Early loss of monocanalicular silicone tubes in congenital nasolacrimal duct obstruction: Incidence, predictors, and effect on outcome

Purpose: To study predictors and implications on outcome of premature silicone tube-loss, a postoperative complication of monocanalicular intubation (MCI) performed for treatment of congenital nasolacrimal duct obstruction (CNLDO). Methods: We conducted a retrospective analysis of cases of post-operative loss of monocanalicular silicone tubes occurring at one medical center from January 2007 to December 2013. Results: During the study period monocanclicular silicone tubes were lost in 24/54 eyes (44%) of 19/46 children. Multivariate regression analysis identified bilateral intubation as an important predictor of early tube-loss (r = 0.54, P = 0.006). Seven of eight (88%) children who had both eyes intubated prematurely lost their tubes compared to 12/38(32%) children who had unilateral intubation (P = 0.005). Treatment success was lower in eyes with early tube-loss (17/24 eyes, 71%) compared to eyes with full tube retention (25/30 eyes, 83%), however this difference was not statistically significant (P = 0.333). In our study, treatment outcome correlated with duration of intubation (r = 0.51, P = 0.002). Surgical success was achieved in 33/39 eyes (85%) in which the tubes were retained at least 2 months compared to 7/15 eyes (47%) with shorter period of intubation (P= 0.012). Conclusions: Spontaneous tube-loss is a post-operative complication of monocanalicular silicone intubation that can occur more frequently than previously reported in certain populations. Tube-loss occurring soon after surgery is often associated with persistent symptoms and increased need of reoperation. (C) 2014 Elsevier Ireland Ltd. All rights reserved.