Determination of the function of a repaired canaliculus after monocanalicular injury by placing a punctal plug in the non-involved punctum on the affected side


Dr Sarah Osborne, Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK. Email:


Background:  To determine whether repair of a monocanalicular laceration using a Mini-Monoka stent provides a functioning system.

Methods:  This prospective study included patients who underwent repair of a monocanalicular laceration with placement of a Mini-Monoka stent. Silicone punctal plugs were placed in the unaffected punctum on the side that had sustained the injury and in the same punctum on the fellow eye. The plug was left in place for between 7 and 17 days. The patient was questioned after placement regarding symptoms of epiphora.

Results:  Eight patients were included in the study; five injuries involved the lower canaliculus, two the upper, and one the upper and lower but only the lower was repaired. Of injuries, 50% were as a result of assault. Seven out of eight patients had no epiphora from the repaired eye during plug placement. One patient complained of significant epiphora from the repaired eye during the time the plugs were placed; this patient had a partial nasolacrimal duct obstruction and no canalicular stenosis. Of patients, 88% had an anatomically patent canaliculus and 100% were tearing-free when no plug was placed.

Conclusions:  In this study, a repaired monocanalicular injury provided a functioning system in 88% of cases. In previous studies, it has been shown that many patients are symptom-free with just one functioning canaliculus. However, a fully functioning canalicular system may help to prevent tearing under stress conditions, and will provide a viable system if the other canaliculus is irreparably damaged in the future. Therefore, repair is recommended.