Clinical Analysis of Seven Cases of Retained Silicone Tubes Detected During External Dacryocystorhinostomy: A Case Series

The human eye produces tears not just to stay moist, but to wash away dust and bacteria, draining them through a tiny, hidden plumbing system into the nose. When this system gets blocked, tears overflow onto the cheek, and the area behind the nose can become a breeding ground for infection, causing pain and swelling. For decades, doctors have treated these blockages by threading a soft, hollow silicone tube through the tear ducts to hold them open while they heal. It is a common, minimally invasive fix that avoids large scars and usually works well. However, sometimes the tube does not come out when it is supposed to, or it breaks and leaves a piece behind. Because the tube is made of a material that does not show up clearly on standard X-rays or CT scans, it can hide inside the body for years, acting like a silent irritant that keeps the infection alive and the blockage in place.

A team of surgeons at Wuxi No.2 People's Hospital recently investigated a puzzling group of patients who had returned with the same symptoms years after their initial treatment. These individuals had undergone the standard tube procedure at other hospitals, only to find their eyes watering and discharging pus again. The researchers looked back at the records of seven adults who had come to them for a second, more invasive surgery to fix the problem. They discovered that in every single one of these seven cases, a piece of the original silicone tube had been left behind, trapped inside the tear drainage system. The tubes had been sitting there for anywhere from three to thirty years, unnoticed by previous doctors and invisible on preoperative scans, slowly causing inflammation and scarring that prevented the tears from draining properly.

The study began by examining patients who had failed their first round of treatment. Before the surgeons opened the skin to perform a new operation, they took detailed pictures of the eye area using computed tomography and a special dye test designed to map the tear ducts. These tests showed that the drainage system was blocked and the tear sac was swollen, but they failed to reveal the presence of the foreign object. The silicone tubes were simply too similar to the surrounding soft tissue to be seen on the images. It was only when the surgeons made a small incision near the inner corner of the eye, opened the tear sac, and looked directly inside that they found the culprit. In five of the patients, they found a whole tube that had never been removed. In the other two, they found just the bottom end of a tube that had snapped off. In every case, the hidden tube was surrounded by angry, red tissue and scar tissue, a clear sign that the body had been fighting this foreign object for a long time.

Once the surgeons located the hidden tubes, they carefully removed every fragment, cleaned out the irritated tissue, and rebuilt the drainage pathway. They then placed a new, temporary tube in the correct position to ensure the new opening stayed open while it healed. The results were immediate and lasting. Within a week, the patients' eyes stopped watering, and the pus disappeared. By the time they returned for their final checkup about a year later, the drainage system was working perfectly in all seven cases, with no signs of the infection returning. The study highlights a specific and often overlooked reason why tear duct surgeries fail: the forgotten tube. While doctors often blame failure on scar tissue or inflammation, this research shows that the cause can sometimes be a piece of the original medical device that was never retrieved.

The researchers noted that the tubes likely broke or stayed in place due to a combination of factors, including the natural aging of the silicone material over many years and the physical stress of blinking or eye rubbing. In some instances, patients may have pulled on the tube themselves, causing it to snap, and then assumed the problem was solved without seeing a doctor to confirm. The study suggests that the material itself can become brittle and fragile after a decade or more, making it prone to breaking during removal or even while sitting inside the body. Because standard imaging cannot see these soft plastic tubes, the only way to find them is through direct visual inspection during surgery. This finding changes how doctors should approach patients who come back with symptoms after a tube procedure. Instead of assuming the blockage is just scar tissue, they must now consider the possibility that a piece of the old tube is still hiding inside.

The success of the second surgery in these seven cases relied entirely on finding and removing the hidden object completely. The surgeons emphasized that leaving even a tiny fragment behind could restart the cycle of inflammation and blockage. They also pointed out that the lack of detection on preoperative scans is a known limitation of current technology, not a mistake in the imaging process itself. The study does not claim that all failed tube surgeries are caused by this issue, but it establishes that it is a real and significant cause that is easily missed. For the patients involved, the solution was straightforward once the hidden cause was identified: remove the irritant, clean the wound, and rebuild the path. The researchers concluded that better communication between doctors and patients about when to remove the tubes, and a more careful check for broken pieces during follow-up surgeries, could prevent this frustrating complication in the future.

This work serves as a reminder that even the most routine medical procedures can leave behind unexpected traces. The silicone tubes used to save sight and comfort are generally safe and effective, but when they are not removed properly or are left in too long, they can turn from a healing tool into a persistent source of trouble. The seven patients in this study spent years suffering from a problem that had a simple physical cause, one that was invisible to the machines but obvious to the human eye once the surgeons looked inside. Their recovery offers a clear path forward for others facing similar struggles: if a tear duct blockage returns after a tube procedure, the possibility of a retained piece of that tube must be considered, and a thorough search is the only way to ensure it is gone.