Ipswich lacrimal tube: pedicle nasal septal tube for the reconstruction of lacrimal drainage passage

Canalicular blockage of the lacrimal system still remains a major challenge for oculoplastic surgeons. The conventional treatment of conjunctival dacryocystorhinostomy using the Lester Jones bypass tube is often associated with tube migration and foreign body reaction. The authors report a new technique to reconstruct the lacrimal passage on a single patient with severe canalicular obstruction following repeated failures from previous Lester Jones tube operations. An epithelial-lined tube was recreated between the nasal cavity and the conjunctiva using a superiorly based mucoperichondrial flap from the nasal septum (Ipswich lacrimal tube). The pedicle of the flap was divided six weeks following the operation. The patient was still symptom free two years following the operation together with a positive dye test confirming the patency of the new lacrimal tube.