Prepare nasal cavity and surgical site
- Local anesthesia infiltration of nasal cavity and medial canthus
- Afrin or cocaine soaked neurosurgical cottonoids to pack nasal cavity
Prepare medial canthus
- Can perform primarily through conjunctival incision (Am J Ophthalmol 2000 129:244) or in conjunction with dacryocystorhinostomy incision (Am J Ophthalmol 1965 59:773)
- Partially excise caruncle to create space for Jones tube cuff.
- Considerations of desired path of Jones Tube
- Consider going through osteotomy path from previous dacryocystorhinostomy.
- Otherwise, consider vector that permits increased bony purchase in pathway.
- Use solid-bore needle (lacrimal trephine) or 14‑gauge angiocath to puncture through site of resected caruncle into nasal passageway by your desired pathway (Ophthal Plast Reconstr Surg 2006 22:253).
- Remove needle and consider dilating passageway by bluntly spreading with Stevens or iris scissors
- Determine need for partial turbinectomy if turbinate lies in path of desired Jones tube placement. (Am J Otolaryngol 2015 36:330-3)
- Replace with probe to estimate desired length of Jones Tube.
- Choose cuff size and length and introduce into new pathway over a probe to determine position.
- Replace Jones tube with different sizes until happy with positioning.
- Examine nasal cavity for position of the Jones Tube.
- Adjust vector until satisfied with position in nasal cavity.
- Can use endoscope to monitor position.
- Secure into place with suture.
- Some tubes have a hole in cuff to secure cuff to medial canthus tissue.
- 5-0 vicryl suture or 6-0 prolene as a purse string or encircling Jones tube neck, respectively
- Tube malpositions were 7.7% in the vicryl group and 21.6%–31% in the prolene group (Br J Ophthalmol 2012 96:674).
- Place suction without tip and irrigate balanced salt solution or fluorescein solution on ocular surface to assure patency of the Jones tube passageway.
Published results
1991–2003 publications cited success rates of 91%–98.5% and satisfaction rates of 70%–91% (Am J Ophthalmol 2004 137:101).