Excision of canaliculi
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This is Richard Allen at the University of Iowa.
This video demonstrates excision of the canaliculi in a patient with chronic dry eye who has failed previous attempts of punctal occlusion with punctal plugs and punctal cautery.
The lower punctum is dilated and a Bowman probe is placed through the canaliculus to demonstrate its patency. The same is performed on the upper eyelid. Westcott scissors are then used to perform a canaliculotomy to expose the interior of the canaliculus. The Westcott scissors are then used to excise the epithelial lined canaliculus. The goal is to eliminate as much of the canaliculus as possible so that it cannot attain post-operative patency. Attention is then directed to the upper eyelid where the canaliculotomy is performed with the Westcott scissors. Again, this exposes the interior of the epithelial lined canaliculus. As much of the epithelial lined canaliculus is resected to the level of the punctum with the Westcott scissors, with the goal to eliminate any remaining epithelium. The area of the canaliculotomy is then closed with interrupted 7-0 Vicryl sutures. This will result in scaring the canaliculus closed to the level of the punctum. At the conclusion of the case, ophthalmic antibiotic ointment is placed into the eye three times per day. Steroid should not be used so that inflammation and scar would not be suppressed. The patient returns in one to two weeks for reevaluation.