Suturing of Stents After Dacryocystorhinostomy-Reply

In Reply. —We would like to thank Drs Kersten and Kulwin for their suggestions. We agree with their assertion that a silk suture represents more of nidus for infection than does a polypropylene suture. Therefore, we have also switched to monofilament suture to secure the two arms of the silicone stent. However, one of our patients had an extrusion after we switched to a monofilament suture and we believe that the suture must be tied tightly and is probably less secure than the silk suture. In addition, the monofilament suture may "cheesewire" through the stent if it is tied too tightly in these cases. We have had some patients with or without silk sutures complain of a malodorous discharge from the nose with a silicone stent in place. In many cases we believe that this is the result of an allergy to the silicone and it is usually relieved by