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AIMS: Hyperlacrimation due to ocular surface or lid abnormality was ruled out and apposition of lower punctum to globe was checked. SUBJECTS AND METHODS: This was a pilot study at a tertiary eye care center where 40 patients of proximal canalicular block 0.05). Complications include tube extrusion, dislocation, conjunctival overgrowth, and sump syndrome. CONCLUSION: Laser and external CDCRs are both effective and safe procedures for the treatment of proximal canalicular blocks with comparable success rates and complications.

A 10-year-old boy with unilateral cryptorchidism and renal aplasia displayed features of unilateral congenital pupil sparing third cranial nerve palsy with exotropia manifesting novel dysinnervation encompassing synergistic divergence with upshoot, convergence on attempted upgaze, gaze-evoked phasic conjugate torsion, and gaze-evoked nystagmus. Congenital third nucleus/nerve hypoplasia with secondary dysinnervation is classfied as congenital cranial dysinnervation disorder (CCDD). It is speculated that miswiring between prenuclear structures, otolithic pathways, interstitial nucleus of Cajal (INC), nucleus prepositus hypoglossi, and third and sixth nerve nuclei likely resulted in this novel dysinnervation. Cryptorchidism and renal aplasia if seen may point towards an overlapping phenotype with Duane-radial ray syndrome and acro-renal-ocular/IVIC syndromes.

Context: Conjunctivodacryocystorhinostomy (CDCR) is the procedure of choice for proximal canalicular blocks. However, the complications of tube migration and extrusion limit its widespread practice. Aim: The aim of this study is to evaluate the efficacy and complications of the new “mirror tuck technique” for fixation of lacrimal bypass glass tube without holes in proximal canalicular blocks in laser CDCR. Materials and Methods: A prospective interventional study was conducted in forty consecutive eyes of adult patients, undergoing 980 nm diode laser CDCR for proximal canalicular blocks. After creating the tract under endoscopic guidance, the collar of the glass tube was fixed to the conjunctiva with 6-0 prolene suture by “mirror tuck technique.” Success was defined as the absence of extrusion of tube with patent tract and relief in epiphora at 1 year of follow-up. Results: Both anatomical and functional success was achieved in 39 (97.5%) cases. Tube displacement occurred in one patient suffering from allergic conjunctivitis in which the tube had to be removed. A temporary heaviness was reported by 5 (12.5%) patients till about 2 weeks. Conjunctival overgrowth over the tube occurred in 1 (2.5%) eye at 5 months which was excised and treated with application of 0.02% mitomycin C with no subsequent recurrence. There were no cases of suture abscess or suture intolerance warranting tube removal. Conclusion: “Mirror tuck technique” is an effective method for tube fixation (for tube without holes) in CDCR. However, it is important to position the conjunctival opening so as to leave sufficient space for passage of sutures for anchorage medially.