Silicone intubation with the Ritleng method in children with congenital nasolacrimal duct obstruction

Purpose: To evaluate the technical properties and clinical efficacy of bicanalicular silicone intubation with the Ritleng method in children with congenital nasolacrimal duct obstruction. Methods. The Ritleng method was used for lacrimal intubation in 50 eyes of 42 consecutive patients (mean age, 37.3 months). All procedures were done by or under the supervision of one surgeon. The hollow Ritleng probe was inserted via the canaliculus into the inferior meatus. The polypropylene (Prolene) thread-guide, attached to the silicone tube, was advanced through the probe. Either the Prolene emerged from the nose spontaneously or it was retrieved using a hook without visualization. The tube ends were sutured to the nasal wall. Tube removal was planned for 3 months postoperatively. Resolution of signs and symptoms of lacrimal obstruction was assessed. The mean follow-up time was 18.1 months (range, 3 to 48 months). Results. The silicone tube was placed successfully in all eyes except 1 (98%). The mean procedure time was 26 minutes for each eye (range, 15 to 45 minutes). Both Prolene guides spontaneously emerged from the nose in only 8 eyes (16%). In the others, one or both Prolene guides were retrieved with a hook. Inadvertent tube dislodgement occurred in 21% of the eyes and required early tube removal. Success, ie, relief of signs and symptoms, was achieved in 86% of eyes. Conclusions:The Ritleng method of intubation for congenital nasolacrimal duct obstruction yields a high rate of success. Contrary to previous reports, our experience suggests that the surgeon must be prepared to retrieve the Prolene guide from the nose.