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Jones Tubes Update

Some small adjustments are needed as the Jones’ tubes “bed in”.
At first glance gardening and oculoplastics appear to be an unlikely coupling. However much care preparing the soil that even the most green-fingered gardener might take while planting a precious shrub, bears little or no relation to a highly skilled oculoplastic surgeon intricately placing a Jones’ tube into the eye of her patient. But there is one thing that both procedures have in common: the plant and the tiny glass tube will each require some gentle bedding in during their settling and adjustment period.
“The first six weeks after surgery are a crucial settling in period for Jones’ tube patients”, explains ophthalmic and Oculoplastic surgeon Jane Olver of Clinica London.
“In some ways I am like a gardener – part of my job is to make sure that the tubes settle in correctly – they might need a little ‘patting down’ and tiny adjustments during this period. Every patient is different and much will depend on tiny lifestyle issues – even their sleeping position.”
It is well known that a Jones’ tube is a lifetime commitment and follow up appointments – especially during the first few weeks – are essential to ensure that the tiny Pyrex tubes remain in the correct position and continue to allow the tears to drain away efficiently.
Jane likes to see her patients two weeks after surgery, then again after two to three months and at six months.
Two weeks after Deborah’s operation it was discovered that one of the tubes had become slightly loose and proud at the top, so a minor adjustment was necessary.
“This is not in any way a set back, but a perfectly normal development”, said Jane.
The correction procedure on the left side, to bury the tube into a deeper position and to replace its holding suture, was carried out under local anaesthetic at the surgery at Clinca London (under the clinic’s Care Quality Commission’s approval to practice).
Jane also cauterised a small “granuloma” (an area of inflammation at the original surgery site in side the nose) which instead of having an overgrowth of mucosa, is now expected to shrink.
“Neither tube was blocked and the ‘sniff test’ produced excellent results”, said Jane. “I would estimate that between 90 and 95 per cent of the tears are draining away without problem.”
Two days after the corrective procedure Deborah commented that although she was aware of the tubes, the main problem was the sensation of “itchiness.”
“This is all part of the healing process at the site of the new stitch”, said Jane. “but she must learn to sit on her hands and not to rub or pick at her eyes as there is always a risk of causing an infection.”
However, with both Jones’ tubes now securely and safely in place it is highly unlikely that they could be inadvertently dislodged.
Patients are advised to wear goggles for contact sports and it is recommended to give swimming a miss for at least two week after surgery.
There is another possible downside to this life-changing operation for patients who practise yoga and like to invert their bodies. As the tubes are positioned horizontally and slightly downwards, it is unlikely that the tear drainage system would work when turned upside down. It could be that holding a headstand for instance, might result in watering eyes.
September 30, 2011

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