Fig. 56 Open bypass tube method. A. Surgery is the same as for a routine dacryocystorhinostomy (DCR) until the formation of mucosal flaps. B. A portion of the caruncle can be excised to provide more room for the Jones tube collar. The needle is removed, and the Jones tube inserted over a straight probe. C. A 6–0 nonabsorbable suture is tied around the collar to the lid on the palpebral surface.