Management of bi-canalicular block: A novel technique
A 45-year-old male presented to us with complaint of epiphora in the left eye and a scar at medial canthus following a road traffic accident 1 year ago, with injury to the left upper and lower eyelid involving both the canaliculi. Primary repair of laceration was performed elsewhere, with no canalicular repair. On examination, left medial canthal dystopia of 4 mm and a scar near the canalicular region was noted. Syringing was performed, which revealed proximal lower canalicular obstruction 3 mm from the punctum and 2 mm obstruction from the upper punctum. The rest of ophthalmic examination was normal.\nDuring the surgical procedure, skin incision site was marked for medial canthoplasty in the form of Z. External DCR through subciliary incision was performed. Lacrimal sac was opened and the common ostium was visualised. The stent of silicon tube, ends of which were bent at right angle, were passed retrogradely into the common internal opening and through the lower canaliculus. The tip of probe was palpable near the eyelid margin, distal to the obstruction, and a no. 15 Bard Parker's blade was used to cut down onto the probe tip, thereby creating pseudopunctum []. Similar procedure was performed for the upper eyelid. Silicone intubation was performed through common ostium, out through the lower pseudopunctum and returned through the upper pseudopunctum down through common ostium into the nose []. DCR was then completed in usual way. Monopedicle flap from the upper eyelid containing skin and orbicularis was created. The medial canthal tendon was sutured to periostium of medial orbital rim at the desired location. Upper eyelid monopedicle flap was transposed to the lower eyelid defect, created after suturing the medial canthal tendon.\nTube was removed 3 months post-operatively and on last follow-up (6 months); patient was symptom free with a patent canaliculus on syringing and good cosmesis.