Combined Jones tube-canalicular intubation and conjunctiva dacryocystorhinostomy.

Six patients underwent combined Jones tube-canalicular intubation and conjunctival dacryocystorhinostomy. These patients had epiphora secondary to partial obstruction of the upper and lower canaliculi, complete obstruction of the common canaliculus or a single canaliculus, or paresis of the orbicularis oculi muscle. In these patients we would have performed a dacryocystorhinostomy with silicone elastic intubation, risking recurrent obstruction, or a conjunctival dacryocystorhinostomy with placement of a Jones tube, risking failure of the procedure and complete obstruction of patent canaliculi by placement of the tube. The combined Jones tube-canalicular silicone elastic intubation and conjunctival dacryocystorhinostomy ensured successful treatment of epiphora for this group of patients. Intubating the canaliculi with Bowman probes during placement of the Jones tube avoids injury and subsequent postoperative canalicular obstruction. After several months, the silicone elastic tubing is removed and the Jones tube is plugged. If the patient is asymptomatic and the canaliculi are patent and can be irrigated freely to the nasal cavity, the Jones tube can be removed. However, if epiphora occurs, the plug can be removed and the tube left in place to drain the tears without additional surgery.