Removal of intracanalicular plug
If video fails to load, use this link: https://vimeo.com/143470669
This is Richard Allen at the University of Iowa.
This video demonstrates retrieval of an intracanalicular plug which has caused chronic canaliculitis.
A Bowman probe is placed through the lower punctum and canaliculus where the obstruction and presumed plug is located. Westcott scissors are then used to cut down over the canaliculus in the area of the obstruction. Significant scar and no patent canaliculus is appreciated; therefore, an additional medial cut down is performed with excision of the intervening scar. Inspection of the area medially shows scar, but gentle dissection does demonstrate a foreign body which is removed and proves to be a permanent intracanalicular plug. A Crawford stent is then placed through the lower punctum and canaliculus. The stent is then placed through the medial cut patent end of the canaliculus, into the lacrimal sac, down the nasolacrimal duct and retrieved from the nose. The patient has a history of upper punctal cautery and a cut down is performed just medial to the punctum to expose the patent upper canaliculus. The other arm of the Crawford stent is then placed through the upper canaliculus and retrieved from the nose. This results in intubation of the entire lacrimal system. The lid margin of the upper lid is repaired with 7-0 Vicryl suture in a vertical mattress fashion so that the stent exits the posterior surface of the eyelid. The lower canalicular defect is repaired by suturing the canaliculus over the Crawford stent. This is performed with the 7-0 Vicryl suture, and the sutures are pericanalicular. The skin and lid margin are then repaired. The stent appears to be in good position with minimal tension. Antibiotic ointment is used three times per day and the stent will be removed in approximately four months.