Endonasal endoscopic assisted replacement of lacrimal drainage tubes

Purpose: To describe an endonasal endoscopic assisted replacement of migrated or lost Lester-Jones (LJ) tubes. Methods: In three consecutive cases of LJ tube migration or loss and an absent obvious transconjunctival tract, a curved paediatric Lusk ball-probe was passed under endoscopic visualization to the conjunctival surface through the internal nasal osteum. The drainage tube was then passed over the tip of the probe and replaced by retracting the probe back into the nose. Results: In all cases, the drainage tube was successfully replaced using an endonasal endoscopic assisted technique. None of the cases, done 1-7 weeks after tube migration or loss, required the use of a K-wire and trephine for tube re-insertion. Conclusion: The conjunctivodacryocystorhinostomy tract appears to be retained following LJ tube migration or loss in selected cases. It can be accessed endonasally, allowing external tube replacement without the need for a repeat trephine.