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.
1991–2003 publications cited success rates of 91%–98.5% and satisfaction rates of 70%–91% (Am J Ophthalmol 2004 137:101).