Lacrimal By-Pass Surgery

The use of Lester Jones bypass tubes remains an important treatment modality for complex lacrimal outflow obstruction that cannot be addressed with other forms of lacrimal surgery. It is particularly effective for structural and functional canalicular disease. Whilst Lester Jones tubes can be highly effective at treating epiphora in this context, there are relatively high rates of failure and revision as a result of migration and malpositioning of the tube. This chapter highlights that the optimisation of outcomes requires significant attention to a variety of issues including tube design, preparation for insertion, tube size, technical aspects of inserting the tube and maintenance. Visualisation of the distal tube with the aid of an endoscope is recommended to ensure good intranasal positioning of the distal tube end and to adapt the technique to different configurations of nasal spaces.