Lacrimal canalicular bypass surgery with the Lester Jones tube

• PURPOSE: To analyze outcomes of lacrimal bypass surgery with the Lester Jones tube and to determine the level of patient satisfaction. • DESIGN: Interventional case series. • METHODS: We retrospectively analyzed the outcomes of 49 patients (42 patients) who underwent conjunctivodacryocystorhinostomy between 1984 and 2002. Data were obtained from medical records, semistructured phone interviews, and written questionnaires. • RESULTS: The causes of lacrimal obstruction were idiopathic and trauma, congenital agenesis, infection, inflammation, herpes, basal cell carcinoma, radiation therapy, penicillin-induced Steven-Johnsons syndrome, systemic chemotherapy, and facial nerve palsy. Patients had undergone previous failed lacrimal surgery in 21% of cases. Complete or significant improvement of epiphora was achieved in 94% of cases. Best results were obtained for trauma and herpetic obstruction. Complications were frequent and included extrusion, recurrent extrusion, malposition, obstruction, discomfort, infection, and diplopia. Of the 32 patients who were interviewed, 70% were satisfied with the result, 35% reported tube maintenance to be troublesome, and all patients were pleased with the esthetics of the Jones tube. • CONCLUSIONS: Conjunctivodacryocystorhinostomy with the insertion of a Jones tube can be expected to improve epiphora significantly in most cases and remains the standard treatment for canalicular obstruction. Complications occur in most cases, requiring replacement, repositioning, and cleaning of the tube by the ophthalmologist over an indefinite period of time. Despite frequent complications, patients will usually be satisfied if they obtain a comfortable, dry eye. If, however, a completely dry eye is not achieved, frequent complications may contribute to patient dissatisfaction.