Monocanalicular repair found effective in most cases

The authors of this study tested the drainage function of monocanalicular lacerations repaired with a Mini-Monoka stent by occluding the fellow punctum using a silicone punctal plug. The results of this small prospective study of eight patients found that a repaired monocanalicular injury provided a functioning system in 88 percent of cases.

All patients in the study underwent repair of a monocanalicular laceration with placement of a Mini-Monoka stent, which was removed a mean of eight months after surgery. Five of the injuries involved the lower canaliculus and two the upper. Injuries to one patient involved both the upper and lower canaliculus but only the lower was repaired. Fifty percent of the injuries were as a result of assault; all of these patients were male. One of the remaining injuries was due to a rugby injury and the other three due to accidents.

In all subjects, the largest-sized silicone plug that would sit comfortably was placed in the unaffected punctum on the side that had sustained the injury and another in the same fellow punctum. The punctal plug was left in place for between seven and 17 days. In order to confirm anatomical patency of the canaliculus, the patient's nasolacrimal system was syringed either immediately after removal of the Mini-Monoka stent or immediately after removal of the silicone plugs.

Seven patients had no epiphora from the repaired eye while the plug was in place. One patient, who had a partial nasolacrimal duct obstruction and no canalicular stenosis, complained of significant epiphora from the repaired eye during the time the plugs were placed. The authors found that 88 percent of the patients had an anatomically patent canaliculus and 100 percent were tearing-free when no plug was placed.

They say the results show that repair of a monocanalicular laceration is achievable and the use of a Mini-Monoka stent does not compromise the other canaliculus. They say that while previous studies have shown that many patients are symptom-free with just one functioning canaliculus, a fully functioning canalicular system may help prevent tearing under stress conditions and will provide a viable system if the other canaliculus is irreparably damaged in the future. The authors conclude that canalicular repair is safe and effective and should be attempted for the treatment of either upper or lower system injuries.