Purpose

A clogged lacrimal by-pass tube, remains one of the main reasons for a follow up visit to the lacrimal specialist, after a conjunctivo-rhinostomy. Pressure syringing remains the choice for cleaning the tube by the majority of surgeons. Recently, interdental brushes have been advocated to facilitate the process of cleaning. The use of an expanding dental floss is an unconventional but very effective cleaning method, the introduction of which is the objective of this presentation.

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Methods

With topical anesthesia of the conjunctiva and nasal mucosa, the rigid lead part of the expanding floss is inserted into the tube, proximal to distal. Using a hand held nasal scope and ear forceps, the lead part is pulled out of the nose. A to and fro motion is applied, thus cleaning the lumen of the tube. The floss expands while in contact with water, increasing the surface area of the fibres. After about 5 to 7 passes the floss is removed through the nose, and the patency of the tube can be checked with a fluorescein dye endoscopic test.

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Results

Sixteen tubes of ten patients were cleaned using the described technique. All patients reported immediate and complete relief of symptoms. The average time to recurrence of epiphora / inability to sniff clean the tube, was 10 months, with a range 6 to 12 months.

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Conclusion

Expanding dental floss is has a large surface area and is designed to clean food debris and plaque (biofilm) from interdental space and orthodontic devices, while being gentle to the periodontium and the gums. This is why it is so efficient in cleaning the inside of a Lester Jones tube, without having to remove it. Although interdental brushes have been advocated for the same purpose, because of a limited length, they are not usefull in longer tubes. Also, the bristles of these brushes can be quite abrasive to the conjunctiva and nasal mucosa.

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Additional Authors

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