Comparative study of safety and efficacy of closed dacryointubation vs. bicanalicular intubation in the treatment of upper tear duct obstruction in adult patients.

Purpose: Upper lacrimal duct obstruction (ULDO) is defined as obstruction or stenosis at the level of the lacrimal puncta, lacrimal canaliculi and/or common canaliculus. Among the alternatives available for its treatment are the placements of lacrimal point plugs, closed dacryointubation with Crawford tube (CDI), conjunctivodacryocystorhinostomy (CJDCR) and bicanalicular intubation (BI). In this study, we compared patency, tearing symptomatology, and postoperative complications between bicanalicular intubation with the autostable bicanaliculus intubation set II (ABI) device and standard treatment (CDI) for the treatment of patients with ULDO.

Methods: Thirty-one patients>18 years old with stenosis or obstruction of the ULD system and epiphora>2 points on the Munk scale, with no previous surgery, were included and randomized using the balanced block technique to receive treatment with CDI (group 1) or ABI (group 2). Patients with ocular surface changes, congenital anomalies or previous trauma were also excluded. The patency of the tear duct with irrigation was verified at the end of the study as either present or absent. Symptoms were evaluated according to the Munk scale before the procedure and at the first, third and fourth postprocedural months. Complications of each procedure were analyzed. Descriptive statistics, chi-square test for nominal variables, Mann-Whitney U test for intergroup comparison of CDI vs. ABI, Wilcoxon test for intragroup comparison (before and after) and Friedman test were performed. Statistical analysis was performed using GraphPad Prism statistical software (version 8.0.2), and statistical significance was set at P<0.05.

Outcomes: Thirty-one eyes of 31 patients were included in the study. Seventeen eyes (58%) were included in the CDI group (group 1), and 14 eyes (42%) were included in the ABI group (group 2). At the conclusion of the study, both groups showed 80% patency on the tear duct irrigation test. Both groups showed significant improvement in tearing symptoms measured using the Munk scale after the surgical procedure throughout the study, and at the fourth month, we found no statistically significant difference between the two groups. Epistaxis occurred in 70% of the cases in group I, and spontaneous extrusion of the auto-stable implant occurred in 35% of the cases in group 2.

Conclusion: The present study demonstrates that ABI shows similar results with respect to symptomatic improvement of tearing and tear duct patency compared to CDI in patients with ULDO and, at the same time, presents fewer complications. Because it is a minimally invasive technique, the present study shows that it may be a good option for the treatment of ULDO.