JPH08122B2 - Equipment for treatment of lacrimal duct obstruction - Google Patents

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a device for treating lacrimal duct obstruction.

[0002]

2. Description of the Related Art As shown in FIG. 1, a lacrimal passage has an upper punctum (1), a lower punctum (2), an upper lacrimal canaliculus (3), a lower lacrimal canaliculus (4), a lacrimal sac (5), and a nose. It consists of a lacrimal duct (6). The nasolacrimal duct is open to the nasal cavity (lower nasal passage). The length from the punctum to the lower end of the nasolacrimal duct depends on the individual, but is 33-45 mm
(Average 38 mm) (Reference, Katsuaki Kurihashi: Anatomy and function of lacrimal passage. Ophthalmic surgery 2: 403-413, 198).
9. ). At any site, lacrimal duct obstruction causes lacrimation and is a serious affliction for the patient.

As a conventional treatment method for lacrimal duct obstruction, a large operation is performed by making an incision in the face, exposing the bone wall, and making a hole in the bone. On the other hand, as a conventional treatment method for lacrimal duct obstruction, without relying on a large operation, after opening the lacrimal duct obstruction part with a thin metal rod, placing a thin silicone tube in the lacrimal duct so as not to re-occlude Has also been conducted and its usefulness has already been confirmed. In recent years, the usefulness of this silicone tube placement technique is increasing.

The conventional method for inserting a silicone tube is as follows. As shown in FIG. 2, a guide probe (thin metal rod) (10, 11) is connected to both ends of the silicone tube (9) and one probe is used. (10) the upper punctum (1)
Silicone through the upper lacrimal canaliculus (3), lacrimal sac (5), nasolacrimal duct (6) to the nasal cavity (lower nasal passage), and pulling out the probe from the nostril (7). Pass the tube (9) through the lacrimal passage through the upper punctum. In the same manner, insert the other probe (11) from the inferior punctum and pull out the probe from the nostril to insert the silicone tube into the lacrimal passage. Then, leave the probe in place as shown in Fig. 3, remove the probe, and remove both ends of the silicone tube. The most common method was to tie them in the nasal cavity.

[0005]

According to this conventional method, the guide probe (10, 11) must be pulled out from the nostril, but this operation is difficult and causes nose bleeding or lower turbinate in the nasal cavity. It was not uncommon to have a bone fracture. It took a long time to pull out the probe from the nostril, which was sometimes impossible. Especially when treating nasolacrimal duct obstruction in babies, it is extremely difficult to pull out the guide probe from a small nostril. Further, a conventional silicone tube for treating lacrimal duct obstruction has a uniform thickness over its entire length, has elasticity, and cannot be strongly bent into a U shape. Therefore, stability in the lacrimal passage was poor, and it was not uncommon for the silicone tube to come out of the punctum after placement. In the conventional technique, both ends of the silicone tube inserted from the upper and lower puncta in the nasal cavity are tied,
It was not uncommon for the knot to come out and enter the lacrimal sac, making it difficult to remove the silicone tube.

[0006]

The gist of the present invention is claim 1.
As described in.

[0007]

Examples In contrast to the above-mentioned conventional techniques, the present inventor has found that the operation for the treatment of lacrimal duct obstruction is simple, the pain to the patient is remarkably reduced, and the indwelling object can be accurately and quickly placed in the lacrimal duct. As a result of continuing diligent research on a therapeutic device that can be inserted,
As shown in (1), a silicone tube having a length of 50 to 120 mm, which is thin and soft in the central portion of 20 to 40 mm and has sharp edges at both ends, is used as a device for treating lacrimal duct obstruction.

As the plastic tube used in the embodiment of FIG. 4, it is essential to select a plastic tube that is substantially non-irritating and non-toxic to the eye tissue and the living body. From this point of view, a silicone tube whose safety has already been established as a device for treating lacrimal duct obstruction is suitable, among which an outer diameter of 0.9 to 1.2 mm and an inner diameter of 0.5 to
0.7 mm silicone tube with an outer diameter of 0.5-0.
A combination of silicone tubes having a diameter of 7 mm and an inner diameter of 0.3 to 0.5 mm is particularly preferably used.

The structure will be described. As shown in FIG. 4, this thinner silicone tube (outer diameter 0.5 to 0.5) is used.
0.7mm, inner diameter 0.3-0.5mm, length 20-40
mm) (14) on both sides of the thicker silicone tube (outer diameter 0.9-1.2 mm, inner diameter 0.5-0.7 mm,
Connect the length (15-50 mm) (12, 13). Silicone tube (12) and silicone tube (13)
Are equal in length. Connection is made by inserting the thinner silicone tube into the lumen of the thicker silicone tube by 2 mm. Therefore, the connecting parts (17, 18) are 2
mm, but the part is bonded with silicone glue. Tip of thicker silicone tube (15, 16)
Keep it sharp and blind. That is, a silicone rod having the same diameter as the inner diameter of the silicone tube is attached to the 2 mm tip portion of the thicker silicone tube with silicone glue and packed. In this manner, the inner cavity of the tip portion of 2 mm was completely filled with silicone, and the tip was cut obliquely so as to have a sharp tip.
5 and 16). To insert a probe of a metal rod with a diameter of 0.4 mm or less into the thicker silicone tube,
Make a small cut (19, 20) with a length of 0.4 mm. The position where the cut is made is 10 to 30 mm from the tip of the thicker silicone tube.

Thus, a silicone tube having a total length of 50 to 120 mm is produced. However, when the thinner silicone tube in the central portion has a length of 25 to 40 mm, the length of the thicker silicone tube on both sides is 15 to 30 mm, and the length is 70 to 100 mm as a whole.

The total length of this silicone tube is
When the nasolacrimal duct is occluded in an adult, 100 to 120 mm is preferable, and when the nasolacrimal duct is occluded in a child, 70 to 100 mm is preferable. The length and thickness of the silicone tube to be used vary depending on the length of the lacrimal duct and the size of the lacrimal duct lumen. When the canaliculus is occluded, 50 to 100 mm is suitable for both adults and children. Use thin ones for children.

In the example of FIG. 4, it is important that the central portion of the silicone tube is thin and soft so that the stability in the lacrimal passage is improved. 0.5-0.7mm diameter without lumen, not 0.5-0.7mm silicone tubing
It may be a soft silicone rod.

The example of FIG. 4 is preferably used after performing local anesthesia or general anesthesia, and the blind end of the silicone tube is inserted from the lower punctum (2). Prior to the insertion, it is the same as the conventional method to insert a probe (a thin metal rod) and open it by puncturing the occlusion part of the lacrimal duct. Similarly to the conventional method, an incision is made in advance on the ear side of the punctum, or the punctum is expanded with a punctum expanding needle. As shown in FIG. 5, the silicone tube (12) is inserted into the thicker silicone tube from a small cut to a thin probe (21) with a metal rod having a diameter of 0.4 mm or less inserted into the silicone tube tip (15). Push it from the lower punctum to the nasal cavity (lower nasal passage) through the lower canaliculus, lacrimal sac, and nasolacrimal duct. Then, the probe (21) is removed leaving only the silicone tube (12). Next, the other silicone tube (13) is inserted from the upper punctum (1). Prior to the insertion, a probe with a diameter of 1 mm (metal rod)
Is inserted from the upper punctum (1). The punctum of the upper punctum is also extended with an ear-side incision or a punctum extending needle. Insert the probe (22) in the same way from the small cut (20) in the central part of the thicker silicone tube, and insert the silicone tube (13) from the superior punctum to the nasal cavity via the lacrimal canaliculus, lacrimal sac, and nasolacrimal duct. Push down to (lower nasal passage).

FIG. 6 shows the indwelling state of the present invention at the end of the operation. The central part of the thin silicone tube (12) between the upper punctum (1) and the lower punctum (2). Can be seen. As described above, there is no difficult intranasal operation in the present invention.

Since the silicone tube is non-irritating and has no biotoxicity, it can be placed for a long period of time. When removing, the thin silicone tube (14) visible between the upper punctum (1) and the lower punctum (2) need only be pinched with tweezers and pulled.

The operation of the above-described embodiment of the present invention will be described below.
Since the central portion of the silicone tube is thin and soft, the silicone tube can be strongly bent in a U shape, and thus the stability in the lacrimal passage is good. Moreover, since the tip of the silicone tube is a blind end, the silicone tube can be reliably pushed into the lacrimal passage.

Next, actual cases in which the present invention is effective will be shown.

Case 1. Right) Canalicular duct obstruction. The main complaint was a strong tearing of the right eye from 20 years ago, and sometimes the tears made things blurry. When the present invention was applied to this patient, tears had decreased 2 days after the administration.
On the 6th day, the silicone tube was normalized while being indwelling. The silicone tube was removed on the 13th day.
However, during that time, the silicone tube did not come out spontaneously. Four months after the operation, the lacrimal passage is open and the tears are in a normal state.

Case 2. Left) Nasolacrimal duct obstruction. The silicone tube was removed on the 7th day after carrying out the present invention. The tears disappeared from the day after the removal. On day 144, the tears had completely disappeared.

Case 3. Right) Nasolacrimal duct obstruction. When the present invention was carried out, after the silicone tube was removed, the silicone tube was reclosed, and lacrimation occurred. When the silicone tube was inserted again in the same manner, the tearing significantly decreased from the second day after the operation, and the healing is now complete.

[0021]

According to the present invention, the following effects are obtained.

Unlike the prior art, the present invention does not require any difficult intranasal operation, so that the operation time is shortened and the burden on the patient is small. Since the central portion of the silicone tube is thin, it can be bent into a U-shape strongly unlike conventional silicone tubes, so it has good stability in the lacrimal passage and does not come out spontaneously.
Even if it fails once, it is easy to try again because there is less pain to the patient. Since both ends of the silicone tube are not tied in the nasal cavity, even if it comes out, it will not enter the lacrimal sac and become difficult to remove like the conventional technique.

[Brief description of drawings]

Figure 1: Schematic diagram of the lacrimal passage

FIG. 2 is a schematic diagram of a conventional technique.

FIG. 3 is a schematic diagram illustrating a method of implementing a conventional technique.

FIG. 4 is a side view of the present invention.

FIG. 5 is a perspective view when the present invention is implemented.

FIG. 6 is a schematic diagram illustrating a method for carrying out the present invention.

[Explanation of symbols]

1 is the upper punctum 2 is the lower punctum 3 is the upper canaliculus 4 is the lower canaliculus 5 is the lacrimal sac 6 is the nasolacrimal duct 7 is the nostril 8 is the inner canthus 9 is the silicone tube 10 is the guide probe (thin metal rod) ) 11 is a probe for guiding (thin metal rod) 12 is a silicone tube (outer diameter 0.9 to 1.2 mm,
Inner diameter 0.5 to 0.7 mm) 13 is a silicone tube (outer diameter 0.9 to 1.2 mm,
Inner diameter 0.5 to 0.7 mm) 14 is a silicone tube (outer diameter 0.5 to 0.7 mm,
Inner diameter 0.3-0.5 mm) 15 is a blind end of a silicone tube 16 is a blind end of a silicone tube 17 is a connecting portion (2 mm) 18 is a connecting portion (2 mm) 19 is Small cut (length 0.4 mm) 20 is small cut (length 0.4 mm) 21 is a probe (metal rod with a diameter of 0.4 mm or less) 22 is a probe (metal rod with a diameter of 0.4 mm or less)

Claims (2)

[Claims] 1. A device for treating lacrimal duct obstruction, characterized in that one end or both ends of a silicone tube are sharpened to form a blind end. 2. A device for treating lacrimal duct obstruction, wherein the central portion of the silicone tube is further narrowed.