68750 Conjunctivorhinostomy (fistulization of conjunctiva to nasal cavity); with insertion of tube or stent

Name of the Procedure:

Conjunctivorhinostomy (fistulization of conjunctiva to nasal cavity); with insertion of tube or stent

Summary

A conjunctivorhinostomy is a surgical procedure that creates an artificial channel between the conjunctiva (the thin membrane covering the white part of the eye) and the nasal cavity. This channel allows tears to drain directly from the eye to the nose, bypassing blocked or damaged tear ducts. During the procedure, a small tube or stent is inserted to keep the new channel open.

Purpose

This procedure addresses issues related to tear duct obstruction, which can cause excessive tearing (epiphora) and chronic eye infections. The goal is to establish a new drainage pathway for tears, thereby relieving symptoms and improving the patient's quality of life.

Indications

• Chronic tearing despite conservative treatments
• Recurrent eye infections due to blocked tear ducts
• Previous unsuccessful dacryocystorhinostomy (DCR) surgery
• Congenital tear duct abnormalities

Preparation

• Patients may need to fast for a specified period before the procedure.
• Avoid certain medications as instructed by the healthcare provider.
• Pre-operative evaluation including blood tests, and imaging studies to assess the tear ducts.

Procedure Description

1. Anesthesia: The procedure is usually performed under local or general anesthesia.
2. Incision: A small incision is made in the conjunctiva.
3. Channel Creation: A channel is carefully created from the conjunctiva to the nasal cavity using specialized surgical tools.
4. Insertion of Tube/Stent: A tube or stent is then inserted into the new channel to keep it open and ensure proper tear drainage.
5. Closure: The surgical site is closed, and the tube or stent remains in place for a predetermined period.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

This surgery is usually performed in an outpatient surgical center or hospital.

Personnel

• Ophthalmic surgeon
• Anesthesiologist
• Surgical nurses
• Supporting medical staff

Risks and Complications

• Infection
• Bleeding
• Displacement or blockage of the tube/stent
• Scarring and re-obstruction of the channel
• Reaction to anesthesia

Benefits

• Relief from chronic tearing and eye discomfort
• Reduced risk of recurrent eye infections
• Improved quality of life
• Results can be noticed shortly after the procedure, although full benefits may take several weeks.

Recovery

• Patients may experience mild discomfort, which can be managed with prescribed medications.
• Use of antibiotic eye drops may be recommended.
• Avoid strenuous activities and follow specific instructions for eye care.
• Recovery typically takes a few weeks, with follow-up appointments to monitor progress and ensure the stent remains in place.

Alternatives

• Conservative treatments such as warm compresses and massaging the tear ducts
• Medications to treat infections and reduce inflammation
• Traditional dacryocystorhinostomy (DCR) surgery, which involves creating a new tear drainage pathway without a stent.

Patient Experience

During the procedure, the patient under general anesthesia will not feel any pain. For those under local anesthesia, there may be some discomfort, but it will be minimized with sedatives. Post-procedure, patients might experience mild pain, swelling, and discomfort around the surgical site. Pain management includes prescribed medications, and comfort measures such as cold compresses can help alleviate symptoms. Regular follow-up visits are essential to monitor healing and remove the stent at the appropriate time.