Conjunctivo-rhinostomy with Métaireau tube implantation: Outcomes and complications

Purpose

To report results and complications from a series of 17 proximal lacrimal pathway obstructions (PLPO) treated with conjunctivo-rhinostomy (CR) and Métaireau tube implantation.

Methods

We conducted a retrospective descriptive study including 16 patients (17 PLPO) treated with CR from April 2010 through June 2017. Surgical procedures were performed under general anesthesia. Métaireau tube implantation draining into the middle meatus was performed through a trans-caruncular osteotomy using a 14G Abbocath catheter under endoscopic control.

Results

A total of 12 women (75%) and 4 men (25%) were included. The median age was 57 years (range, 32–78). The indication for surgery was constant epiphora (Munk 4) due to obstruction < 8 mm from the punctum. The follow-up time was 28 months (range, 2–85). Epiphora improved 1 month after the intervention (Munk 0.35 ± 1) and at the end of follow-up (Munk 1.5 ± 1.10) vs baseline values (Munk 4). The most comon postoperative symptoms were hyperemia (35%), discharge (24%), and tearing (24%). The signs found were conjunctival folds and papillomas at the proximal end of the tube (35% and 24%, respectively) and tube malapposition (18%). One patient developed restrictive strabismus. A total of 41% of the cases required, at least, 1 surgery to reposition or remove the tube.

Conclusions

CR with Métaireau tube implantation is a therapeutic alternative for PLPO. Despite the good anatomic results, patients should be warned about the potential complications, which are common and may require reinterventions.