We would like to thank Drs. Klapper and Jordan for reminding us of a previous report where they used a similar technique
for conjunctivodacryocystorhinostomy
They described the use of an 18-gauge needle to create a track between the eye and the nose. A dilator was then used to enlarge this track and place a Jones tube anterior to the middle turbinate. They used this technique in 2 cases of infants born with canalicular agenesis.
It is useful to identify and reinforce some differences that we believe are of critical importance between their technique and ours. We describe the use of a 14-gauge angiocatheter. This size allows the insertion of the tube without further dilations.
The use of the Teflon sheath to guide the insertion minimizes inadvertent trauma to the septum. In adult patients, it is usually difficult to place the tube anterior to the middle turbinate, because the area of thin lacrimal bone that allows the passage of the angiocatheter lies more posterior. That is why a limited anterior turbinectomy is usually necessary.
Finally, many authors have previously tried different ways of placing the Jones tube without a skin incision and we have cited them in our work. We inadvertently missed the report by the above authors, so we would like to apologize.
Martin H. Devoto, M.D.
Francesco P. Bernardini, M.D.
Carlo de Conciliis, M.D.
