Retina & vitreous · practice question
[READINESS SEED] A patient undergoes wide excision of a recurrent, aggressive…
[READINESS SEED] A patient undergoes wide excision of a recurrent, aggressive medial-canthal cutaneous carcinoma; clearing the margins sacrifices both canaliculi. The reconstructive surgeon asks about restoring tear drainage at the same sitting. What is the most appropriate approach to lacrimal drainage?
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Answer: A. Do not reconstruct drainage now; observe for years and place a Jones tube (CDCR) later only if the patient stays recurrence-free
After resecting a high-recurrence periocular malignancy that sacrifices the canaliculi, tear-drainage reconstruction is deliberately deferred: creating a bypass at the time of surgery could mask or channel residual/recurrent tumour and commits the patient before the field is shown to be clear. The accepted approach is to leave the drainage unreconstructed, keep the area visible for surveillance over several years, and offer a conjunctivo-DCR with a Lester Jones tube only once the patient has remained recurrence-free. Symptomatic epiphora in the interim is managed conservatively.
Clinical pearl: After ablative surgery for aggressive periocular cancer, watch before you plumb — defer CDCR/Jones-tube drainage for years until recurrence-free, so a bypass tract never hides or seeds tumour.