D ACRYOCYSTORHINOSTOMY followed by the insertion of a roughened glass (Pyrex) tube from the conjunctival sac into the nasal cavity is the management of choice for patients with canalicular obstruction not amenable to canalicular surgery1
The standard method of inserting the polyethylene tube, (replaced later by a roughened glass tube), described by Lester Jones,2 can be technically difficult in some patients.
A trephining technique has been developed for the insertion of a polyethylene tube which is simple, quick, and reduces operative trauma to a minimum.
The instruments used in the technique are illustrated in Fig 1, top. A dacryocystorhinostomy is performed up to the stage where the posterior mucosal flaps have been sutured. The caruncle is then completely excised. The 20 gauge guide wire is inserted into the caruncle bed 2mm posterior to the cutaneous margin of the medial canthal angle and aimed downwards at approximately 30°
Henderson PN. A Trephining Technique for the Insertion of Lester Jones Tubes. Arch Ophthalmol. 1971;85(4):448-450. doi:10.1001/archopht.1971.00990050450010