A Jones tube is a small glass bypass tube placed between the inner corner of the eye and the nasal cavity, and keeping it functioning well over the long term requires a combination of daily attention at home and periodic professional care. Complications occur in most cases over time, typically requiring cleaning, repositioning, or replacement by an ophthalmologist on an ongoing basis. About a third of patients describe the maintenance as troublesome, yet the majority remain satisfied with the relief from chronic tearing the tube provides. Understanding what to expect and how to stay ahead of problems makes a real difference in how well you live with a Jones tube for years or even decades.
Why Jones Tubes Need Ongoing Care
A Jones tube creates an artificial channel for tears to drain from the eye’s surface into the nose when the body’s natural drainage passages are too damaged or absent to reconstruct. The tube is typically indicated when there is not enough healthy canalicular tissue remaining, or when the eyelid’s natural pumping mechanism has failed.1American Journal of Ophthalmology. Lacrimal canalicular bypass surgery with the Lester Jones tube The underlying causes vary: the majority of cases are idiopathic (no identifiable cause), while trauma, tumors, congenital abnormalities, and conjunctival inflammation account for the rest.2PubMed. Conjunctivodacryocystorhinostomy with Jones tube. A 10-year study
Unlike the body’s natural tear drainage system, a Jones tube is a passive glass channel. Research using nuclear scanning has shown that tears flow through a Jones tube more slowly than through a normal tear drainage system, and that blinking and lid function play a larger role than breathing in driving that flow.3PubMed. Mechanism of tear flow after dacryocystorhinostomy and Jones’ tube surgery Because the tube relies heavily on your blink to push tears through, anything that interferes with the tube’s opening, position, or internal cleanliness can slow drainage and bring tearing right back. That is why maintenance is not optional: it is the price of keeping the system working.
The Main Problems That Develop Over Time
Jones tube complications fall into a few recurring categories, and knowing what they look like helps you catch them before they become serious.
Blockage and Debris Buildup
The tube’s narrow lumen can become obstructed by dried mucus, crusting, or cellular debris. Nasal endoscopy in patients with poorly draining tubes frequently reveals thick crusting blocking the nasal end of the tube.4American Journal of Otolaryngology. In-Office Jones tube exchange using the Seldinger technique This is probably the most common day-to-day issue you will face. Keeping the tube clear is the single most important maintenance task, and it is one you largely handle yourself at home.
Most ophthalmologists teach patients to irrigate the tube regularly with sterile saline, using a small syringe or squeeze bottle directed at the tube’s opening in the inner corner of the eye. How often you need to do this varies. Some people flush once a day; others find that a few times a week is enough. The key is consistency. If you notice your eye starting to water more than usual, a quick flush often solves the problem before a proper blockage forms. During allergy season or when you have a cold, you may need to flush more frequently because of increased mucus production.
Tube Migration and Displacement
The tube sitting in its bony channel can gradually shift position, either sliding outward toward the eye’s surface or inward toward the nose. Displacement or outright extrusion is a well-recognized cause of procedure failure.5PubMed. Recurrent Jones tube extrusions successfully treated with a modified glass tube The risk is especially high for people whose medial canthal area (the inner corner of the eye) has been compromised by trauma, tumor removal, or radiation. In a study comparing children and adults, tube dislodgement and obstruction occurred in roughly 37% of tubes over the follow-up period in both groups.6British Journal of Ophthalmology. Jones lacrimal bypass tubes in children and adults
You can check your tube’s position at home by looking in a mirror. The outer flange should sit snugly in the inner corner of your eye, just behind the caruncle (the small pink fleshy area). If it looks like the tube has moved, is poking out more than usual, or has disappeared from sight entirely, contact your ophthalmologist before it either falls out or causes irritation. Rubbing your eyes near the inner corner is a common cause of accidental displacement, so developing a habit of avoiding that area is worthwhile.
Biofilm and Infection
One of the less obvious but more concerning long-term issues is bacterial biofilm forming inside the tube. Biofilm is a thin, sticky layer of bacteria that adheres to the glass surface and is difficult to remove with simple flushing. A study examining removed Jones tubes found biofilm in the majority of those tested, with bacteria such as Pseudomonas and Staphylococcus species being the most common colonizers. Interestingly, biofilm was found even in patients who had no symptoms, not just in those complaining of irritation and discharge.7PubMed. Bacterial Biofilms in Jones Tubes
In some cases, the bacteria involved are drug-resistant. A case series documented methicillin-resistant Staphylococcus aureus (MRSA) biofilm developing on Jones tubes in all six patients studied, requiring treatment with specialized antibiotic drops and in-office biofilm removal.8PubMed. Successful treatment of methicillin-resistant Staphylococcus aureus infection associated with Jones tube using vancomycin eye drops and rifampicin Signs of infection include new or worsening discharge (especially if it becomes thick, yellow, or green), redness around the tube, increased tearing, or pain. These warrant a prompt visit to your eye doctor rather than a wait-and-see approach.
Daily and At-Home Care Routine
Living with a Jones tube is a bit like wearing contact lenses in the sense that a small daily routine prevents most of the larger problems. Here is what tends to work for long-term patients:
- Saline flushes: Use a sterile saline solution and a small syringe or squeeze bottle to irrigate the tube. Direct the flow gently into the tube opening at the inner corner of the eye. You should feel saline dripping into the back of your throat or nose, confirming the tube is clear.
- Gentle cleaning: Keep the skin around the tube’s outer opening clean. A damp cotton swab can remove dried discharge from around the flange without disturbing the tube’s position.
- Position checks: Glance at the tube’s flange in a mirror regularly. Familiarity with how it normally looks makes it easier to spot a subtle shift.
- Avoid rubbing: Touching or rubbing the inner corner of the eye is one of the easiest ways to dislodge the tube. If your eye itches, rub the outer part of the lid instead, or use a prescribed drop.
- Nose care: Because the tube exits into the nasal cavity, nasal congestion or crusting on the nasal side can block drainage. Saline nasal spray or a gentle nasal rinse can help keep that end clear, especially in dry climates or during winter.
Some patients are also taught to perform self-irrigation of the tube using a technique their surgeon demonstrates, where saline is directed through the tube from the eye side and is expected to drain into the nose. In the pediatric-and-adult comparison study mentioned earlier, two adults required routine self-irrigation to keep their tubes patent.6British Journal of Ophthalmology. Jones lacrimal bypass tubes in children and adults Most patients develop their own rhythm over time, learning to gauge how often and how aggressively they need to flush based on how their eye feels.
What Happens at Office Visits
Even with excellent home care, periodic professional maintenance is part of life with a Jones tube. Your ophthalmologist will typically examine the tube’s position, check for signs of tissue overgrowth or infection, and verify that the tube is draining properly. A common clinical test involves placing a drop of fluorescein dye in the eye and checking whether it appears in the nose, confirming flow through the tube.
When crusting or debris blocks the nasal end of the tube and home flushing cannot clear it, an in-office procedure may be needed. One approach uses nasal endoscopy to visualize the blockage directly and clean or replace the tube. A technique described in the literature uses the Seldinger method, threading a guidewire through the existing tube tract so a new tube can be placed in the same channel without a full surgical procedure.4American Journal of Otolaryngology. In-Office Jones tube exchange using the Seldinger technique This kind of exchange can be done in the office under local anesthesia and avoids the need for an operating room.
Tube sizing adjustments are also surprisingly common. In a study tracking frosted Jones tubes over a long follow-up period (averaging about three years), nearly half the eyes required a change in tube size, usually an increase in the collar diameter or a decrease in the tube length.9Ophthalmic plastic and reconstructive surgery. The Effectiveness and Long-Term Outcome of Conjunctivodacryocystorhinostomy with Frosted Jones Tubes Tissue changes around the tube over months and years mean the fit that was perfect at first may need tweaking. This is normal and not a sign that something has gone wrong.
Tube Design Makes a Difference
Not all Jones tubes are identical, and the type of tube you have influences how much maintenance you can expect. The original plain glass tube has been in use for decades, but refinements have targeted the most persistent problem: extrusion. A frosted-surface tube was developed to give surrounding tissue something to grip, reducing the tendency to slide out. More recently, a design called the StopLoss Jones tube added a flexible internal silicone flange for additional anchoring. In a 12-year comparison of all three types, the StopLoss tube had zero extrusions over the follow-up period, while both plain and frosted tubes had significantly higher extrusion rates.10Ophthalmic Plastic & Reconstructive Surgery. Twelve-Year Experience of Lester Jones Tubes—Results and Comparison of 3 Different Tube Types
Collar size also matters. The collar is the flared outer end of the tube that rests against the tissue at the inner corner of the eye, acting as an anchor. Larger collar sizes help prevent the tube from migrating inward. A study specifically examining variable collar sizes found that after larger collar frosted tubes became available, the incidence of tube loss dropped substantially.11PubMed. Success Rate of Variable Collar Size Frosted Jones Tubes In the long-term frosted tube study, once collars larger than 4 mm became available, only one tube was lost out of the entire cohort.9Ophthalmic plastic and reconstructive surgery. The Effectiveness and Long-Term Outcome of Conjunctivodacryocystorhinostomy with Frosted Jones Tubes If you have an older plain tube and have experienced repeated displacement, it is worth asking your surgeon about upgrading to a frosted or StopLoss design with a larger collar.
Managing Irritation and Tissue Changes
The most common ongoing complaint among Jones tube patients is intermittent irritation around the tube. In the frosted tube study, about 17% of eyes experienced this, and it usually resolved with a short course of antibiotic-steroid drops or tube replacement and cleaning.9Ophthalmic plastic and reconstructive surgery. The Effectiveness and Long-Term Outcome of Conjunctivodacryocystorhinostomy with Frosted Jones Tubes The irritation typically comes from the tube rubbing against surrounding tissue, from mild infection, or from tissue growing over or around the tube opening.
Tissue overgrowth around the tube’s outer flange can partially or fully cover the opening, reducing drainage and sometimes causing discomfort. Your ophthalmologist can trim excess tissue in the office, but it may recur. The combination of a chronic foreign body and a moist environment means the tissue around the tube is always adapting. Accepting that the area will occasionally need attention helps set realistic expectations.
A broader point about satisfaction is revealing. One large study found a surgical success rate above 90%, meaning the tube was working and tears were draining, yet about 12% of patients with a functionally successful tube were still dissatisfied, and roughly a third reported more complications than they had expected.12Elsevier. Patient Dissatisfaction After Functionally Successful Conjunctivodacryocystorhinostomy With Jones Tube Dissatisfaction was highest among patients aged 70 and older and those 19 and younger. The gap between “the tube is working” and “I am happy with the tube” often comes down to maintenance burden, so the more prepared you are for that burden going in, the less likely it is to feel overwhelming.
How Long Can a Jones Tube Actually Last
There is sometimes an assumption that a Jones tube will need replacing every few years, but the evidence suggests some tubes can last far longer than that. A study looking at long-term tolerance found that about a quarter of originally placed tubes were still present and functioning after a mean of 34 years, with the longest-surviving tube in place for over 44 years. When considering all tubes in the study, including those eventually lost and replaced, the median survival was about 7 years, and the mean was close to 14 years.13PubMed Central. Can Lester Jones tubes be tolerated for decades?
Most patients in that study needed between zero and nine tube replacements over their follow-up period, with an average of about two. A third of eyes had lost their tubes entirely by the last check-in, but of those, most had minimal or no symptoms, meaning the opening had healed or adapted enough that tearing was no longer a significant problem. The takeaway is that some people keep the same tube for decades with modest maintenance, while others go through several replacements. Both outcomes are within the range of normal.
Long-term success depends on a mix of factors: the underlying anatomy, the type of tube used, how reliably you maintain it at home, and whether complications like displacement or biofilm are caught and treated early. The evidence is reasonably encouraging that, with proper care, Jones tubes are a durable solution. But “durable” does not mean “maintenance-free.” Framing the tube as something you actively care for, rather than something that was installed and forgotten, aligns your expectations with what the research shows.
Age-Related Considerations
Age influences both the complication rate and the practical realities of tube care. In children, Jones tubes present a unique challenge because a young child cannot perform self-irrigation or reliably check tube position. The dislodgement rate in pediatric tubes is similar to adults, around 36%, but the practical burden falls entirely on parents and caregivers.6British Journal of Ophthalmology. Jones lacrimal bypass tubes in children and adults Children also grow, which means the tube fit may change as the facial skeleton develops, potentially requiring size adjustments more frequently.
At the other end of the age spectrum, older adults face their own set of challenges. Dissatisfaction after surgery was highest among patients 70 and older in one study, with more than one in five expressing unhappiness even when the tube was technically working.12Elsevier. Patient Dissatisfaction After Functionally Successful Conjunctivodacryocystorhinostomy With Jones Tube Reduced manual dexterity can make self-irrigation difficult, and cognitive changes can interfere with the daily routine. If you are caring for an older family member with a Jones tube, helping them establish and stick with a simple maintenance schedule is one of the most practical things you can do. Some ophthalmologists schedule more frequent office visits for elderly patients to compensate for less reliable home care.
Nasal Health and Its Overlooked Role
Because the tube drains into the nasal cavity, nasal conditions directly affect how well the tube functions. A deviated nasal septum can obstruct the nasal end of the tube, and the in-office exchange case described in the literature involved exactly this scenario: a deviated septum on the same side as the tube, with crusting blocking the lumen.4American Journal of Otolaryngology. In-Office Jones tube exchange using the Seldinger technique Chronic sinusitis, nasal polyps, and even seasonal allergies with significant nasal congestion can all impair tube drainage from below.
If you have a Jones tube and notice that it seems to clog more during certain seasons or when you have a head cold, the problem is often on the nasal side rather than the eye side. Saline nasal rinses, nasal steroid sprays (if your doctor prescribes them), and staying well-hydrated in dry environments all help keep the nasal passage around the tube’s lower opening clear. Some patients find that a humidifier in the bedroom during winter makes a noticeable difference in how often they need to flush the tube. It is worth mentioning nasal symptoms to your ophthalmologist even if they seem unrelated to your eyes, because the two ends of the tube are part of one connected system.
When a Tube Needs to Come Out
Occasionally, a Jones tube needs to be removed entirely rather than replaced. Persistent infection that does not respond to antibiotics, repeated extrusion that cannot be solved with a different tube design, or a patient’s decision that the maintenance burden outweighs the benefit can all lead to permanent removal. Interestingly, among patients who lost their tubes in long-term follow-up, most had minimal or no symptoms afterward.13PubMed Central. Can Lester Jones tubes be tolerated for decades? In some cases, the surgical tract may remain partially open or the underlying condition may have changed enough that the severe tearing that prompted surgery in the first place is no longer as bothersome.
That said, removing the tube does not guarantee a return to the pre-surgery status quo. Scar tissue, changes to the inner corner of the eye, and the surgical opening itself may all leave lasting changes. If you are considering asking to have your tube removed, a frank conversation with your surgeon about what to expect afterward is essential. For patients whose tearing returns and becomes intolerable, a repeat procedure with a newer tube design is usually an option.