DACRYOCYSTORHINOSTOMY

DACRYOCYSTORHINOSTOMY

Dacryocystorhinostomy (DCR) is a common oculoplastic procedure performed to treat and relieve the symptoms of blocked tear ducts such as excessive watering of the eyes.

There are two small openings along the eyelids that drain some of the tears covering your eye into an area called the lacrimal sac, which then leads to the tear duct. The tear duct passes around the bony structures surrounding your nose and drains into your nasal cavity. Sometimes, this drainage system gets blocked and this can cause excessive tearing (epiphora), crusting around the eyelids, and mucous discharge. The blocked tear duct can also become infected.

When the nasolacrimal draining system does not function properly, the aim of the DCR is to restore the flow of tears from the lacrimal sac into the nose by creating a new passage, bypassing blockage below the lacrimal sac and allows tears to drain normally again.

Do I need DCR surgery?

Not everyone who has a blocked tear duct needs a DCR. Depending on the cause of your blocked tear duct and severity of your symptoms, different treatment options may be recommended by your surgeon. If your symptoms of watery eyes, mucous discharge, and crusting around the eyelids are severe enough to interfere with your daily activities, then DCR surgery may be indicated. DCR would be required if you have an infection in the tear sac (acute dacryocystitis) as a result of the blocked tear duct, in order to prevent repeated attacks of a red, painful swelling at the corner of the eye.

What happens during the procedure?

DCR may be performed externally through the skin or endoscopically from within the nose. During an external DCR, a small incision in the skin is made in the area under your eye and next to your nose.  Through this incision, the surgeon creates a small opening in the bone beneath which then connects the lacrimal sac to the nasal cavity. Sometimes a small tube may be left there to help keep the new tear duct open. In endoscopic DCR, the tear sac is reached from the inside of the nose, using a small telescopic instrument called an endoscope. The endoscope allows the surgeon to see inside the nose and make an opening between the tear sac and the nose but without a cut in the skin or stitches for this operation. Silicone tubing is always placed at the time of surgery to keep the new tear passage open. The surgeon will recommend the best type of surgery for you.

What are the risks and benefits?

The success rate for DCR is high at approximately 80-90%. There should be a resolution or an improvement in the symptoms of watery eyes, resulting in significant comfort level. DCR is very successful in treating infection of the blocked tear ducts (acute dacryocystitis). Risks with any surgery need to be considered and they include bleeding from the nose or the tissues around the eye, scarring of the nose after external DCR, infections, displacement of the tube. If the initial operation fails to resolve the excessive tearing, a further operation may be required.