Mini Monoka Stent Insertion for the Management of Epiphora Secondary to Canalicular Obstruction or Stenosis

Epiphora is a common presenting problem in ophthalmological clinical practice. There are multiple causes for epiphora. Canalicular obstruction/stenosis is common and increases with age with a female preponderance. Treatment for epiphora is often controversial and notalways successful. The gold standard of treatment involves retrograde silicone intubation most commonly with Lester Jones bypass tubes plus or minus dacryocystorhinostomy (DCR) or sometimes more complex procedures such as canaliculodacryocystorhinostomy or conjunctivodacryocystorhinostomy if there is total canalicar obstruction. 

DCR with retrograde intubation is reported to alleviate or reduces epiphora in 60-70% of patients with proximal or mid-canalicular disease. There is a poorer prognosis for more distal obstructions, with successin the range of 50%. Other complex procedures such as canalicular trephinationwith silicone stent intubation, balloon canaliculoplasty and endocanalicular laser surgery have also recently been described with varying success rates (43 to 84%). Finally, canaliculodacryocystorhinostomy has a reported success rate of approximately 80% if there is common canalicular obstruction whilst conjunctivodacryocystorhinostomy has success rates of around 90% if performed correctly, with unfortunately high complication rates (as high as 50%).