Transnasal lacrimal insert

Abstract

A temporary transnasal lacrimal insert is used in a surgical procedure for improving drainage from a patient's lacrimal sac to his or her nasal cavity. The insert includes a tubular member with a proximal end and an enlarged distal end. The insert also includes an attachment element about which ends of a silastic tube can be fastened. In the procedure, a hole is created extending from the lacrimal sac into the nasal cavity using surgical techniques or a laser probe. Then, opposite ends of a silastic tube are introduced through the patient's upper and lower puncta, through the patient's upper and lower canaliculi, through the lacrimal sac, through the hole, and into the nasal cavity. The ends of the silastic tube are then threaded through the passage in the insert. The insert is then placed from the nasal cavity into the hole by forcing the proximal end of the insert through the hole and into the lacrimal sac, and abutting the enlarged distal end, which is larger than the hole, against a surface in the nasal cavity surrounding the hole. The ends of the silastic tube are then fastened to the attachment element of the insert. Excess tube extending into the nasal cavity is then cut short to reduce nasal irritation. After the hole has sufficiently healed in about 3-6 months, the silastic tube and the insert are removed.

1 . A transnasal lacrimal insert, comprising: 
 a tubular member having a passage extending therethrough, said tubular member having a proximal end and an enlarged distal end; and    an attachment element at said distal end of said tubular member about which ends of a silastic tube can be fastened, wherein said tubular member and said attachment element comprise biocompatible material.    
     
     
         2 . The transnasal lacrimal insert of  claim 1 , wherein said tubular member is generally L-shaped.  
     
     
         3 . The transnasal lacrimal insert of  claim 1 , wherein said insert comprises a soft, flexible material.  
     
     
         4 . The transnasal lacrimal insert of  claim 1 , wherein said insert comprises silicone.  
     
     
         5 . The transnasal lacrimal insert of  claim 1 , wherein said insert comprises silastic material.  
     
     
         6 . The transnasal lacrimal insert of  claim 1 , wherein said tubular member has a wall thickness of about 0.5 mm to 1 mm.  
     
     
         7 . The transnasal lacrimal insert of  claim 1 , wherein said enlarged distal end comprises a flange projecting about said tubular member.  
     
     
         8 . The transnasal lacrimal insert of  claim 7 , wherein said flange has a circular periphery.  
     
     
         9 . The transnasal lacrimal insert of  claim 8 , wherein said flange has an outer diameter of about 10 mm.  
     
     
         10 . The transnasal lacrimal insert of  claim 7 , wherein said flange has a thickness of about 0.5 mm to 1 mm.  
     
     
         11 . The transnasal lacrimal insert of  claim 1 , wherein said proximal end of said tubular member is tapered to facilitate insertion of the insert in a rhinostomy hole, and said proximal end is adapted to stay inside the lacrimal sac.  
     
     
         12 . The transnasal lacrimal insert of  claim 1 , wherein said attachment element comprises an elongated rod extending across an opening at said distal end of said tubular member leading to said passage.  
     
     
         13 . A surgical procedure for improving drainage from a patient's lacrimal sac to his or her nasal cavity, comprising the steps of: 
 (a) inflating the lacrimal sac with Healon;    (b) passing a fiber optic laser probe through the patient's canaliculus and into the lacrimal sac;    (c) placing the tip of an endoscope in the nasal cavity to facilitate proper positioning of the laser probe;    (d) applying laser energy through the laser probe to form a hole extending from the lacrimal sac into the nasal cavity;    (e) removing the laser probe and endoscope from the patient;    (f) introducing opposite ends of a silastic tube, each through one of the patient's upper and lower puncta, through the corresponding upper and lower canaliculi, through the lacrimal sac, through the hole, and into the nasal cavity;    (g) providing a transnasal lacrimal insert, said insert comprising a tubular member having a passage extending therethrough, said tubular member including a proximal end and an enlarged distal end, said distal end being larger than said hole; and said insert including an attachment element about which ends of a silastic tube can be fastened;    (h) threading the ends of the silastic tube through the passage in the insert from the proximal end through the distal end;    (i) introducing the insert from the nasal cavity into the hole by forcing the proximal end of the insert through the hole and into the lacrimal sac, and abutting the enlarged distal end against a surface in the nasal cavity surrounding the hole;    (j) attaching the ends of the silastic tube to the attachment element of the insert;    (k) cutting and removing excess portions of the silastic tube extending into the nasal cavity; and    (l) removing the silastic tube and the insert from the patient after sufficient healing of said hole.    
     
     
         14 . A method of improving drainage from a patient's lacrimal sac to his or her nasal cavity, comprising the steps of: 
 (a) creating a hole extending from the lacrimal sac into the nasal cavity;    (b) introducing opposite ends of a silastic tube through the patient's upper and lower puncta, through the patient's upper and lower canaliculi, through the lacrimal sac, through the hole, and into the nasal cavity;    (c) providing a transnasal lacrimal insert, said insert comprising a tubular member having a passage extending therethrough, said tubular member including a proximal end and an enlarged distal end, said distal end being larger than said hole; and said insert including an attachment element about which ends of a silastic tube can be fastened;    (d) threading the ends of the silastic tube through the passage in the insert;    (e) introducing the insert from the nasal cavity into the hole by forcing the proximal end of the insert through the hole and into the lacrimal sac, and abutting the enlarged distal end against a surface in the nasal cavity surrounding the hole;    (f) attaching the ends of the silastic tube to the attachment element of the insert; and    (g) removing the silastic tube and the insert from the patient after sufficient healing of said hole.    
     
     
         15 . The method of  claim 14 , wherein step (a) comprises applying laser energy from a fiber optic laser probe inserted in the lacrimal sac.  
     
     
         16 . The method of  claim 15 , further comprising placing the tip of an endoscope in the nasal cavity to confirm proper positioning of the laser probe.  
     
     
         17 . The method of  claim 14 , wherein step (a) is performed using surgical techniques.  
     
     
         18 . The method of  claim 14 , further comprising cutting and removing excess portions of the silastic tube extending into the nasal cavity after step (f).  
     
     
         19 . The method of  claim 14 , wherein step (a) comprises creating a hole having a diameter of approximately 5-7 mm.  
     
     
         20 . The method of  claim 14 , wherein step (g) is performed about 3-6 months after step (f).  
     
     
         21 . The method of  claim 14 , wherein said tubular member of said insert is generally L-shaped.  
     
     
         22 . The method of  claim 14 , wherein said insert comprises a soft, flexible material.  
     
     
         23 . The method of  claim 14 , wherein said insert comprises silicone.  
     
     
         24 . The method of  claim 14 , wherein said insert comprises silastic material.  
     
     
         25 . The method of  claim 14 , wherein said tubular member of said insert has a wall thickness of about 0.5 mm to 1 mm.  
     
     
         26 . The method of  claim 14 , wherein said enlarged distal end of said insert comprises a flange projecting about said tubular member.  
     
     
         27 . The method of  claim 26 , wherein said flange has a circular periphery.  
     
     
         28 . The method of  claim 27 , wherein said flange has an outer diameter of about 10 mm.  
     
     
         29 . The method of  claim 26 , wherein said flange has a thickness of about 0.5 mm to 1 mm.  
     
     
         30 . The method of  claim 14 , wherein said proximal end of said tubular member is tapered to facilitate insertion of the insert in a hole.  
     
     
         31 . The method of  claim 14 , wherein said attachment element comprises an elongated rod extending across an opening at said distal end of said tubular member leading to said passage.