Conjunctivo-dacryocystorhinostomy (CDCR) + Lester Jones tube

Conjunctivo-dacryocystorhinostomy (CDCR) + Lester Jones tube
This operation is performed for patients who have a watery eye due to a complete blockage of the canaliculi e.g. following trauma or a herpes virus infection of the eye. The operation is very similar to a “DCR” but instead of a removable silicone stent, a tiny pyrex tube is placed between the inner corner of the eye and the nose. Unlike a silicone stent this tube remains in place indefinitely. This is prone to problems in some patients e.g. foreign body reactions. On the whole, however, these tubes are very well tolerated in patients of all ages as long as the patient is able to comply with daily cleaning. This simply involves cleaning any mucus from around the tube morning and evening using a moistened cotton tip applicator and instilling simple watery artificial tears (Hypromellose drops) twice a day and sniffing while occluding the opposite nostril. The tube is not visible to others. Occasionally the nose may need to be rinsed out using a solution “Sinurinse” from Neilmed. This is particularly important during periods of nasal congestion.

This surgery is most often performed endoscopically avoiding the need for an external incision and a scar. Occasionally there is insufficient space within the nose to accommodate the tube e.g. due to a deviation of the nasal septum which divides the nose into 2 separate cavities. If the septum is deviated a septoplasty is performed, also endoscopically.

A patient with a Lester Jones tube.

What happens before and after surgery?
See under Endoscopic DCR.

Consultants who undertake this procedure:

Saj Ataullah
Anne Cook
Brian Leatherbarrow
Ahmed Sadiq