New “pushed” intubation device appears effective for nasolacrimal duct obstruction

This retrospective study reports on the use of "pushed" monocanalicular nasolacrimal intubation with the Masterka (FCI-Ophthalmics, Marshfield Hills, Mass.) device to manage nasolacrimal duct obstruction in children. Based on the results, the authors conclude that it was an effective primary treatment for nasolacrimal duct obstruction associated with mucosal obstructions in this population.

The study included 88 consecutive patients (110 eyes) with nasolacrimal duct obstruction who were treated with primary probing and intubation with the Masterka. They were an average age of 2.4 years (range, 1 to 8 years). Only patients noted to have a membranous (mucosal) obstruction were considered for treatment with the Masterka.

The device was made to reduce the complications of pulled intubations. It uses a metal guide placed inside a silicone tube for "pushed" intubation as opposed to material attached at the distal end of the silicone for intranasal retrieval ("pulled" intubations). Probe removal is accomplished via an upper route, thus avoiding the nasal recovery step of pulled intubations and allowing for shorter, face-mask anesthesia. A "pulled" self-threading monocanalicular stent requires placing the patient under general anesthesia for adequate intranasal stent retrieval, and laryngeal protection usually is recommended as well.

The average operating time was three minutes. Persistent tearing occurred in 24 percent of eyes, roughly three-fourths of which resolved after stent removal. After an average follow-up of 33.7 weeks, success, defined as an absence of symptoms after stent removal or loss, was achieved in 85 percent of eyes. Keratitis was noted in two eyes. Early stent loss occurred in 17 ducts (15 percent).