Implanted Nasolacrimal Duct Tube Helps Manage Most Pediatric Epiphora Cases

Child at the hospital.
Operating room – child having a medical treatment.
Endoscopic visualization can aid in preventing intraoperative complications during nasolacrimal duct intubation, a report shows.

Crawford tube insertion with endoscopic visualization is safe and effective for treating children with epiphora, according to a study published in the Canadian Journal of Ophthalmology. The research also provides evidence that treatment success may not be associated with the length of time the tubes are in situ

Pediatric patients with epiphora are frequently treated with silicone nasolacrimal stents. The recommended treatment duration is approximately 3 to 6 months; however, tubes are often removed accidently by the child earlier, the researchers explain. 

They analyzed 50 eyes of 42 patients who underwent Crawford stents placed between January 1, 2009 and December 31, 2019. The investigators obtained data from both paper charts and electronic medical records at the Children’s Hospital, London Health Sciences Centre (LHSC). All patients were younger than 18 years and all cases involved a pediatric otolaryngologist. When the tube could not pass through both puncta, monocanalicular intubation was performed. 

The report shows that spontaneous extrusion of tubes occurred in 54% of eyes. Tubes remained in situ for an average of 17.1 weeks (range: 0-113 weeks). Researchers found that Crawford tube implantation successfully resolved symptoms in 86% of eyes. They reported no intraoperative complications. The only reported complication was a red eye which occurred in 2 children (4.8%). No associations were found between persistent symptoms and the duration of treatment.

“Nasolacrimal duct intubation using Crawford tubes performed under direct endoscopic visualization is consistently successful for the treatment of epiphora,” according to the study authors. “Endoscopic visualization can help prevent intraoperative complications.”

Study limitations include the single center design, a relatively small sample size, the retrospective nature, some paper charts were missing, and some patients were lost to follow-up. In addition, it remains undetermined if the resolution of symptoms is associated with the use of the placement of the Crawford tube itself or if the length of placement plays a role. 


Gandhi K, Dzioba A, Husein M, Makar I, Sharan S. Effectiveness of pediatric Crawford tube implants when endoscopically assisted by ENT surgeons. Can J Ophthalmol. Published online January 14, 2022. doi:10.1016/j.jcjo.2021.12.004