Purpose

To compare outcomes of Nunchaku and BIKA bicanalicular intubation in dacryocystorhinostomy (DCR).

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Methods

A retrospective comparative study of consecutive adult patients undergoing external or endonasal DCR with Nunchaku or BIKA intubation at Moorfields Eye Hospital, London, between January 2024 and November 2025. Primary outcomes were symptomatic improvement at 6 and 18 weeks and anatomical success at 18 weeks. Secondary outcomes included tube-related complications.

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Results

182 procedures were performed in 154 patients (BIKA n=123, Nunchaku n=59). While groups were comparable in age, sex, and surgical approach, a significantly higher proportion of procedures in the BIKA group were revisions (p=0.034) and performed by a consultant (p=0.008). Symptomatic improvement was comparable at 6 weeks (83.7% vs 91.5%, p=0.256) and 18 weeks (89.6% vs 92.3%, p=0.395) for BIKA and Nunchaku respectively. Nasolacrimal patency was confirmed in 97.2% of BIKA and 98.1% of Nunchaku cases (p=1.000). Tube extrusion was more frequent with Nunchaku (11.9%) than BIKA (2.4%) (p=0.015). Preseptal cellulitis (n=2) and return to theatre for tube retrieval (n=1) occurred exclusively in the BIKA group. Malodour was noted in 3 Nunchaku vs 1 BIKA case. BIKA tubes have a lower unit cost than Nunchaku tubes (£77-81 vs £133-137).

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Conclusion

Symptomatic outcomes and anatomical success are comparable between Nunchaku and BIKA following DCR. Nunchaku tubes carry higher rates of extrusion and malodour, but allow easier retrieval with minimal risk of return to theatre. Cost considerations favour BIKA, with a unit cost approximately 40% lower than Nunchaku.

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Additional Authors

First name	Last name	Base Hospital / Institution
Hee La	Lee	Moorfields Eye Hospital
Mumta	Kanda	Moorfields Eye Hospital
Munazzah	Chou	Moorfields Eye Hospital
Laura	Ah-Kye	Moorfields Eye Hospital
Swan	Kang	Moorfields Eye Hospital

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