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INTRODUCTION
One of the most frustrating experiences of pediatric ophthalmology is to place Crawford tubes for a persistent nasolacrimal duct obstruction, only to have the parents call a few days later and inform you that the tube is in a loop over the eye. Surgeons have attempted to avoid this complication by various techniques including attaching large bolsters to the tied ends of the tubes in the nose, such as scleral buckling elements,^sup 1,2^ or silicone buttons.^sup 3^ Others anchor the tied end of the tube with a suture inside the nose.^sup 4^ I describe a technique I have been using on small children to secure Crawford tubes. This report is not intended to be a review of success in treatment of childhood nasolacrimal duct obstruction by Crawford tubes, but merely presentation of a method to avoid one complication of their use.
METHOD
Prior to placing the tubes, a suture of 5-0 polypropylene on double-armed taper needles is placed through the lumen of the Crawford tube about halfway along its length. The suture lies within the lumen for only about 3 mm, which is the approximate distance between the superior and inferior puncta when the eye is open. It is essential to use a taper needle to place the suture, so as not to weaken the tube and risk tearing of the tubing during insertion or later. The Crawford tubes are then placed in the conventional manner,^sup 5^ leaving the portion with the suture in the interpalpebral fissure. The tubing is tied in the nose with three knots and cut.
At this point, the needles are driven subcutaneously from near the puncta to the medial canthal area, superiorly and inferiorly....