What is a Lester Jones bypass tube?
A Lester Jones bypass tube is a thin tube made from toughened glass that passes from the inner corner of the eye to the inside of the nose. It is designed to drain the tears from the eye to the nose. Surgery to insert the tube is usually done as a day procedure under local or general anaesthetic.
Why do I need a Lester Jones tube?
Most people who need a Lester Jones tube have damaged tear ducts that cannot be repaired. Some will have tear ducts that are not physically blocked, but behave as if they are blocked. This is called a functional tear duct blockage. In these cases, a Lester Jones tube provides the best way to drain tears from the eye to the nose.
What happens in surgery?
The Lester Jones tube is inserted at the time of the initial surgery on the tear ducts if you have not had previous surgery. If you have previously had a tear duct operation (DCR or dacryocystorhinostomy) that has not worked and you need a Lester Jones tube, it can be inserted as an independent procedure without the need for any incisions on the side of the nose.
Is a Lester Jones tube permanent?
Yes, the tube is designed to be permanent. However, the tube can develop problems, including becoming dislodged (see below).
Can the tube break?
The tube will not break even if you are unlucky enough to be hit directly on the tube.
Is it normal to feel air come out of the tube when I blow my nose?
Yes, this is quite normal. It means the tube is working properly. However, be careful not to blow too hard (see below).
How should I look after my Lester Jones tube?
The main aim of caring for your Lester Jones tube is to prevent it becoming blocked or dislodging. To help keep the tube clear, you can splash some water into your eye or put 2 or 3 drops of artificial tears in the eye with your head held back, and then sniff inwards to draw the fluid down the tube and into the nose. You should do this once a day. It can also be done in the shower, letting the water run onto the eye and then sniffing inwards.
To prevent or minimise the chance of the tube dislodging, you should try and avoid blowing your nose very hard or sneezing violently. If you do blow your nose or sneeze, then you can squeeze your eyes shut tightly to reduce the chance of the tube dislodging.
You should come for a check-up at least once a year to have the tube examined and cleaned.
What can go wrong with a Lester Jones tube?
The commonest problems with a Lester Jones tube are:
- Dislodgement: this usually occurs when the tube shifts and comes out towards the eye. It can come out completely, or partially. If it comes out a small amount, you can sometimes push it back in to position with your finger. If it cannot be pushed back into place or it comes out completely, you should seek medical attention immediately. If you are seen within 1 -2 days then often the tube can be replaced without the need for a trip to hospital. Sometimes the tube dislodges inwards towards the nose. If this happens, the tube will stop working and will not be visible at the corner of the eye, and you should go promptly to the hospital.
- Blockage of the tube: if this happens, the tube will stop working and the eye will become watery. If you sniff inwards strongly sometimes you might clear the blockage. If you can’t do this, then contact the hospital for an early appointment.
- Protein build up in the tube: after some years, the lining of the tube can become coated with a protein material that stops the tears flowing along the tube properly. If this happens, a new tube can be put in, often this is a small procedure in the outpatient clinic without needing to have surgery.
Follow up care
After discharge from hospital, you will usually be seen again in the outpatient clinic after about a week, and then again some months later.
During the first week or two, you will be asked to apply ointment to the wound, or drops to the eye. Pain is usually mild after surgery to place a Lester Jones tube, and strong pain killers are very rarely needed.