JPH06142129A - In-lachrymal gland inserting tube implement - Google Patents

Abstract

PURPOSE:To provide the in-lachrymal gland inserting tube implement of a nunchaku type, in which the center part of the tube is thin and soft and stability in a luchrymal gland is improved. CONSTITUTION:To both ends of soft and thin tubes or rods 40, 41 whose outside diameter and length are 0.5-0.7mm and 20-40mm, respectively, tubes (outside diameter and length are 0.9-1.2mm and 15-50mm, respectively) 42, 43 being thicker and harder than them are connected, and they are set to the length of 5-120mm as a whole, and both its ends 2mm 53, 54 are filled with a silicone and formed to blind ends, thereafter, sharpened into a conical shape.

Description

Detailed Description of the Invention

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a lacrimal duct intubation device for treating lacrimal duct obstruction and dry eye.

2. Description of the Related Art The lacrimal passage, as shown in FIG.
1, a lower lacrimal punctum 12, an upper lacrimal canaliculus 13, a lower lacrimal canaliculus 14, a common lacrimal canaliculus 15, a lacrimal sac 16, and a nasolacrimal canal 17. The nasolacrimal duct 17 opens into the lower nasal passage in the nasal cavity. The length from the punctum to the lower end of the nasolacrimal duct varies depending on the individual, but is 33 to 45 mm.
(Average 38 mm). See, for example, Katsuaki Kurihashi, Anatomy and Function of the Lacrimal Path, Ophthalmic Surgery 2: 403-413, 1989. At any site, lacrimal duct obstruction causes lacrimation and is a very distressing disease for patients. On the other hand, dry eye is a disease that causes changes in the eye surface due to a lack of tear fluid secreted from the lacrimal gland 19, which causes dry eye symptoms such as dry eye, eye fatigue, and stickiness, and is equivalent to tearing. , A disease that bothers patients. As a conventional treatment method for lacrimal duct obstruction, a large operation is performed by making an incision in the face, exposing the bone wall of the frontal process of the maxilla, and making a hole in the bone. On the other hand, as a conventional treatment method for lacrimal duct obstruction, there is also a method of opening the obstructed part of the lacrimal duct with a son without opening it and then placing a thin silicone tube in the lacrimal duct so as not to re-occlusion. It has been carried out and its usefulness has already been confirmed. The frontal process of the maxilla acts as a strong barrier for the fragile ethmoid bone behind it, and the major operation for lacrimal duct obstruction is the operation of making a large hole in the frontal process of the maxilla. Therefore, it is desirable to treat lacrimal duct obstruction without performing as much surgery as possible. Therefore, in recent years, the usefulness of this silicone tube indwelling technique is increasing more and more. A conventional silicone tube insertion method is disclosed in Japanese Patent Publication No. 56-50579. The method by John S. Clauford disclosed therein is a typical conventional method. To explain this, as shown in FIG. 2 and FIG. 3, the guide sons 20, 21 are connected to both ends 22, 23 of the silicone tubes 24, 25, 26, and one of the sons 20 is connected to the lower punctum. 12 through the lower lacrimal canaliculus 14, the common lacrimal canaliculus 15, the lacrimal sac 16, the nasolacrimal canal 17 to the inferior nasal passage, and the hook 29 from the nostril 18 to insert the bulge 27 of the tip of the son.
By pulling it out of the lower nasal passage,
The silicone tube 24 connected to it is pulled into the lacrimal passage from the lower punctum. In the same manner, insert the other son 21 from the upper punctum 11, hook the hook 29 on the bulge 28 at the tip of the son and pull out the son from the lower nasal passage to the other side 25 of the silicone tube. 3 into the lacrimal duct and place it in the lacrimal duct as shown in FIG. 3, remove the sons 20 and 21 from both sides of the silicone tube.
4, 25 are tied in the nasal cavity as in FIG. After insertion of the silicone tube, the central portion 26 of the silicone tube appears between the upper and lower puncta. The other conventional methods are similar in that the silicone tube is pulled in by pulling out the son from the lower nasal passage. Further, as a method for treating dry eye, the upper and lower puncta 11 and 12 are cauterized and closed so that tears are not excreted from the lacrimal passage. Since then, there are patients who have lacrimation, and now a punctal plug made of plastic is inserted into the punctum. Freeman's punctal plug (Freemann JM: Trans Am)
Acad Ophthalmol Otolaryn
gol 79: 874-879, 1975) is well known. When I tried the punctal plug and found no problems, the punctal closure with cauterization was performed.

These conventional methods are as follows.
It is necessary to pull out the guiding sons 20 and 21 from the nostrils, but this operation is difficult and causes nose bleeding,
It was not uncommon to fracture the bone of the inferior turbinate in the nasal cavity. It took a long time to pull out his son from his nostril, which was sometimes impossible. Especially when treating a nasolacrimal duct obstruction in a baby, it is extremely difficult to pull out a guiding son from a small nostril. Further, a conventional silicone tube for treating lacrimal duct obstruction has a uniform thickness over its entire length, has elasticity, and cannot be strongly bent into a U shape. Therefore, the stability in the lacrimal passage is poor, and it is not uncommon for the silicone tube to come out of the punctum after placement. In the conventional technique, both ends of a silicone tube inserted from the upper and lower punctal points are tied in the nasal cavity, but there is a case where the child pulls it out with a finger when it comes out. Then, the knot 30 enters the lacrimal sac 16 as shown in FIG. 5, and it becomes difficult to remove the silicone tube. Kraft et al: Am. J.
Ophthalmol 94: 290-298, 198.
2) and Psilas et a1: Dac
riology News No. 1: 25,199
In 2), a silicone tube was indwelled by a conventional method for lacrimal duct obstruction, and high success rates of 80.3% and 78% were obtained, respectively. However, generally, a silicone tube is not placed for lacrimal duct obstruction, and a large operation such as lacrimal nasal anastomosis is immediately performed. As a cause of this,
With the conventional silicone tube placement method, it is very difficult to pull out the son from the lower nasal passage. If there were such a simple silicone tube placement method without such a difficult intranasal operation, all physicians would start placing the silicone tube before major surgery. It is believed that many patients will heal with silicone tube placement alone and not have to undergo major surgery. Further, for dry eye, a punctal plug is inserted into the punctum and left in place, but the problem is that the plug is easily inserted because it is shallow.

The gist of the present invention is the intubation device described in each of claims 1 to 9.

EXAMPLE The present inventor has a simple operation for the treatment of lacrimal duct obstruction and dry eye, significantly reduces the pain to the patient, and can insert the indwelling instrument into the lacrimal duct accurately and quickly.
As a result of continuous research on a treatment tool that is difficult to remove after insertion and that can be easily removed when the purpose is reached, an intubation device as shown in FIGS. 6, 7 and 8 was invented. A silicone tube having a length of 50 to 120 mm is thin and soft in the central portion 20 to 40 mm, both ends thereof are thick and hard, and both ends thereof are sharp and blind ends. As described above, it was found that it is extremely suitable for the above-mentioned purpose to use a device having a shape like a nunchaku used in Chinese martial arts as a lacrimal duct intubation device, and has completed the present invention. . Nunchaku is a chain of two rods. As the plastic tube used in the present invention, it is preferable to select a plastic tube which is substantially non-irritating and non-toxic to the eye tissue and the living body. From this point of view, a silicone tube whose safety has already been established as a treatment tool for lacrimal duct obstruction is suitable, and among them, the outer diameter is 0.9 to 1.2 m.
m, an inner diameter of 0.5 to 0.7 mm silicone tube,
A combination of silicone tubes having an outer diameter of 0.5 to 0.7 mm and an inner diameter of 0.3 to 0.5 mm is particularly preferably used. Explaining the configuration, as shown in FIGS. 6, 9 and 10, this thin tube (outer diameter 0.5 to
0.7 mm, inner diameter 0.3-0.5 mm, length 20-40
thicker tubes (outer diameter 0.
9-1.2 mm, inner diameter 0.5-0.7 mm, length 15-
50 mm) 42, 43 are connected. The lengths of the tube 42 and the tube 43 are almost equal. The thin tube is connected by inserting 2 mm into the lumen of the thick tube. Therefore, the connecting portions 45 and 46 are 2 mm in size, but these portions are bonded with silicone glue. The tips 47, 48 of the thicker tube are sharpened to leave a blind end. That is, a rod having the same diameter as the inner diameter of the tube is filled with silicone glue and packed in a portion of the thicker tube having a tip of 2 mm. In this way, the lumen at the tip of 2 mm is completely filled with silicone, and then the tip is sharply cut to form both sides 47 and 48 which are pointed at the blind ends. Small cuts with a length of 0.5 mm for inserting a 0.4 mm diameter son into the thicker tube 49, 50
So that it is parallel to the tube. Making a cut perpendicular to the tube can cause the tube to break during operation. The position where the cut is made is 10 to 45 mm from the tip of the thicker tube, but if you make small cuts 49, 50 at the midpoint 50 of the thicker tube and two places 49 near the connection part, these The tube can be easily pushed into the lacrimal passage by inserting a son from a small cut. It is convenient to mark the part corresponding to the break so that the position of the small break can be easily seen. In this way, the total length is 50 to 120 m
Make a tube of m. However, when the thin tube in the central portion is 25 to 40 mm, the length of the thicker tubes on both sides is set to 15 to 30 mm, and 70 to 10 as a whole.
If the length is 0 mm, it is easy to insert. The total length of this tube is 100-120 when an adult nasolacrimal duct is occluded.
mm is useful, and 70 to 70 for children with nasolacrimal duct obstruction.
A 100 mm one is useful. The length and thickness of the tube to be used differ depending on the length of the lacrimal passage and the size of the lacrimal passage lumen, but the thin portion at the center is 0.64 in thickness.
mm, length 25 mm, long part on both sides is 0.94 m thick
m, length 40 mm, and total length 105 mm are most often used. For the treatment of dry eye, it is effective to insert two thin articles of the present invention or use a thick article of the present invention. In order to improve the stability in the lacrimal passage, it is important that the central part of the tube is thin and soft. What makes the central part is the tube with an outer diameter of 0.5 to 0.7 mm described above. Instead, it may be a soft rod with a lumen of 0.5-0.7 mm in diameter. Mark the midpoint 44 of the thin portion in the center. This mark may be attached to the tube itself, or 9-0 nylon thread may be attached so as to make a round at the midpoint of the tube. The thin part in the center may be white or transparent, but the thick parts on both sides should be transparent so that you can see how far the inserted son has entered. It is possible to confirm whether or not the son has been correctly inserted by putting a mark 44 at the middle point of the thin portion in the center. If properly inserted, the mark 44 will be between the upper and lower punctum. If it is shifted to one side, the mark 44 cannot be seen. It is very rare for the son to be displaced once it is correctly inserted, but if it is displaced, the connection parts 45 and 46 of the thin tube and the thick tube form a step, which causes tears in the upper and lower tears. Once between the points, the stump of the thicker tube at the connection stimulates the cornea and the patient complains of pain. Even if such a displacement occurs, it is better to form smooth slopes 51 and 52 so that the connection part does not become a step as shown in FIG. 7 so as not to stimulate the cornea. This can be made into a smooth gradient 41, 42 by applying silicone glue to the stepped portion of the connection portion. Further, as shown in FIG. 7, when the both ends 53 and 54 of the present invention are formed into a pointed conical shape, it becomes easier to insert from the punctum. It is extremely rare that the connection parts 45 and 46 come off, but as shown in FIG.
From the beginning, it is best that the central portions 40, 41 are made of thin tubes or rods, and both sides 42, 43 are made of thick tubes without any connecting portion. In addition, in FIG. 8, as shown in FIG.
Similarly, 3 and 54 are conical in shape and have a blind end, and that the boundaries 51 and 52 between the thick and thin portions have no step and have a gentle slope. As shown in FIG. 9, it is convenient that the tube is fitted with a son from the beginning. The above configuration is for inserting a tube into the lacrimal duct from the upper and lower puncta as shown in FIG. 10, but as shown in FIG. 13, only the upper punctum (or only the lower punctum). Placing a tube in the lacrimal duct is also an excellent method for treating lacrimal duct obstruction. In this method, as shown in FIG. 11, only the thick portion 42 of FIGS. 7 and 8 is used, the tip 54 of which is also a conical blind end. When pushing this into the lacrimal passage from the upper punctum 1, as shown in FIG.
The tube 3 is pushed into the lacrimal passage while the tube 3 is passed through to the tip 54 of the tube 42. After pushing the tube in, the son 63 is removed, and the other end of the tube is fixed with 7-0 nylon threads 64, 65. As shown in FIG. 17, when the upper and lower lacrimal canaliculi 13 and 14 are scarred, the common lacrimal canaliculus 15 is opened, and a match rod-shaped tube or rod as shown in FIGS. 14, 15, and 16 is inserted. This tube consists only of the thick part of the previous embodiment and has a tip 47
Is a blind end, and the other end 55 bulges like a match stick. As shown in FIG. 15, it is also preferable that the tip end is conical and sharpened to form the blind end 54. Rather than a tube, a similarly shaped rod 56 having one pointed end and the other end bulging like a matchstick is also useful (FIG. 1).
6). Although the present invention is usually used after performing local anesthesia or general anesthesia under a surgical microscope, almost all patients can be easily administered with local anesthesia. First, a method for implementing the intubation device according to the present invention will be described with reference to FIGS. 6, 7, 8, 9, and 10. From the lower punctum 2 to the blind end of the tube (47 or 5
3) Insert. Prior to the insertion, it is the same as the conventional method to insert the son and open it by puncturing the occlusion part of the lacrimal duct. In addition, as in the conventional method, an incision is made on the ear side of the punctum or the punctum is dilated with a punctal dilation needle in advance. As shown in Fig. 9, the diameter is 0.4 mm from the small cut 49 made in the thicker tube.
Insert the son 61 of the tip of the tube 42 (47 or 53)
The distal end 47 or 53 of the tubes 40, 42 from the lower punctum 12 to the lower canaliculus 14 / total canaliculus 15.
It is pushed through the lacrimal sac 16 and the nasolacrimal duct 17 to the lower nasal passage. Then, only the tubes 40 and 42 are left and the son 61 is removed. Next, the other tube 13 is pushed into the lacrimal passage from the upper punctum 11, but before that, a son having a diameter of 1 mm is inserted from the upper punctum 11. The upper punctum is also expanded with an ear incision or a punctal dilation needle. Insert the son 62 in the same way from the small cut 50 in the center of the thicker tube, and
The tips (48 or 54) of Nos. 1 and 43 are pushed from the upper punctum 11 through the upper lacrimal canaliculus 13, the common lacrimal canaliculus 15, the lacrimal sac 16 and the nasolacrimal canal 17 to the lower nasal passage. FIG. 6 shows an indwelling state of the intubation device at the end of the operation, and a mark placed between the upper punctum 11 and the lower punctum 12 at the midpoint of the thin tubes 40 and 41 in the central portion of the present invention. 44 can be seen. As described above, according to the present invention, there is no difficult intranasal operation. Since the silicone tube is non-irritating and has no biotoxicity, it can be placed for a long period of time. When removing the upper punctum 11
It suffices to pinch the thin midpoint 44 visible between the lower punctum 12 and tweezers and pull it. Next, a method of implementing another example of the intubation instrument will be described with reference to FIGS. As shown in FIG. 12, the tube 4
2 The son 63 is a conical tube with a sharp end 54
As shown in FIG. 13, the upper punctum 1
From 1 to the upper lacrimal canaliculus 13, the common lacrimal canaliculus 15, the lacrimal sac 16, and the nasolacrimal canal 17 to the lower nasal passage. Then, for the purpose of preventing the tube from falling off, the other end of the tube was fixed to the upper punctum and the upper lacrimal canaliculus using a 7-0 nylon thread. One of the nylons goes out of the upper punctum and the other goes through the upper canaliculus to the outside so that they are tied together so that the knot 64 does not go out of the punctum. By pulling this 7-0 nylon thread, the tube comes out of the upper punctum 11 and can be removed. Fixing the 7-0 nylon thread is not enough,
The other end of the 7-0 nylon thread 65 passed through the other tube is taken out of the lacrimal canaliculus via the upper lacrimal canaliculus and tied together so that the knot is located on the innermost skin surface of the upper eyelid. Similarly, place the tube 42 from the lower punctum 12 into the lacrimal passage and
The method of fixing the tube with -0 nylon thread is also useful, but the method of inserting from the upper punctum is easier. Next, a method of implementing still another embodiment will be described with reference to FIGS. As shown in FIG. 16, the upper lacrimal canaliculus 13,
When the inferior lacrimal canaliculus 14 is scarred, it is used to harness the remaining total lacrimal canaliculus 15. After accurately opening the opening of the common lacrimal canaliculus 15 under a surgical microscope, FIGS.
Insert the tube or rod shown in (1) through the opening of the common lacrimal canaliculus. The other end is bulging like a matchstick, so the tube or rod will not fall off.
Therefore, it is easy to remove. The present inventor has confirmed in a plurality of examples that, if only the small canaliculus remains, the tears flow to the lacrimal passage by opening the opening. When all the canalicular canaliculi are occluded, similarly, the opening of the lacrimal sac is opened, and a matchstick-shaped object is inserted from there.
A thicker outer diameter of 1.75 mm in the shape shown in FIGS. 14, 15 and 16 is also useful. According to the present invention, the central portion of the tube is made of a thin and soft tube or rod, and both sides of the tube are made of hard and thick tubes, so that the tube can be made into a U-shape. Therefore, the stability in the lacrimal passage is good. Further, since the tip of the tube is a blind end, the tube can be surely pushed into the lacrimal passage by passing the son. Next, an actual case in which the intubation device according to the present invention is effective will be shown. Case 1. Right) Canalicular duct obstruction. The main complaint was a strong tearing of the right eye from 20 years ago, and sometimes the tears made things blurry. When this patient was treated with a nunchaku-shaped silicone tube, tears had decreased 2 days after the treatment. On the 6th day, the silicone tube was normalized while being indwelling. The silicone tube was removed on the 13th day. However, during that time, the silicone tube did not come out spontaneously. Four months after the operation, the lacrimal passage is open and the tears are in a normal state. Case 2. Left) Nasolacrimal duct obstruction. After the treatment was performed using the Nunchaku type silicone tube, the silicone tube was removed on the 7th day. The tears disappeared from the day after the removal. On day 144, the tears had completely disappeared. Case 3. Right) Nasolacrimal duct obstruction. When intubation was performed using a nunchaku-shaped silicone tube, the silicone tube was removed and reclosed, resulting in lacrimation.
When the silicone tube was inserted again in the same manner, the tearing significantly decreased from the second day after the operation, and the healing is now complete. Case 4. Right) An infant with nasolacrimal duct obstruction. I have been treated in various clinics but I have not been cured. A silicone tube was quickly intubated under local anesthesia, and after 2 weeks, the silicone tube was removed and treated. Case 5. Left) A young adult male with upper and lower canaliculus obstruction. The symptoms of lacrimation were strong, my mental condition had deteriorated, and I was unable to work. When the canaliculus was opened and a silicone tube was inserted through it, a new lacrimal duct was opened three months later, and tearing was remarkably reduced. My mental condition improved and I was able to work. Case 6. It has dry eyes. After intubation using a nunchaku-shaped silicone tube, tears slightly accumulated in the right eye, and the dryness of the right eye decreased from the next day. Of 31 adult nasolacrimal duct obstructions treated with the nunchaku-shaped silicone tube according to the present invention, 18 (58.1%) were successful. In addition, when the same nunchaku-shaped silicone tube was used to treat the canalicular canaliculus obstruction in 8 adults, the success rate was 100%. When the same tube was used for the treatment of two complications of canaliculus obstruction and nasolacrimal duct obstruction, one case (50%) was successful. Therefore, with a success rate of 27 out of 41 cases (65.9%), these successful patients were able to escape major surgery.

According to the present invention, the following effects are obtained. Unlike the prior art, the intubation device according to the present invention does not require any difficult intranasal operation, so that the operation time is shortened and the burden on the patient is small. If the central part of the tube is made of a thin and soft tube or rod, it can be strongly bent into a U-shape unlike conventional tubes, so that it has good stability in the lacrimal passage and does not come out spontaneously. Even if it fails once, it is easy to try again because there is less pain to the patient. Since both ends of the tube are not tied in the nasal cavity, even if it comes out, it will not enter the lacrimal sac and become difficult to remove like the conventional technique. The intubation device according to the present invention is easy to insert into and remove from the lacrimal passage, but does not come out during insertion. Also, if there is a mark on the center of the thin part,
It is easy to check whether it is entered correctly. Also,
The one that eliminates the connection between the thin tube or rod and the thick tube is more excellent because there is no concern that the connection will come off. In addition, in the case where the transition between the thick portion and the thin portion of the tube is smooth, the stump of the thick tube rarely stimulates the cornea even if there is a deviation. Also, by making small cuts in a thick tube parallel to the tube, the tube no longer tears and tears. In addition, by making the tip of the tube sharp in a conical shape,
Instead of making an incision on the ear side of the punctum, the punctum can be inserted simply by expanding the punctum with a punctal needle. By using this tube, it became easy to place the tube in the lacrimal duct. This makes it easier for physicians to routinely perform tube placement prior to major surgery, and 60-80% of patients will heal with this simple treatment without having to undergo major surgery. it is conceivable that. This is a great gospel for patients.
In addition, the nunchaku-shaped intubation device of the present invention can be used for treating a patient with dry eye, and has an advantage that it is hard to come out as compared with a conventional punctal plug.

[Brief description of drawings]

FIG. 1 is a schematic diagram showing a lacrimal passage.

FIG. 2 is a schematic diagram showing a conventional technique.

FIG. 3 is a schematic diagram for explaining how to implement the conventional technique.

FIG. 4 is a schematic diagram for explaining how to implement the conventional technique.

FIG. 5 is a schematic diagram for explaining the problems of the conventional technology.

FIG. 6 is a side view showing an intubation device according to the present invention.

FIG. 7 is a side view showing an intubation device according to the present invention.

FIG. 8 is a side view showing an intubation device according to the present invention.

FIG. 9 is a perspective view showing a state when the intubation device according to the present invention is implemented.

FIG. 10 is a schematic view illustrating a method of implementing an intubation device according to the present invention.

FIG. 11 is a side view of an intubation device according to the present invention.

FIG. 12 is a perspective view showing a state when the intubation device according to the present invention is implemented.

FIG. 13 is a schematic view for explaining a method of implementing an intubation device according to the present invention.

FIG. 14 is a side view showing an intubation device according to the present invention.

FIG. 15 is a side view showing an intubation device according to the present invention.

FIG. 16 is a side view showing an intubation device according to the present invention.

[Explanation of symbols]

11 Upper punctum 12 Lower punctum 13 Upper lacrimal canal 14 Lower lacrimal canal 15 Total lacrimal canal 16 Lacrimal sac 17 Nasal lacrimal 18 Nasal 19 Lacrimal glands 20, 21 Extinction 22, 23 Both ends of silicone tube 24, 25 Both sides of silicone tube 26 center of silicone tube 27, 28 bulge of tip of son 29 hook 30 knot of silicone tube 40 left half of thin tube 41 right half of thin tube 42 left side of thick tube 43 right side of thick tube 44 inside of thin tube Marks on points 45,46 Connections 47,48 Both ends of the tube with a sharp pointed end 49,50 Small cuts on a thick tube 51,52 Smoothed slopes 53 that eliminate the step at the connection. 54 Both ends of a tube with a conical sharpened blind end 55 Match End of the tube that is bulging 56 Match rod rod 61, 62 Sinus inserted through small cuts 50, 42 63 Sinus inserted through the opening at the other end of the tube 64 Nylon 7-0 threaded through the tube 65-0 Nylon thread attached to a tube

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[Procedure amendment]

[Submission date] March 30, 1993

[Procedure Amendment 1]

[Document name to be amended] Statement

[Correction target item name] Full text

[Correction method] Change

[Correction content]

[Document name] Statement

[Title of Invention] Endotracheal intubation device

[Claims]

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a lacrimal duct intubation device for treating lacrimal duct obstruction and dry eye.

[0002]

2. Description of the Related Art The lacrimal passage, as shown in FIG.
1, a lower lacrimal punctum 12, an upper lacrimal canaliculus 13, a lower lacrimal canaliculus 14, a common lacrimal canaliculus 15, a lacrimal sac 16, and a nasolacrimal canal 17. The nasolacrimal duct 17 opens into the lower nasal passage in the nasal cavity. The length from the punctum to the lower end of the nasolacrimal duct varies depending on the individual, but is 33 to 45 mm.
(Average 38 mm). See, for example, Katsuaki Kurihashi, Anatomy and Function of the Lacrimal Path, Ophthalmic Surgery 2: 403-413, 1989. At any site, lacrimal duct obstruction causes lacrimation and is a very distressing disease for patients. On the other hand, dry eye is a disease that causes changes in the eye surface due to a lack of tear fluid secreted from the lacrimal gland 19, which causes dry eye symptoms such as dry eye, eye fatigue, and stickiness, and is equivalent to tearing. , A disease that bothers patients.

As a conventional treatment method for lacrimal duct obstruction, a large operation is performed by making an incision in the face, exposing the bone wall of the frontal process of the maxilla and making a hole in the bone. On the other hand, as a conventional treatment method for lacrimal duct obstruction, there is also a method of opening the obstructed part of the lacrimal duct with a son without opening it and then placing a thin silicone tube in the lacrimal duct so as not to re-occlusion. It has been carried out and its usefulness has already been confirmed. The frontal process of the maxilla acts as a strong barrier for the fragile ethmoid bone behind it, and the major operation for lacrimal duct obstruction is the operation of making a large hole in the frontal process of the maxilla.
Therefore, it is desirable to treat lacrimal duct obstruction without performing as much surgery as possible. Therefore, in recent years, the usefulness of this silicone tube indwelling technique is increasing more and more.

The conventional silicone tube insertion method is as follows:
It is disclosed in Japanese Patent Publication No. 56-50579. The method by John S. Clauford disclosed therein is a typical conventional method. To explain this, see FIG.
And as shown in FIG. 3, silicone tubes 24, 2
5 and 26 both ends 22 and 23 for guiding sons 20 and 21
And one of the sons 20 is inserted from the inferior punctum 12 through the inferior canaliculus 14, the common canaliculus 15, the lacrimal sac 16 and the nasolacrimal canal 17 to the inferior nasal passage, and the hook 29 is inserted from the nostril 18. By inserting and hooking on the bulged portion 27 of the tip of the son and pulling it out from the inferior nasal passage, the silicone tube 24 connected to it is pulled from the inferior punctum into the lacrimal passage. Do the same for the other son 21 in the same way.
Insert it more and hook 29 to the bulge 28 at the tip of the son.
, The other side 25 of the silicone tube is pulled into the lacrimal passage by pulling it out from the lower nasal passage, and is placed in the lacrimal passage as shown in FIG.
And tie the silicone tubes on both sides 24, 25 in the nasal cavity as shown in FIG. After inserting the silicone tube, the middle part 2 of the silicone tube between the upper and lower puncta
6 appears.

The other conventional methods are similar in that the silicone tube is pulled in by pulling the son off from the lower nasal passage.

As a method for treating dry eye, the upper and lower puncta 11 and 12 are cauterized and closed so that tears are not excreted from the lacrimal passage. Since then, there are patients who have lacrimation, and now a punctal plug made of plastic is inserted into the punctum. As a punctal plug, Freeman's punctal plug (Free
mann JM: Trans Am Acad Op
hthalmol Otolaryngol 79: 8
74-879, 1975) is well known. When I tried the punctal plug and found no problems, the punctal closure with cauterization was performed.

[0007]

These conventional methods are as follows.
It is necessary to pull out the guiding sons 20 and 21 from the nostrils, but this operation is difficult and causes nose bleeding,
It was not uncommon to fracture the bone of the inferior turbinate in the nasal cavity. It took a long time to pull out his son from his nostril, which was sometimes impossible. Especially when treating a nasolacrimal duct obstruction in a baby, it is extremely difficult to pull out a guiding son from a small nostril.

Further, the conventional silicone tube for treating lacrimal duct obstruction has a uniform thickness over its entire length, has elasticity, and cannot be strongly bent into a U shape. Therefore, the stability in the lacrimal passage is poor, and it is not uncommon for the silicone tube to come out of the punctum after placement. In the conventional technique, both ends of a silicone tube inserted from the upper and lower punctal points are tied in the nasal cavity, but there is a case where the child pulls it out with a finger when it comes out. Then, the knot 30 enters the lacrimal sac 16 as shown in FIG. 5, and it becomes difficult to remove the silicone tube.

Kraft et al:
Am. J. Ophthalmol 94: 290-
298, 1982) and Psilas et al.
al: Dacyology News No.
1:25, 1992) has a silicone tube indwelled by a conventional method for lacrimal duct obstruction.
It has a high success rate of 3% and 78%. However, generally, a silicone tube is not placed for lacrimal duct obstruction, and a large operation such as lacrimal nasal anastomosis is immediately performed.
This is because it is very difficult to pull out the son from the inferior nasal passage by the conventional silicone tube placement method. If there were such a simple silicone tube placement method without such a difficult intranasal operation, all physicians would start placing the silicone tube before major surgery. It is believed that many patients will heal with silicone tube placement alone and not have to undergo major surgery. Further, for dry eye, a punctal plug is inserted into the punctum and left in place, but the problem is that the plug is easily inserted because it is shallow.

[0010]

The gist of the present invention is the intubation device described in each of claims 1 to 9.

[0011]

EXAMPLE The present inventor has a simple operation for the treatment of lacrimal duct obstruction and dry eye, significantly reduces the pain to the patient, and can insert the indwelling instrument into the lacrimal duct accurately and quickly.
As a result of continuous research on a treatment tool that is difficult to remove after insertion and that can be easily removed when the purpose is reached, an intubation device as shown in FIGS. 6, 7 and 8 was invented. A central portion 20 to 40 mm of a tube having a length of 50 to 120 mm is thin and soft, both ends are thick and hard, and both ends are sharp and blind ends. As described above, it was found that it is extremely suitable for the above-mentioned purpose to use a device having a shape like a nunchaku used in Chinese martial arts as a lacrimal duct intubation device, and has completed the present invention. . Nunchaku is a chain of two rods.

As the plastic tube used in the present invention, it is preferable to select a plastic tube which is substantially non-irritating and non-toxic to the eye tissue and the living body. From this viewpoint, a silicone tube whose safety has already been established as a treatment tool for lacrimal duct obstruction is suitable, and among them, a silicone tube having an outer diameter of 0.9 to 1.2 mm and an inner diameter of 0.5 to 0.7 mm, A combination of silicone tubes having an outer diameter of 0.5 to 0.7 mm and an inner diameter of 0.3 to 0.5 mm is particularly preferably used.

The structure will be described. As shown in FIGS. 6, 9 and 10, this thin tube (outer diameter 0.5 to 0.5) is used.
0.7 mm, inner diameter 0.3-0.5 mm, length 20-40
thicker tubes (outer diameter 0.
9-1.2 mm, inner diameter 0.5-0.7 mm, length 15-
50 mm) 42, 43 are connected. The lengths of the tube 42 and the tube 43 are almost equal. The thin tube is connected by inserting 2 mm into the lumen of the thick tube. Therefore, the connecting portions 45 and 46 are 2 mm in size, but these portions are bonded with silicone glue. The tips 47, 48 of the thicker tube are sharpened to leave a blind end. That is, a rod having the same diameter as the inner diameter of the tube is filled with silicone glue and packed in a portion of the thicker tube having a tip of 2 mm. In this way, the lumen at the tip of 2 mm is completely filled with silicone, and then the tip is sharply cut to form both sides 47 and 48 which are pointed at the blind ends. Small cuts with a length of 0.5 mm for inserting a 0.4 mm diameter son into the thicker tube 49, 50
So that it is parallel to the tube. Making a cut perpendicular to the tube can cause the tube to break during operation. The position where the cut is made is 10 to 45 mm from the tip of the thicker tube, but if you make small cuts 49, 50 at the midpoint 50 of the thicker tube and two places 49 near the connection part, these The tube can be easily pushed into the lacrimal passage by inserting a son from a small cut. It is convenient to mark the part corresponding to the break so that the position of the small break can be easily seen.

In this way, a tube having a total length of 50 to 120 mm is produced. However, when the thin tube in the center is 25 to 40 mm, the length of the thick tubes on both sides is set to 15 to 30 mm, and 70 to 100 mm as a whole.
It is easy to insert when the length is set.

The total length of the tube is preferably 100 to 120 mm for obstruction of the nasolacrimal duct in an adult, and 70 to 100 mm for obstruction of the nasolacrimal duct in a child. The length and thickness of the tube used will vary depending on the length of the lacrimal passage and the size of the lacrimal passage lumen.
The thin part at the center has a thickness of 0.64 mm and a length of 25 mm, the long parts on both sides have a thickness of 0.94 mm and a length of 40 mm, and the one having a total length of 105 mm is most used. For the treatment of dry eye, it is effective to insert two thin articles of the present invention or use a thick article of the present invention.

In order to improve the stability in the lacrimal passage, it is important that the central part of the tube is thin and soft. The central part is 0.5 mm in outer diameter as described above.
~ 0.7 mm tubing, not lumenless diameter 0.
A soft rod of 5 to 0.7 mm may be used.

A mark is made on the midpoint 44 of the thin portion of the central portion. This mark may be on the tube itself, but
It is also possible to tie a -0 nylon thread around the center of the tube so that it goes around once. The thin part in the center may be white or transparent, but the thick parts on both sides should be transparent so that you can see how far the inserted son has entered.

It is possible to confirm whether or not the tube has been inserted correctly by placing a mark 44 at the middle point of the thin portion in the center. If properly inserted, the mark 44 will be between the upper and lower punctum. If it is shifted to one side, the mark 44 cannot be seen. Once correctly inserted,
It is extremely rare for the son to slip, but if it does, the connection 45 between the thin and thick tubes,
46 forms a step, and when it comes between the upper and lower puncta, the stump of the thicker tube at the connection stimulates the cornea and the patient complains of pain. Even if such a displacement occurs, it is better to form smooth slopes 51 and 52 so that the connection part does not become a step as shown in FIG. 7 so as not to stimulate the cornea. This is because the smooth gradient 41, by applying silicone glue to the step portion of the connection part,
It can be 42.

Further, as shown in FIG. 7, a sharp conical shape as shown at both ends 53 and 54 of the present invention makes it easier to insert from the punctum.

It is extremely rare for the connecting portions 45 and 46 to come off, but as shown in FIG. 8, the connecting portions are eliminated and the central portions 40 and 41 are thin tubes or rods from the beginning, and both sides 42 and 43 thereof are formed. It is best to use one that consists of a thick tube with no connections at all.

Further, in FIG. 8, as shown in FIG. 7, the both ends 53, 54 are conical and pointed to be a blind end, and the boundaries 51, 52 between the thick and thin portions are stepped. It is the same as making a gentle gradient without making. As shown in FIG. 9, it is convenient that the tube is fitted with a son from the beginning.

The above-mentioned configuration is as shown in FIG.
The tube is inserted into the lacrimal duct through the upper and lower puncta, but as shown in FIG. 13, the tube can be placed in the lacrimal duct only from the upper punctum (or only the lower punctum). It is an excellent method for treating obstruction. In this way,
As shown in FIG. 11, only the thick portion 42 of FIGS. 7 and 8 is used and its tip 54 is also a conical blind end. When pushing this into the lacrimal passage from the upper punctum 1, as shown in FIG.
The tube is pushed into the lacrimal passage with the tip 54 of No. 3 being passed through. After pushing the tube in, the son 63 is removed and the other end of the tube is fixed with 7-0 nylon threads 64, 65 (FIG. 13).

As shown in FIG. 16, the upper and lower canaliculus 1
When 3 and 14 are scarred, the common lacrimal canaliculus 15 is opened, and a match rod-shaped tube or rod as shown in FIGS. 14, 15 and 16 is inserted. This tube consists only of the thick portion of the above-mentioned embodiment, the tip 47 is a blind end, and the other end 55 is bulging like a match rod. As shown in FIG. 15, it is also preferable that the tip end is conical and sharpened to form the blind end 54. A similarly shaped rod 56 with one pointed end and the other end bulging like a matchstick, rather than a tube, is also useful (FIG. 16). Although the present invention is usually used after performing local anesthesia or general anesthesia under a surgical microscope, almost all patients can be easily administered with local anesthesia.
First, FIG. 6 shows a method of implementing an intubation device according to the present invention.
This will be described with reference to 7, 8, 9, and 10.

Insert one end (47 or 53), which is the blind end of the tube, from the lower punctum 2. Prior to insertion
Inserting a son and opening it by puncturing the occlusion of the lacrimal duct is the same as the conventional method. In addition, as in the conventional method, an incision is made on the ear side of the punctum or the punctum is dilated with a punctal dilation needle in advance. As shown in FIG. 9, the tube 40 with the small size cut 49 formed in the thicker tube inserted into the tip end (47 or 53) of the tube 42 from the small end 49 of the tube 42,
42 from the lower punctum 12 to the lower 47 or 53
4. The small canaliculus 15, the lacrimal sac 16 and the nasolacrimal duct 17 are pushed into the lower nasal passage. Then tube 4
Only 0 and 42 are left and the son 61 is removed. Next, the other tube 13 is pushed into the lacrimal passage from the upper punctum 11, but before that, a son having a diameter of 1 mm is inserted from the upper punctum 11. The upper punctum is also expanded with an ear incision or a punctal dilation needle. In the same way, insert the son 62 from the small cut 50 in the center of the thicker tube, and insert the tips (48 or 54) of the tubes 41, 43 above the upper punctum 11 and the total lacrimal canaliculus 13. Teardrop 16
-Push it through the nasolacrimal duct 17 to reach the lower nasal passage.

FIG. 6 shows the indwelling state of the intubation device at the end of the operation. It is attached between the upper and lower punctal points 11 and 12 at the middle point of the thin tubes 40 and 41 in the central portion of the present invention. The mark 44 can be seen. As described above, according to the present invention, there is no difficult intranasal operation.

Since the silicone tube is non-irritating and has no biotoxicity, it can be placed for a long period of time. When removing, it is sufficient to pinch the thin midpoint 44 visible between the upper punctum 11 and the lower punctum 12 with tweezers and pull it.

Next, a method of implementing another example of the intubation instrument will be described with reference to FIGS.

As shown in FIG. 12, in the state in which the son 63 is inserted into the tube 42 up to the conical sharp end 54 of the tube as shown in FIG. 12, as shown in FIG. , Common canaliculus 15, lacrimal sac 16, nasolacrimal duct 17
Insert through to the lower nasal passage. Then, for the purpose of preventing the tube from falling off, the other end of the tube was fixed to the upper punctum and the upper lacrimal canaliculus using a 7-0 nylon thread. One of the nylons goes out of the upper punctum and the other goes through the upper canaliculus to the outside so that they are tied together so that the knot 64 does not go out of the punctum. By pulling this 7-0 nylon thread, the tube comes out of the upper punctum 11 and can be removed. Fixing the 7-0 nylon thread is not enough, and both ends of the 7-0 nylon thread 65, which has been passed through the other tube, are taken out of the lacrimal canal via the upper lacrimal canaliculus, and the knot is tied to the upper eyelid. It should be on the inside skin. Similarly, the tube 42 is placed in the lacrimal passage from the inferior punctum 12 and the 7-
The method of fixing the tube with 0 nylon thread is also useful, but the method of inserting from the upper punctum is easier.

Next, a method of implementing another embodiment will be described with reference to FIGS.

As shown in FIG. 16, the method is used to reclaim the remaining total canaliculus 15 when the upper and lower canaliculus 13 and 14 are scarred. After accurately opening the opening of the common lacrimal canaliculus 15 under a surgical microscope, FIG.
The tube or rod shown at 15 and 16 is inserted through the opening of the common lacrimal canaliculus. The other end is bulging like a matchstick, so the tube or rod will not fall off. Therefore, it is easy to remove. The present inventor has confirmed in a plurality of examples that, if only the small canaliculus remains, the tears flow to the lacrimal passage by opening the opening. When all the canalicular canaliculi are occluded, similarly, the opening of the lacrimal sac is opened, and a matchstick-shaped object is inserted from there. A thicker outer diameter of 1.75 mm in the shape shown in FIGS. 14, 15 and 16 is also useful.

According to the present invention, since the central portion of the tube is made of a thin and soft tube or rod, and both sides of the tube are made of hard and thick tubes, the tube can be made into a U shape. Therefore, the stability in the lacrimal passage is good. Further, since the tip of the tube is a blind end, the tube can be surely pushed into the lacrimal passage by passing the son.

Next, actual cases 1 to 3 in which the effect is obtained by using the intubation device using the silicone tube shown in FIGS. 6, 13 and 14 according to the present invention will be shown.

Case 1. Right) An infant with nasolacrimal duct obstruction.
I have been treated in various clinics but I have not been cured. The silicone tube shown in FIG. 13 was quickly intubated with local anesthesia, and after 2 weeks, it was removed and treated.

Case 2. Left) A young adult male with upper and lower canaliculus obstruction. The symptoms of lacrimation were strong, my mental condition had deteriorated, and I was unable to work. When the common canaliculus was opened, and the silicone tube shown in FIG. 14 was inserted from there, a new lacrimal duct opening was formed after 3 months, and tearing was remarkably reduced. My mental condition improved and I was able to work.

Case 3. It has dry eyes. When intubation using the nunchaku-shaped silicone tube shown in FIG. 6 was performed only on the right eye, tears slightly accumulated in the right eye, and the dryness of the right eye was reduced from the next day.

Out of 31 adult cases of nasolacrimal duct obstruction treated with the nunchaku-shaped silicone tube according to the present invention, 18 cases (58.1%) were successful. In addition, when the same nunchaku-shaped silicone tube was used to treat the canalicular canaliculus obstruction in 8 adults, the success rate was 100%. When the same tube was used for the treatment of two complications of canaliculus obstruction and nasolacrimal duct obstruction, one case (50%) was successful. Therefore, 27 out of 41 cases (65.9%)
The successful rate of these successful patients was able to escape major surgery.

[0037]

According to the present invention, the following effects are obtained.

Unlike the prior art, the intubation device according to the present invention does not require any difficult intranasal operation, so that the operation time is shortened and the burden on the patient is small. If the central part of the tube is made of a thin and soft tube or rod, it can be bent into a U shape strongly unlike conventional tubes, so it has good stability in the lacrimal passage and does not come out naturally. . Even if it fails once, it is easy to try again because there is less pain to the patient. Since both ends of the tube are not tied in the nasal cavity, even if it comes out, it will not enter the lacrimal sac and become difficult to remove like the conventional technique.

The intubation device according to the present invention is easy to insert into and remove from the lacrimal passage, but does not come out during insertion. Also, if there is a mark on the center of the thin part,
It is easy to check whether it is entered correctly. Also,
The one that eliminates the connection between the thin tube or rod and the thick tube is more excellent because there is no concern that the connection will come off. In addition, in the case where the transition between the thick portion and the thin portion of the tube is smooth, the stump of the thick tube rarely stimulates the cornea even if there is a deviation. Also, by making small cuts in a thick tube parallel to the tube, the tube no longer tears and tears. In addition, by making the tip of the tube sharp in a conical shape,
Instead of making an incision on the ear side of the punctum, the punctum can be inserted simply by expanding the punctum with a punctal needle. By using this tube, it became easy to place the tube in the lacrimal duct. This makes it easier for physicians to routinely perform tube placement prior to major surgery, and 60-80% of patients will heal with this simple treatment without having to undergo major surgery. it is conceivable that. This is a great gospel for patients.
In addition, the nunchaku-shaped intubation device of the present invention can be used for treating a patient with dry eye, and has an advantage that it is hard to come out as compared with a conventional punctal plug.

[Brief description of drawings]

FIG. 1 is a schematic diagram showing a lacrimal passage.

FIG. 2 is a schematic diagram showing a conventional technique.

FIG. 3 is a schematic diagram for explaining how to implement the conventional technique.

FIG. 4 is a schematic diagram for explaining how to implement the conventional technique.

FIG. 5 is a schematic diagram for explaining the problems of the conventional technology.

FIG. 6 is a side view showing an intubation device according to the present invention.

FIG. 7 is a side view showing an intubation device according to the present invention.

FIG. 8 is a side view showing an intubation device according to the present invention.

FIG. 9 is a perspective view showing a state when the intubation device according to the present invention is implemented.

FIG. 10 is a schematic view illustrating a method of implementing an intubation device according to the present invention.

FIG. 11 is a side view of an intubation device according to the present invention.

FIG. 12 is a perspective view showing a state when the intubation device according to the present invention is implemented.

FIG. 13 is a schematic view for explaining a method of implementing an intubation device according to the present invention.

FIG. 14 is a side view showing an intubation device according to the present invention.

FIG. 15 is a side view showing an intubation device according to the present invention.

FIG. 16 is a side view showing an intubation device according to the present invention.

[Explanation of symbols] 11 upper punctum 12 lower punctum 13 upper lacrimal canal 14 lower lacrimal canal 15 total canaliculus 16 lacrimal sac 17 nasolacrimal duct 18 nostril 19 lacrimal gland 20, 21 son 22, 23 both ends of silicone tube 24, 25 Both Sides of Silicone Tube 26 Center of Silicone Tube 27, 28 Bulging part of tip of son 29 Hook 30 Knot of silicone tube 40 Left half of thin tube 41 Right half of thin tube 42 Left side of thick tube 43 Right side of thick tube 44 Marks attached to the middle point of a thin tube 45, 46 Connection parts 47, 48 Both ends of a tube with a sharp pointed end 49, 50 Small cuts 51, 52 made in a thick tube Smooth slope without a step at the connection part Contained part 53, 54 Conical pointed blind end of tube Both ends 55 Ends of tube bulging like match stick 56 Match rod shaped rods 61, 62 Sons inserted from small cuts 50, 42 63 Sons inserted through opening at the other end of tube 64 Threaded through tube 7- 0 Nylon yarn 65 7-0 Nylon yarn attached to a tube ───────────────────────────────────── ─────────────────

[Procedure amendment]

[Submission date] April 5, 1993

[Procedure Amendment 1]

[Document name to be corrected] Drawing

[Name of item to be corrected] Fig. 12

[Correction method] Change

[Correction content]

[Fig. 12]

[Procedure amendment]

[Submission date] December 9, 1993

[Procedure Amendment 1]

[Document name to be amended] Statement

[Correction target item name] Full text

[Correction method] Change

[Correction content]

[Document name] Statement

[Title of Invention] Endotracheal intubation device

[Claims]

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a lacrimal duct intubation device for treating lacrimal duct obstruction and dry eye.

[0002]

2. Description of the Related Art The lacrimal passage, as shown in FIG.
1, a lower lacrimal punctum 12, an upper lacrimal canaliculus 13, a lower lacrimal canaliculus 14, a common lacrimal canaliculus 15, a lacrimal sac 16, and a nasolacrimal canal 17. The nasolacrimal duct 17 opens into the lower nasal passage in the nasal cavity. The length from the punctum to the lower end of the nasolacrimal duct varies depending on the individual, but is 33 to 45 mm.
(Average 38 mm). See, for example, Katsuaki Kurihashi, Anatomy and Function of the Lacrimal Path, Ophthalmic Surgery 2: 403-413, 1989. At any site, lacrimal duct obstruction causes lacrimation and is a very distressing disease for patients. On the other hand, dry eye is a disease that causes changes in the eye surface due to a lack of tear fluid secreted from the lacrimal gland 19, which causes dry eye symptoms such as dry eye, eye fatigue, and stickiness, and is equivalent to tearing. , A disease that bothers patients.

As a conventional treatment method for lacrimal duct obstruction, a large operation is performed by making an incision in the face, exposing the bone wall of the frontal process of the maxilla and making a hole in the bone. On the other hand, as a conventional treatment method for lacrimal duct obstruction, there is also a method of opening the obstructed part of the lacrimal duct with a son without opening it and then placing a thin silicone tube in the lacrimal duct so as not to re-occlusion. It has been carried out and its usefulness has already been confirmed. The frontal process of the maxilla acts as a strong barrier for the fragile ethmoid bone behind it, and the major operation for lacrimal duct obstruction is the operation of making a large hole in the frontal process of the maxilla.
Therefore, it is desirable to treat lacrimal duct obstruction without performing as much surgery as possible. Therefore, in recent years, the usefulness of this silicone tube indwelling technique is increasing more and more.

The conventional silicone tube insertion method is as follows:
It is disclosed in Japanese Patent Publication No. 56-50579. The method by John S. Clauford disclosed therein is a typical conventional method. To explain this, see FIG.
And as shown in FIG. 3, silicone tubes 24, 2
5 and 26 both ends 22 and 23 for guiding sons 20 and 21
And one of the sons 20 is inserted from the inferior punctum 12 through the inferior canaliculus 14, the common canaliculus 15, the lacrimal sac 16 and the nasolacrimal canal 17 to the inferior nasal passage, and the hook 29 is inserted from the nostril 18. By inserting and hooking on the bulged portion 27 of the tip of the son and pulling it out from the inferior nasal passage, the silicone tube 24 connected to it is pulled from the inferior punctum into the lacrimal passage. Do the same for the other son 21 in the same way.
Insert it more and hook 29 to the bulge 28 at the tip of the son.
, The other side 25 of the silicone tube is pulled into the lacrimal passage by pulling it out from the lower nasal passage, and is placed in the lacrimal passage as shown in FIG.
And tie the silicone tubes on both sides 24, 25 in the nasal cavity as shown in FIG. After inserting the silicone tube, the middle part 2 of the silicone tube between the upper and lower puncta
6 appears.

The other conventional methods are similar in that the silicone tube is pulled in by pulling the son off from the lower nasal passage.

As a method for treating dry eye, the upper and lower puncta 11 and 12 are cauterized and closed so that tears are not excreted from the lacrimal passage. Since then, there are patients who have lacrimation, and now a punctal plug made of plastic is inserted into the punctum. As a punctal plug, Freeman's punctal plug (Free
mann JM: Trans Am Acad Op
hthalmol Otolaryngol 79: 8
74-879, 1975) is well known. When I tried the punctal plug and found no problems, the punctal closure with cauterization was performed.

[0007]

These conventional methods are as follows.
It is necessary to pull out the guiding sons 20 and 21 from the nostrils, but this operation is difficult and causes nose bleeding,
It was not uncommon to fracture the bone of the inferior turbinate in the nasal cavity. It took a long time to pull out his son from his nostril, which was sometimes impossible. Especially when treating a nasolacrimal duct obstruction in a baby, it is extremely difficult to pull out a guiding son from a small nostril.

Further, the conventional silicone tube for treating lacrimal duct obstruction has a uniform thickness over its entire length, has elasticity, and cannot be strongly bent into a U shape. Therefore, the stability in the lacrimal passage is poor, and it is not uncommon for the silicone tube to come out of the punctum after placement. In the conventional technique, both ends of a silicone tube inserted from the upper and lower punctal points are tied in the nasal cavity, but there is a case where the child pulls it out with a finger when it comes out. Then, the knot 30 enters the lacrimal sac 16 as shown in FIG. 5, and it becomes difficult to remove the silicone tube.

Kraft et al:
Am. J. Ophthalmol 94: 290-
298, 1982) and Psilas et al.
al: Dacyology News No.
1:25, 1992) has a silicone tube indwelled by a conventional method for lacrimal duct obstruction.
It has a high success rate of 3% and 78%. However, generally, a silicone tube is not placed for lacrimal duct obstruction, and a large operation such as lacrimal nasal anastomosis is immediately performed.
This is because it is very difficult to pull out the son from the inferior nasal passage by the conventional silicone tube placement method. If there were such a simple silicone tube placement method without such a difficult intranasal operation, all physicians would start placing the silicone tube before major surgery. It is believed that many patients will heal with silicone tube placement alone and not have to undergo major surgery. Further, for dry eye, a punctal plug is inserted into the punctum and left in place, but the problem is that the plug is easily inserted because it is shallow.

[0010]

The gist of the present invention is the intubation device described in each of claims 1 to 9.

[0011]

EXAMPLE The present inventor has a simple operation for the treatment of lacrimal duct obstruction and dry eye, significantly reduces the pain to the patient, and can insert the indwelling instrument into the lacrimal duct accurately and quickly.
As a result of continuous research on a treatment tool that is difficult to remove after insertion and that can be easily removed when the purpose is reached, an intubation device as shown in FIGS. 6, 7 and 8 was invented. A central portion 20 to 40 mm of a tube having a length of 50 to 120 mm is thin and soft, both ends are thick and hard, and both ends are sharp and blind ends. As described above, it was found that it is extremely suitable for the above-mentioned purpose to use a device having a shape like a nunchaku used in Chinese martial arts as a lacrimal duct intubation device, and has completed the present invention. . Nunchaku is a chain of two rods.

As the plastic tube used in the present invention, it is preferable to select a plastic tube which is substantially non-irritating and non-toxic to the eye tissue and the living body. From this viewpoint, a silicone tube whose safety has already been established as a treatment tool for lacrimal duct obstruction is suitable, and among them, a silicone tube having an outer diameter of 0.9 to 1.2 mm and an inner diameter of 0.5 to 0.7 mm, A combination of silicone tubes having an outer diameter of 0.5 to 0.7 mm and an inner diameter of 0.3 to 0.5 mm is particularly preferably used.

The structure will be described. As shown in FIGS. 6, 9 and 10, this thin tube (outer diameter 0.5 to 0.5) is used.
0.7 mm, inner diameter 0.3-0.5 mm, length 20-40
thicker tubes (outer diameter 0.
9-1.2 mm, inner diameter 0.5-0.7 mm, length 15-
50 mm) 42, 43 are connected. The lengths of the tube 42 and the tube 43 are almost equal. The thin tube is connected by inserting 2 mm into the lumen of the thick tube. Therefore, the connecting portions 45 and 46 are 2 mm in size, but these portions are bonded with silicone glue. The tips 47, 48 of the thicker tube are sharpened to leave a blind end. That is, a rod having the same diameter as the inner diameter of the tube is filled with silicone glue and packed in a portion of the thicker tube having a tip of 2 mm. In this way, the lumen at the tip of 2 mm is completely filled with silicone, and then the tip is sharply cut to form both sides 47 and 48 which are pointed at the blind ends. Small cuts with a length of 0.5 mm for inserting a 0.4 mm diameter son into the thicker tube 49, 50
So that it is parallel to the tube. Making a cut perpendicular to the tube can cause the tube to break during operation. The position where the cut is made is 10 to 45 mm from the tip of the thicker tube, but if you make small cuts 49, 50 at the midpoint 50 of the thicker tube and two places 49 near the connection part, these The tube can be easily pushed into the lacrimal passage by inserting a son from a small cut. It is convenient to mark the part corresponding to the break so that the position of the small break can be easily seen.

In this way, a tube having a total length of 50 to 120 mm is produced. However, when the thin tube in the center is 25 to 40 mm, the length of the thick tubes on both sides is set to 15 to 30 mm, and 70 to 100 mm as a whole.
It is easy to insert when the length is set.

The total length of the tube is preferably 100 to 120 mm for obstruction of the nasolacrimal duct in an adult, and 70 to 100 mm for obstruction of the nasolacrimal duct in a child. The length and thickness of the tube used will vary depending on the length of the lacrimal passage and the size of the lacrimal passage lumen.
The thin part at the center has a thickness of 0.64 mm and a length of 25 mm, the long parts on both sides have a thickness of 0.94 mm and a length of 40 mm, and the one having a total length of 105 mm is most used. For the treatment of dry eye, it is effective to insert two thin articles of the present invention or use a thick article of the present invention.

In order to improve the stability in the lacrimal passage, it is important that the central part of the tube is thin and soft. The central part is 0.5 mm in outer diameter as described above.
~ 0.7 mm tubing, not lumenless diameter 0.
A soft rod of 5 to 0.7 mm may be used.

A mark is made on the midpoint 44 of the thin portion of the central portion. This mark may be on the tube itself, but
It is also possible to tie a -0 nylon thread around the center of the tube so that it goes around once. The thin part in the center may be white or transparent, but the thick parts on both sides should be transparent so that you can see how far the inserted son has entered.

It is possible to confirm whether or not the tube has been inserted correctly by placing a mark 44 at the middle point of the thin portion in the center. If properly inserted, the mark 44 will be between the upper and lower punctum. If it is shifted to one side, the mark 44 cannot be seen. Once correctly inserted,
It is extremely rare for the son to slip, but if it does, the connection 45 between the thin and thick tubes,
46 forms a step, and when it comes between the upper and lower puncta, the stump of the thicker tube at the connection stimulates the cornea and the patient complains of pain. Even if such a displacement occurs, it is better to form smooth slopes 51 and 52 so that the connection part does not become a step as shown in FIG. 7 so as not to stimulate the cornea. This is because the smooth gradient 41, by applying silicone glue to the step portion of the connection part,
It can be 42.

Further, as shown in FIG. 7, a sharp conical shape as shown at both ends 53 and 54 of the present invention makes it easier to insert from the punctum.

It is extremely rare for the connecting portions 45 and 46 to come off, but as shown in FIG. 8, the connecting portions are eliminated and the central portions 40 and 41 are thin tubes or rods from the beginning, and both sides 42 and 43 thereof are formed. It is best to use one that consists of a thick tube with no connections at all.

Further, in FIG. 8, as shown in FIG. 7, the both ends 53, 54 are conical and pointed to be a blind end, and the boundaries 51, 52 between the thick and thin portions are stepped. It is the same as making a gentle gradient without making. As shown in FIG. 9, it is convenient that the tube is fitted with a son from the beginning.

The above-mentioned configuration is as shown in FIG.
The tube is inserted into the lacrimal duct through the upper and lower puncta, but as shown in FIG. 13, the tube can be placed in the lacrimal duct only from the upper punctum (or only the lower punctum). It is an excellent method for treating obstruction. In this way,
As shown in FIG. 11, only the thick portion 42 of FIGS. 7 and 8 is used and its tip 54 is also a conical blind end. When pushing this into the lacrimal passage from the upper punctum 1, as shown in FIG.
The tube is pushed into the lacrimal passage with the tip 54 of No. 3 being passed through. After pushing the tube in, the son 63 is removed and the other end of the tube is fixed with 7-0 nylon threads 64, 65 (FIG. 13).

As shown in FIG. 16, the upper and lower canaliculus 1
When 3 and 14 are scarred, the common lacrimal canaliculus 15 is opened, and a match rod-shaped tube or rod as shown in FIGS. 14, 15 and 16 is inserted. This tube consists only of the thick portion of the above-mentioned embodiment, the tip 47 is a blind end, and the other end 55 is bulging like a match rod. As shown in FIG. 15, it is also preferable that the tip end is conical and sharpened to form the blind end 54. A similarly shaped rod 56 with one pointed end and the other end bulging like a matchstick, rather than a tube, is also useful (FIG. 16). Although the present invention is usually used after performing local anesthesia or general anesthesia under a surgical microscope, almost all patients can be easily administered with local anesthesia.
First, FIG. 6 shows a method of implementing an intubation device according to the present invention.
This will be described with reference to 7, 8, 9, and 10.

Insert one end (47 or 53), which is the blind end of the tube, from the lower punctum 2. Prior to insertion
Inserting a son and opening it by puncturing the occlusion of the lacrimal duct is the same as the conventional method. In addition, as in the conventional method, an incision is made on the ear side of the punctum or the punctum is dilated with a punctal dilation needle in advance. As shown in FIG. 9, the tube 40 with the small size cut 49 formed in the thicker tube inserted into the tip end (47 or 53) of the tube 42 from the small end 49 of the tube 42,
42 from the inferior punctum 12 to the inferior lacrimal canal 1
4. The small canaliculus 15, the lacrimal sac 16 and the nasolacrimal duct 17 are pushed into the lower nasal passage. Then tube 4
Only 0 and 42 are left and the son 61 is removed. Next, the other tube 13 is pushed into the lacrimal passage from the upper punctum 11, but before that, a son having a diameter of 1 mm is inserted from the upper punctum 11. The upper punctum is also expanded with an ear incision or a punctal dilation needle. In the same way, insert the son 62 from the small cut 50 in the center of the thicker tube, and insert the tips (48 or 54) of the tubes 41, 43 above the upper punctum 11 and the total lacrimal canaliculus 13. Teardrop 16
-Push it through the nasolacrimal duct 17 to reach the lower nasal passage.

FIG. 6 shows the indwelling state of the intubation device at the end of the operation. It is attached between the upper and lower punctal points 11 and 12 at the middle point of the thin tubes 40 and 41 in the central portion of the present invention. The mark 44 can be seen. As described above, according to the present invention, there is no difficult intranasal operation.

Since the silicone tube is non-irritating and has no biotoxicity, it can be placed for a long period of time. When removing, it is sufficient to pinch the thin midpoint 44 visible between the upper punctum 11 and the lower punctum 12 with tweezers and pull it.

Next, a method of implementing another example of the intubation instrument will be described with reference to FIGS.

As shown in FIG. 12, in the state in which the son 63 is inserted into the tube 42 up to the conical sharp end 54 of the tube as shown in FIG. 12, as shown in FIG. , Common canaliculus 15, lacrimal sac 16, nasolacrimal duct 17
Insert through to the lower nasal passage. Then, for the purpose of preventing the tube from falling off, the other end of the tube was fixed to the upper punctum and the upper lacrimal canaliculus using a 7-0 nylon thread. One of the nylons goes out of the upper punctum and the other goes through the upper canaliculus to the outside so that they are tied together so that the knot 64 does not go out of the punctum. By pulling this 7-0 nylon thread, the tube comes out of the upper punctum 11 and can be removed. Fixing the 7-0 nylon thread is not enough, and both ends of the 7-0 nylon thread 65, which has been passed through the other tube, are taken out of the lacrimal canal via the upper lacrimal canaliculus, and the knot is tied to the upper eyelid. It should be on the inside skin. Similarly, the tube 42 is placed in the lacrimal passage from the inferior punctum 12 and the 7-
The method of fixing the tube with 0 nylon thread is also useful, but the method of inserting from the upper punctum is easier.

Next, a method of implementing another embodiment will be described with reference to FIGS.

As shown in FIG. 16, the method is used to reclaim the remaining total canaliculus 15 when the upper and lower canaliculus 13 and 14 are scarred. After accurately opening the opening of the common lacrimal canaliculus 15 under a surgical microscope, FIG.
The tube or rod shown at 15 and 16 is inserted through the opening of the common lacrimal canaliculus. The other end is bulging like a matchstick, so the tube or rod will not fall off. Therefore, it is easy to remove. The present inventor has confirmed in a plurality of examples that, if only the small canaliculus remains, the tears flow to the lacrimal passage by opening the opening. When all the canalicular canaliculi are occluded, similarly, the opening of the lacrimal sac is opened, and a matchstick-shaped object is inserted from there. A thicker outer diameter of 1.75 mm in the shape shown in FIGS. 14, 15 and 16 is also useful.

According to the present invention, since the central portion of the tube is made of a thin and soft tube or rod, and both sides of the tube are made of hard and thick tubes, the tube can be made into a U shape. Therefore, the stability in the lacrimal passage is good. Further, since the tip of the tube is a blind end, the tube can be surely pushed into the lacrimal passage by passing the son.

Next, actual cases 1 to 3 in which the effect is obtained by using the intubation device using the silicone tube shown in FIGS. 6, 13 and 14 according to the present invention will be shown.

Case 1. Right) An infant with nasolacrimal duct obstruction.
I have been treated in various clinics but I have not been cured. The silicone tube shown in FIG. 13 was quickly intubated with local anesthesia, and after 2 weeks, it was removed and treated.

Case 2. Left) A young adult male with upper and lower canaliculus obstruction. The symptoms of lacrimation were strong, my mental condition had deteriorated, and I was unable to work. When the common canaliculus was opened, and the silicone tube shown in FIG. 14 was inserted from there, a new lacrimal duct opening was formed after 3 months, and tearing was remarkably reduced. My mental condition improved and I was able to work.

Case 3. It has dry eyes. When intubation using the nunchaku-shaped silicone tube shown in FIG. 6 was performed only on the right eye, tears slightly accumulated in the right eye, and the dryness of the right eye was reduced from the next day.

Out of 31 adult cases of nasolacrimal duct obstruction treated with the nunchaku-shaped silicone tube according to the present invention, 18 cases (58.1%) were successful. In addition, when the same nunchaku-shaped silicone tube was used to treat the canalicular canaliculus obstruction in 8 adults, the success rate was 100%. When the same tube was used for the treatment of two complications of canaliculus obstruction and nasolacrimal duct obstruction, one case (50%) was successful. Therefore, 27 out of 41 cases (65.9%)
The successful rate of these successful patients was able to escape major surgery.

[0037]

According to the present invention, the following effects are obtained.

Unlike the prior art, the intubation device according to the present invention does not require any difficult intranasal operation, so that the operation time is shortened and the burden on the patient is small. If the central part of the tube is made of a thin and soft tube or rod, it can be bent into a U shape strongly unlike conventional tubes, so it has good stability in the lacrimal passage and does not come out naturally. . Even if it fails once, it is easy to try again because there is less pain to the patient. Since both ends of the tube are not tied in the nasal cavity, even if it comes out, it will not enter the lacrimal sac and become difficult to remove like the conventional technique.

The intubation device according to the present invention is easy to insert into and remove from the lacrimal passage, but does not come out during insertion. Also, if there is a mark on the center of the thin part,
It is easy to check whether it is entered correctly. Also,
The one that eliminates the connection between the thin tube or rod and the thick tube is more excellent because there is no concern that the connection will come off. In addition, in the case where the transition between the thick portion and the thin portion of the tube is smooth, the stump of the thick tube rarely stimulates the cornea even if there is a deviation. Also, by making small cuts in a thick tube parallel to the tube, the tube no longer tears and tears. In addition, by making the tip of the tube sharp in a conical shape,
Instead of making an incision on the ear side of the punctum, the punctum can be inserted simply by expanding the punctum with a punctal needle. By using this tube, it became easy to place the tube in the lacrimal duct. This makes it easier for physicians to routinely perform tube placement prior to major surgery, and 60-80% of patients will heal with this simple treatment without having to undergo major surgery. it is conceivable that. This is a great gospel for patients.
In addition, the nunchaku-shaped intubation device of the present invention can be used for treating a patient with dry eye, and has an advantage that it is hard to come out as compared with a conventional punctal plug.

[Brief description of drawings]

FIG. 1 is a schematic diagram showing a lacrimal passage.

FIG. 2 is a schematic diagram showing a conventional technique.

FIG. 3 is a schematic diagram for explaining how to implement the conventional technique.

FIG. 4 is a schematic diagram for explaining how to implement the conventional technique.

FIG. 5 is a schematic diagram for explaining the problems of the conventional technology.

FIG. 6 is a side view showing an intubation device according to the present invention.

FIG. 7 is a side view showing an intubation device according to the present invention.

FIG. 8 is a side view showing an intubation device according to the present invention.

FIG. 9 is a perspective view showing a state when the intubation device according to the present invention is implemented.

FIG. 10 is a schematic view illustrating a method of implementing an intubation device according to the present invention.

FIG. 11 is a side view of an intubation device according to the present invention.

FIG. 12 is a perspective view showing a state when the intubation device according to the present invention is implemented.

FIG. 13 is a schematic view for explaining a method of implementing an intubation device according to the present invention.

FIG. 14 is a side view showing an intubation device according to the present invention.

FIG. 15 is a side view showing an intubation device according to the present invention.

FIG. 16 is a side view showing an intubation device according to the present invention.

[Explanation of symbols] 11 upper puncta 12 lower puncta 13 upper lacrimal canal 14 lower lacrimal canal 15 total lacrimal canal 16 lacrimal sac 17 nasolacrimal duct 18 nostril 19 lacrimal gland 20, 21 extinction 22, 23 both ends of silicone tube 24, 25 Both Sides of Silicone Tubing 26 Center of Silicone Tubing 27, 28 Bulging part of tip of son 29 Hook 30 Knot of silicone tube 40 Left half of thin tube 41 Right half of thin tube 42 Left side of thick tube 43 Right side of thick tube 44 Marks attached to the middle point of a thin tube 45, 46 Connection parts 47, 48 Both ends of a tube with a sharp pointed end 49, 50 Small cuts 51, 52 made in a thick tube Smooth slope without a step at the connection part Contained part 53, 54 Conical pointed blind end of tube End 55 End of matchstick-like bulging tube 56 Matchstick rod 61, 62 Sinus inserted through small cut 50, 42 63 Silas inserted through opening at the other end of tube 64 Passed through tube 7- 0 nylon yarn 65 7-0 nylon yarn attached to a tube

Claims (9)

[Claims] 1. A flexible tube having a predetermined length to be inserted into the lacrimal duct and a pair of sons inserted through small cuts on both sides of the tube, both ends of the tube being sharp and blind ends. And the central part of the tube is made up of thinner and softer tubes and rods,
A lacrimal duct intubation device, characterized in that it is made of thick and thick tubes on both sides. 2. The intubation device according to claim 1, wherein the middle point of the thin and soft portion of the tube is marked. 3. A pair of thickenings inserted in parallel to each of the thick and hard portions on both sides of the tube from a small cut to both ends of the tube. The intubation instrument according to Item 1 or 2. 4. The tube has conical ends at both ends,
The intubation device according to claim 1, 2 or 3, which is a blind end. 5. The intubation instrument according to claim 1, 2, 3 or 4, wherein a connecting portion between a central thin portion and a thick portion on both sides of the tube has a smooth slope. 6. A tube for forming a thin portion in the center or a rod and a tube for forming a thick portion on both sides are made of one tube without any connecting portion, and the central portion is made of a thin and soft tube or rod, both sides of which are thick. An intubation device, which is made of a rigid tube and has a conical shape on both sides with blind ends. 7. An intubation device, characterized in that a tube consisting of only a thick portion has a conical tip and is a blind end. 8. An intubation device, characterized in that the tube is composed only of a thick portion or a rod, and one end is sharp and the other end is bulged like a head of a match stick. 9. The tube is made of silicone.
e) formed in step e).
The intubation device according to 3, 4, 5, 6, 7 or 8.