Endoscopic endonasal management of prolapsed silicone tubes after dacryocystorhinostomy

Loss or prolapse of silicone tubes at the medial canthus may occur after dacryocystorhinostomy (DCR) surgery. Repositioning of the prolapsed tubes is often difficult and can necessitate early removal of tubes. The goal of this study was to determine the incidence of tube prolapse after DCR, review the methods used to reposition them, and identify the optimum management. Retrospective, noncomparative, interventional case series. A total of 205 adults patients who had DCR with intubation by a specialist lacrimal service in West London over a 3-year period. Patients with spontaneous tube loss or prolapse were identified from clinic attendance and case note review. Incidence and timing of prolapse, techniques used for repositioning and success, whether prolapse recurred, and further intervention necessary. Five (2.5%) had tube loss or prolapse or both, all within the first month after surgery. The tubes were repositioned initially in four patients, but prolapse recurred in two patients necessitating further intervention. Only nasal endoscopy enabled precise tube visualization and endonasal manipulation with eventual tube stability. Tube prolapse is rare after DCR surgery. The tubes can be pushed back in, but prolapse may recur unless the endonasal aspect is addressed. The position of the tie or knots should be inspected endonasally and the tubes further secured if indicated. Repositioning is best managed with endoscopic assistance, which is a simple office procedure.