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Surgical technique provides permanent, reversible treatment for refractory dry eye
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Canalicular ligation is an effective, permanent surgical treatment for refractory dry eye, according to a recent study. The procedure can be easily reversed if patients develop epiphora or other bothersome conditions, the study authors said.
Sheri L. DeMartelaere, MD, and colleagues at Texas Oculoplastic Consultants in Austin, Texas, reviewed their results in a consecutive series of 59 eyelids of 29 patients treated with canalicular ligation for refractory keratoconjunctivitis sicca over a 7-year period.
Canalicular ligation was developed as a potentially reversible technique that avoids complications associated with similar permanent surgeries, the study authors said. In the technique, a full thickness, vertical eyelid margin incision is made perpendicular to the gray line and 2 mm nasal to the punctum. It is continued to the horizontal portion of the canaliculus without disturbing the ampulla or punctum. The surgeon then oversews both the proximal and distal canalicular ends and sutures the eyelid margin incision anteriorly and centrally.
No intraoperative or postoperative complications were seen in the study. With a mean 20 months of follow-up, 91% of patients reported an improvement in symptoms. All patients were satisfied with their results, based on their responses to subjective questionnaires.
Two patients who developed symptomatic epiphora more than 1 year postoperatively underwent "uncomplicated reversal" under local anesthesia, the study authors said. Both patients remained symptom-free at final follow-up.
"The technique we now present is performed on an outpatient basis, under local anesthesia, without requiring the use of special equipment, and can be performed by any ophthalmologist comfortable with the repair of canalicular injuries," Dr. DeMartelaere and colleagues said. "It provides a superb cosmetic result while not disrupting the puncta, ampulla or distorting the eyelid margin, thus assuring patency of the remaining canalicular drainage system. The remaining canaliculus is then available to reestablish drainage should excessive tearing develop. This is the major advantage of this procedure."
The procedure, which uses suture ligation rather than cauterization, allows easy reversibility and prevents the buildup of scar tissue that can lead to epiphora, the authors said.
The study is published in the October issue of Ophthalmic Plastic and Reconstructive Surgery.