What is a Jones Tube?
A Jones tube is a glass Pyrex tube, which bypasses a severe tear duct obstruction or loss affecting the small channels called the canaliculi.
The canaliculi can obstruct with drugs treatment, be removed as part of tumour clearance or be damaged severely by trauma, for instance, a road traffic accident and other surgeries are not able to provide relief with the watering.
Some patients also lose function of the lower lid tear pump and require a Jones tube. This can happen after blepharoplasty surgery or with increasing age. The lower eyelid muscle, which usually helps to pump the tears along the bottom lid and down the tear duct and, no longer works optimally. This is called functional epiphora, or functional watering because it is caused by a failure of function of the eyelid pump. The Jones tube is done either at the same time as a DCR (Dacryocystorhinostomy) or afterwards.
Dr Lester Jones from Portland, Oregon, USA designed the Jones tube in the mid-1940s. For many decades the Jones Tubes has been hand blown glass Pyrex with very smooth edges, so it sits inertly in the corner of the eye.
The Jones tube is placed at the medial (towards the nose) corner of the eye where it is virtually invisible and goes through the soft tissue bypassing the scarred obstruction and opening into the nose. The tears then drain down the inside of the glass tube and into the nose by what is called “capillary action.”
Jones tubes require a commitment by the patient and by the surgeon to look after the Jones tube.
The patient has to sniff air through the tube every day to check that it is working and every so often they have to come back to the clinic to have it cleaned. That can often be done in situ, or occasionally removed, cleaned and replaced.
Sometimes the Jones tubes are very stable and cause no problems for many years. Whereas on other occasions, they may start to bury in a little bit, so that the end that is to be catching the tears is no longer so efficient, in which case a replacement is in order.
A Jones tube is for life, and it can significantly relieve a watering eye when no other operation has been able to do that. A DCR has to be done initially to create the opening through the bone into the nose, and once that is done, it is quite easy to place the Jones tube. It has to be secured and stable and takes a few weeks to settle into its final position. Patients who have Jones tubes can expect to have an eye free of watering for over 70% of the time. However, there will be some situations where they will still experience a watering eye.
For instance, positional Jones tube problems can cause intermittent watering, because the tube does rely on catching the tears at the corner of the eye and letting them drain all the way down. If the patient is leaning or tilting their head, for instance, lying on their right side and they have a right tube then the opening would not be in the right position to catch the tears.
The patient satisfaction from Jones tube once they have dedicated themselves to having it is very high.