Canalicular reconstruction for difficult cases: lacrimal stents and multiple traction sutures.

Twelve cases with canalicular disorders were treated by a new technique using multiple traction sutures (MTS) under an operating microscope. The MTS using black silk or 5-0 nylon were applied at the medial canthus, near the upper and lower puncta and at the caruncle. Additional traction sutures were applied to locate a deep canalicular system if needed, resulting in a total of 5-10 traction sutures. The patient's face was turned sideways towards the left in the operation of the right eye, and to the right in the operation of the left eye. By using the new technique, the opening of the common canaliculus could easily be located without resorting to an open-sky technique requiring skin incision. A new canaliculus could easily be made using a free graft of oral mucous membrane between the common canaliculus and medial canthus with the help of MTS in 7 cases out of 12. As stents, a match-style silicone tubing, a nunachaku-style silicone tubing, an ordinary silicone tubing and a silicone tubing with a silicone sponge were used for 7, 1, 1 and 3 cases, respectively. After a mean follow-up 17.2 months, symptomatic relief and patency of the lacrimal passage were achieved in all cases.