DCR or dacryocystorhinostomy operations are done to relieve a watery, sticky eye caused by a blockage between the tear sac at the corner of the eye and the tear duct into the nose. The aim of surgery is to make a new passage from the tear sac into the nose. This bypasses the blockage and allows the tears to drain normally again. DCR surgery is worth undertaking if the watering is bad enough to interfere with patient's daily life. It is also recommended if patient has had an attack of acute dacryocystitis (infection in
the tear sac) as a result of a blocked tear duct; otherwise patient may have repeated attacks of a red, painful swelling at the corner of the eye.
The surgery can be performed in two ways: · Externally -- through the skin
· Endoscopically -- from within the nostril.
External DCR: A small cut (1-2 cm) is made on the side of the nose, approximately where a pair of glasses rests. A piece of bone between the tear sac and the nose is removed to make a new channel for the tears. Some surgeons use (Not shown in this video) a soft silicone tube or cord to keep the tear passage open during healing. This tube is not usually noticeable and is removed in clinicabout 12 weeks after the operation.
The operation takes about 1-1.5 hours, so is NOT a minor procedure.
The success rate for this operation is 85-90%. Success means that the watering stopscompletely or only happens in very windy weather. Surgery stops you having a watery eye that needs wiping all the time. For cure of infection (acute dacryocystitis) the success rate is over 95% - patient will no longer have a painful swelling at the corner of your eye and need frequent courses of antibiotics.
Endonasal DCR:
This is performed together with an Ear, Nose and Throat specialist. The tear sac is approached from inside the nose using an endoscope. This instrument allows the surgeon to see inside the nose and make an opening between the tear sac and the lining of the nose, without using stitches. There is no cut in the skin for this operation and the operation is usually quicker. Silicone tubing is often used at the time of surgery to keep the tear passage open during healing.
Which surgery is better?
There is no scar with endonasal DCR, but the scar from external DCR is often invisible after a few months. External DCR is better if the tiny tear ducts in the eyelids (canaliculi) are blocked, as well as the bigger duct in the nose. Endonasal surgery may be better if patient has sinus or other nasal problems -- these may be dealt with at the same time as the
tear duct operation.
What type of anaesthetic is used?
The operation will be done under local anaesthesia. Most patients stay in hospital overnight but some can go home the same day.
After the operation: Patient may have some bleeding from your nose after the operation. Usually, this is only a trickle and more serious bleeding is rare. If there is bleeding at the end of surgery, the surgeon may pack the nostril and the pack is removed the next day. If patient has a nosebleed after he/she has left hospital, it is helpful to pinch the soft part of the nose for at least 10 minutes and place an ice pack on the bridge of the nose. If the bleeding
continues it is better to contact the surgeon. The patient should not blow nose hard for two weeks after the operation as this may cause bleeding.
After external DCR patient will have a dressing on the side of nose which will be removed next day. Patient may find it difficult to wear your glasses until the dressing is removed. There will be stitches in the cut on the side of nose that will absorb away by themselves.
