Dacryocystorhinostomy is a surgical technique used in the treatment of nasolacrimal duct obstruction or a blocked tear duct.
The eyelids have two small drainage openings through which excess tears from the eye surface flow into the eye's drainage system. When a person blinks, the old tears are pushed through the openings into a small tube that leads to a tear reservoir called the lacrimal sac. It empties into the tear duct, which drains into the nasal cavity.
In some cases, the drainage system becomes obstructed or blocked due to many factors, including:
- Nose injury
- Nose polyps
- Chronic nasal infections
- Congenital anatomical disorders
A blocked tear duct is associated with various symptoms, such as:
- Eye irritation
- Excessive tearing
- Inflammation of the eye
- Chronic mucus discharge
- Infection of the lacrimal sac
- Painful swelling in the inner corner of the eye
The DCR procedure is employed when there is a near or complete blockage of the duct. It creates a new tear drain to bypass the blocked drainage system and alleviate the symptoms.
The treatment is more often used for adults than children.
Also Known As
Preparation & Expectation Before Surgery
It's essential to realize that the treatment for a blocked tear duct depends on the cause. For example, blockage due to a tumor needs a different kind of surgery. That being said, the surgeon and the patient will discuss the best treatment option and what to expect before and after the procedure. S/he will provide guidelines on how the patient should prepare for the DCR surgery.
S/he will also conduct certain tests before the operation, including:
- Nasal passages MRI scan
- Nasal passages CT scan
Types, Purpose & Procedure
The DCR procedure aims to eliminate mucus and fluid retention in the lacrimal sac and improve tear drainage for the relief of the eye's excessive watering.
The surgery has two approaches, i.e., within the nose (Endoscopic dacryocystorhinostomy) and through the skin (External dacryocystorhinostomy).
- Endoscopic dacryocystorhinostomy
It's a minimally-invasive surgical technique that makes alternative tear drainage between the eyes and nose. The surgeon creates a new duct between the lining of the nose and the lacrimal sac without cutting the skin. S/he temporarily places a tiny tube (stent) in the new passage to keep it open as it heals. The stent is removed after about a month following the surgery.
- External dacryocystorhinostomy
The surgery involves making a small cut along the lower eyelid crease to reach the lateral nasal wall. The surgeon will remove a small piece of the nasal bone to create a new tear drain bypassing the blocked tear duct. S/he will place a stent in the new duct to keep it open as it heals. The tube is removed a few months after the procedure. The operation is performed under general anesthesia and the location of the cut is carefully chosen to minimize the appearance of scarring.
In most cases, the patient can go home the same day. Plan to have someone go home with you after the procedure.
Risks, Side Effects & Complications
The possible risks and complications associated with the DCR procedure differ depending on the type of technique, patient age, and other health conditions. They include:
- Linear scar
- Nose bleeding
- Additional surgery
- Prominent facial scar
- Abnormally fused nasal tissue
- Internal healing with blockage
- Displacement of the stent placed in the duct
The patient can discuss with the surgeon their concerns and the risks that are most applicable to them.
It's normal to have bruising and some soreness around the area after the surgery.
After Care, Recovery & Outcome
After the surgery, the patient's nose may be packed with material to reduce the bleeding risk. The surgeon will prescribe antibiotics to help prevent infection and eye drops for enhancing healing. In some cases, s/he may also prescribe additional medication such as nasal decongestants and steroids.
S/he will also give instructions about how to care for the eye, nasal cavity and wound during the recovery period. Over the counter painkiller may help to manage any pain associated with the bruising and soreness around the area. The patient may also be required to avoid certain activities like swimming, straining, and heavy lifting while they recover.
Tip for promoting quick recovery after DCR surgery
- Apply cold compresses to the area at least four times a day for 20 minutes during the first two days after surgery
- Undertake only light activity for the first two days after surgery. Consult the doctor before resuming a normal exercise routine
- Avoid blowing the nose for at least two days after surgery to minimize the risk of a nosebleed
- Avoid hot tubs, spas, whirlpools and swimming for at least ten days after surgery
- Keep the inner lining of the nose moist
The surgeon will need to closely follow up with the patient to monitor the outcome. S/he may need to see the patient the day after the surgery and regularly after that. If the patient has a stent, it is removed once the wound heals.
The patient should contact the doctor immediately if they experience increasing pain, unusual bleeding, swelling, or fever.