8 mm from the punctum, with an absent or unidentifiable lacrimal sac. Intervention: Patients underwent canaliculorhinostomy, whereby direct anastomosis of the canaliculi or common canaliculus to the nasal mucosa was performed. Main Outcome Measures: Anatomic and functional success.
Our study comprised 16 patients with a mean age of 44.9 ± 21.9 years. Ten (62.5%) were female and 6 (37.5%) male. Mean duration of follow-up was 7.8 years. Causes of an absent or unidentifiable lacrimal sac included previous trauma (n = 8, 50.0%), previous dacryocystorhinostomy (n = 4, 25.0%), chronic dacryocystitis (n = 3, 18.8%), and previous dacryocystectomy (n = 1, 6.2%). Anastomoses between the upper and lower canaliculi and the nasal mucosa was performed in 6 patients, while that between the common canaliculus and nasal mucosa was performed in 10. Anatomic and functional success rates were 87.5% (n = 14) and 81.3% (n = 13), respectively.
Ahn, Eric S.; Hauck, Matthew J.; Kirk Harris, Jonathan; Robertson, Charles E.; Dailey, Roger A.
Purpose: To investigate the presence and microbiology of bacterial biofilms on Jones tubes (JTs) by direct visualization with scanning electron microscopy and polymerase chain reaction (PCR) of representative JTs, and to correlate these findings with inflammation and/or infection related to the JT.
Methods: In this study, prospective case series were performed. JTs were recovered from consecutive patients presenting to clinic for routine cleaning or recurrent irritation/infection. Four tubes were processed for scanning electron microscopy alone to visualize evidence of biofilms. Two tubes underwent PCR alone for bacterial quantification. One tube was divided in half and sent for scanning electron microscopy and PCR. Symptoms related to the JTs were recorded at the time of recovery.
Results: Seven tubes were obtained. Five underwent SEM, and 3 out of 5 showed evidence of biofilms (60%). Two of the 3 biofilms demonstrated cocci and the third revealed rods. Three tubes underwent PCR. The predominant bacteria identified were Pseudomonadales (39%), Pseudomonas (16%), and Staphylococcus (14%). Three of the 7 patients (43%) reported irritation and discharge at presentation. Two symptomatic patients, whose tubes were imaged only, revealed biofilms. The third symptomatic patient’s tube underwent PCR only, showing predominantly Staphylococcus (56%) and Haemophilus (36%) species. Two of the 4 asymptomatic patients also showed biofilms. All symptomatic patients improved rapidly after tube exchange and steroid antibiotic drops.
Conclusions: Bacterial biofilms were variably present on JTs, and did not always correlate with patients’ symptoms. Nevertheless, routine JT cleaning is recommended to treat and possibly prevent inflammation caused by biofilms.