Factors affecting the success of canalicular repairs
Reviewed by James Hsuan

This is a ten year retrospective review of 137 canalicular laceration repairs, looking for factors which affected the outcome. A successful outcome was defined as no epiphora at three months or more after removal of the stent. Overall the success rate was 72%, but 86% of repairs done in an operating theatre were successful compared with 37% of those done in a minor procedures room. Level of training was also a major determinant, with a fellowship trained oculoplastic consultant achieving 84% success, oculoplastic fellows 44%, non-oculoplastic consultants 29% and residents 25%. There was no significant difference comparing monocanalicular with bicanalicular intubation, but only 17 patients had bicanalicular stenting. The vast majority of those left with epiphora found it bothersome to some degree. The authors admit that lack of epiphora is not the same as anatomical patency, and using this criterion alone probably overestimates the success of surgery. There is no analysis of outcomes comparing upper lid lacerations with lower lids, but the authors recommend all canalicular lacerations are repaired. This is the first publication to address the specific factors of level of training and location of surgery as determinants of success in canalicular repairs. The highly significant difference in success rates make a strong case for recommending that all canalicular repairs should be done by, or supervised by, an oculoplastic trained consultant in main theatres. 

Canalicular laceration repair: an analysis of variables affecting success.
Murchisan AP, Bilyk JR.
OPHTHALMIC PLASTIC AND RECONSTRUCTIVE SURGERY
2014;30:410-4.