68745 Conjunctivorhinostomy (fistulization of conjunctiva to nasal cavity); without tube

Name of the Procedure:

Conjunctivorhinostomy (fistulization of conjunctiva to nasal cavity); without tube

Summary

Conjunctivorhinostomy is a surgical procedure that creates a direct connection between the conjunctiva of the eye and the nasal cavity. This is done without inserting a tube.

Purpose

The procedure is performed to allow tears to drain from the eye to the nasal cavity in patients with blocked tear ducts, improving tear drainage and reducing discomfort or infections caused by tear duct obstructions.

Indications

• Chronic tearing
• Recurrent eye infections
• Specific types of tear duct blockages
• Failure of less invasive treatments to alleviate symptoms

Preparation

• Fasting may be required for a few hours before the procedure.
• Patients may need to adjust certain medications, particularly blood thinners.
• Pre-procedure imaging or tear duct assessments might be necessary.
• An overall health check to ensure fitness for surgery.

Procedure Description

1. Anesthesia is administered (local or general, depending on patient specifics).
2. A small incision is made near the inner corner of the eye.
3. The surgeon creates a passage from the conjunctiva to the nasal cavity.
4. The new drainage pathway is made without inserting any tubes.
5. Sutures may be used to close any incisions made during the procedure.
6. The surgical area is cleaned and dressed as necessary.

Duration

Typically, the procedure takes about 30 minutes to an hour.

Setting

• Outpatient clinic
• Hospital surgical suite

Personnel

• Ophthalmologist or specialized eye surgeon
• Surgical nurse
• Anesthesiologist (if general anesthesia is used)

Risks and Complications

• Infection
• Bleeding
• Scarring
• Incomplete drainage or failure of the new drainage pathway
• Need for additional surgery if the passage closes off

Benefits

• Relief from chronic tearing
• Reduction in recurrent eye infections
• Improved eye comfort and health
• Potential immediate improvement in symptoms

Recovery

• Patients might experience mild discomfort and swelling post-procedure.
• Use of prescribed antibiotics and anti-inflammatory medications.
• Avoid rubbing the eye and strenuous activities for a few weeks.
• Follow-up appointments to monitor healing and effectiveness.

Alternatives

• Dacryocystorhinostomy (DCR) with stenting or without stenting
• Medications to manage symptoms
• Observation and regular follow-ups if symptoms aren’t severe
• Pros: Some alternatives might be less invasive; Cons: May not be as effective in severe cases

Patient Experience

• During the procedure: Expect local anesthesia numbing or general anesthesia to prevent any pain.
• Post-procedure: Some soreness, swelling, and possible mild bleeding. Use of over-the-counter pain relief and prescribed medication for discomfort.
• Most patients can go home the same day and resume normal activities with some restrictions within a week or two.

Pain management and adherence to follow-up care are crucial for optimal recovery and outcome.