Download 41 coagulation of lachrymal canals

41
COAGULATION OF
LACHRYMAL CANALS
Programme data
Timed 20 hundredths of a second
- Coag microelectrodes - 20 Watts
- EM 10 Yellow.
A reduction of the natural tear production may occur in isolation (keratoconjunctivitis sicca), in association
with salivary gland dysfuction (primary Siogren syndrome) or as a consequence of connective tissue disea-
se. Coagulation of the lachrymal
canals prevents outflow and maximises the effect of any residual tear
production.
When medication does not improve
the patient’s condition, the operator
obliterates the lachrymal canals with
a timed emission (F. Reggiardo, 1993).
The reduced outflow allows the lubrication of the cornea to be improved
(Fig. 41.0.1).
Fig. 41.0.1 The lachrymal canals are the route for outflow of tears.
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41 - COAGULATION OF LACHRYMAL CANALS
Prior to definitive treatment, tests
can be performed to assess the likely
benefit from lachrymal duct obliteration. A fine filament of cellulose is
inserted into the lower lachrymal
canal. This prevents tear ouflow and
allows any improvement in the lubrication of the eye and the development of epiphora to be assessed.
Patients who show an improvement
after this test may undergo timedsurgical obliteration of the lower
lachrymal canal (Fig. 41.0.2). If
marked epiphora occurs, the upper
lachrymal canal is coagulated. The
procedure is carried out under topical anaesthesia with oxybuprocaine
chloride (4mg/ml). After positioning
the patient’s return electrode, the
operator sets the Timed apparatus to
Fig. 41.0.2 The point of the EM 10 electromaniple is inserted about 4 mm into the upper
lachrymal canal.
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41 - COAGULATION OF LACHRYMAL CANALS
the timed mode, the emission time
to 20 hundredths of a second, the
function to coagulation with
microelectrodes and the power to
14 or 20 Watts; an EM 10 Yellow
electromaniple is used. The tip of the
electromaniple is inserted 3 or 4 mm
into the canal. After the first emission, which is carried out in depth,
the point is gradually withdrawn,
while a second and then a third emission are generated. The efficacy of
the timed emissions is indicated by
whitening of the tissue around the
canal and by the organic material
attached to the tip of the electromaniple after coagulation (Fig. 41.0.3-5).
The patient receives medication with
an antibiotic eyewash for a few days
after the procedure .
Fig. 41.0.3 The timed emission causes whitening of the tissues around the canal. Programme
data: coagulation with microelectrodes, 20 Watts, 20 hundredths of a second, EM 10
Yellow electromaniple. Topical anaesthesia.
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41 - COAGULATION OF LACHRYMAL CANALS
Fig. 41.0.4 Canal mucosa cells are visible on the tip of the electromaniple.
Fig. 41.0.5 Obliteration of the lachrymal canal reduces the outflow of tears, allowing the surface of the cornea to remain moist.
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