Impact of the Intubation System on Postoperative Foreign Body Sensation Following Lacrimal Surgery

Abstract

Background Monocanalicular intubation systems such as Mini-Monoka and Monoka are well established in the treatment of adult patients with nasolacrimal duct obstruction (NLDO). This retrospective study aimed to analyse the occurrence and subjective burden of postoperative foreign body sensation (FBS) following DCR using either intubation method.

Methods A total of 130 adult patients who underwent DCR with monocanalicular nasolacrimal duct intubation for 3 months via the upper punctum were included. Group 1 (n = 68) received Mini-Monoka, while Group 2 (n = 62) received Monoka (4 mm) intubation. FBS was assessed via a standardised patient questionnaire.

Results Mean age was 63.7 years (range 22 – 91) in group 1 and 61.2 years (range 25 – 79) in group 2. The male-to-female ratio was 3.25 : 1 and 4.64 : 1, respectively. Postoperative FBS was reported by 22.1% in group 1 and 40.3% in group 2. Moderate to severe discomfort was reported by 40% and 56% of affected patients, respectively. Logistic regression revealed a significant influence of the stent system (p = 0.024), but not gender (p = 0.617).

Conclusion Both stenting systems are associated with postoperative FBS in a considerable proportion of patients. Due to the higher rate of perceived discomfort under Monoka, Mini-Monoka should be preferred whenever anatomically feasible.

Keywords

lacrimal surgery - dacryocystorhinostomy - monocanalicular intubation - Monoka - Mini-Monoka - lacrimal intubation

Publikationsverlauf

Eingereicht: 03. Mai 2025

Angenommen: 25. September 2025

Accepted Manuscript online:
22. Oktober 2025

Artikel online veröffentlicht:
12. Dezember 2025

• References/Literatur

• 1 Heichel J, Hassan T, Bredehorn-Mayr T. et al. [External Dacryocystorhinostomy–Analysis of Patient Material of the University Hospital Halle from 2000 to 2011]. Klin Monbl Augenheilkd 2016; 233: 29-37
• 2 Heichel J, Struck HG. Tränenwegsstenosen im Erwachsenenalter. Klin Monbl Augenheilkd 2020; 238: 211-230
• 3 Toti A. Nuovo metodo conservatore di cura radicale (Dacriocistorinostomia). Clin Mod Firenze 1904; 10: 385-389
• 4 Heichel J, Dettmer W, Paulsen F. et al. Transcutaneous (External) Dacryocystorhinostomy with Reconstruction of the Ductus nasolacrimalis. Klin Monbl Augenheilkd 2024; 241: 30-38
• 5 Detorakis ET, Mavrikakis I, Ioannakis K. et al. Monocanalicular intubation in external dacryocystorhinostomy. Ophthalmic Plast Reconstr Surg 2011; 27: 439-441
• 6 Kasaee A, Eshraghi B, Ameli K. et al. Pulled versus Pushed Monocanalicular Silicone Intubation in Adults with Lacrimal Drainage System Stenosis: A Comparative Case Series. J Ophthalmol 2021; 2021: 5592039
• 7 Sahan B, Ciftci F. The significance of primary monocanalicular silicone tube intubation in late surgical treatment in children. Eur J Ophthalmol 2022; 32: 1464-1468
• 8 Fayet B, Bernard JA, Assouline M. et al. Bicanalicular versus monocanalicular silicone intubation for nasolacrimal duct impatency in children: a comparative study. Orbit 1993; 12: 149-156
• 9 Oliphant H, Rajak S. Iatrogenic punctal prolapse. Clin Exp Ophthalmol 2018; 46: 700
• 10 Heichel J, Neumann C, Bethmann D. et al. [Dacryoliths and Iatrogenic Foreign Bodies as Classical Triggers for Inflammatory Pseudotumors of the Lacrimal Drainage System]. Klin Monbl Augenheilkd 2018; 235: 898-904
• 11 Attas-Fox L, Codère F. Nonsurgical retrieval of retained lacrimal stenting material. Ophthalmic Plast Reconstr Surg 2012; 28: 303-304
• 12 Fayet B, Bernard JA, Pouliquen Y. Reparation des plaies canaliculaires recentes avec une sonde mono-canaliculaire a fixation meatique. Bulletin des sociétés dʼophtalmologie de France 1989; 89: 819-825
• 13 [Anonymous] The management of dry eye. Drug Ther Bull 2016; 54: 9-12
• 14 Komínek P, Cervenka S, Pniak T. et al. Monocanalicular versus bicanalicular intubation in the treatment of congenital nasolacrimal duct obstruction. Graefes Arch Clin Exp Ophthalmol 2011; 249: 1729-1733
• 15 Hirt B, Granzotto EE, Silva FL. et al. Efficacy of monocanalicular versus bicanalicular intubation in the treatment of congenital nasolacrimal duct obstruction. Graefes Arch Clin Exp Ophthalmol 2020; 79: 33-37
• 16 Sodhi PK, Pandey RM, Malik KP. Experience with bicanalicular intubation of the lacrimal drainage apparatus combined with conventional external dacryocystorhinostomy. J Craniomaxillofac Surg 2003; 31: 187-190
• 17 Nuhoğlu F, Sarıcı K, Esin Özdemir F. Outcome of external dacryocystorhinostomy with bicanalicular silicone tube stenting. J Acad Res Med (JAREM) 2014; 4: 88-92