Dacryocystorhinostomy (DCR) is a procedure performed for the treatment of tearing (epiphora) due to blockage of the nasolacrimal duct. Tears originate in the lacrimal gland, located at the upper outer margin of the eye. As tears cross the eye with each blink, they are directed into small openings in the eyelids called puncta. From this point, tears travel through a pathway known as the canalicular system into the lacrimal sac. The lacrimal sac is located between the eye and the nose, and funnels tears into the nasal cavity through the nasolacrimal duct.
What Is Dacryocystorhinostomy(DCR)?
This is an operation to form a new tear drain between your eye and nose when there has been a blockage. If the normal drainage passage gets blocked or narrow, you might get a watery eye or repeated eye infections.
How Do The Tears Normally Drain Away?
Tears are produced continuously and when you blink they are drawn into two small holes in the inner corner of your eyelids. Each hole is known as a punctum. There is one in each of the upper and lower eyelids. They lead into small tubes known as the canaliculi, which in turn drain into the lacrimal sac. This lies between the corner of your eye and your nose and has a duct at the bottom, which drains into your nose, the nasolacrimal duct.
Why Do The Passages Become Blocked?
The normal system does not have much spare capacity (that is why we “cry”), and the narrow drainage channel becomes even narrower with age, especially if you have had nose or sinus disease.
During DCR, your tear drainage passages are opened so that the tears can drain into the nose. There are two approaches to DCR surgery: external DCR and endoscopic endonasal DCR, often referred to as EndoDCR. They are similar operations with similar success rates.
External DCR
The operation takes place through a 10-15mm incision in the side of your nose, where a pair of glasses would rest. This heals up very quickly and is rarely visible when healing is complete in most people. You will have sutures, which are usually removed seven to 10 days later. As part of the procedure, small polythene rods (often referred to as tubes, although they do not assist with drainage) are positioned internally to ensure that the newly made passage remains open during the healing phase. These rods are removed after four to six weeks.
Endoscopic DCR
Endoscopic DCR is a minimally invasive procedure to unblock tear ducts. The operation is very similar to external DCR, except there is no cut through the skin and no scar afterwards. Access is through your nose, using a small thin camera (endoscope). As with all DCR surgery, small rods will be placed internally, positioned in the newly created passage and these will be removed after four to six weeks.
What Are The Main Complications Following A DCR?
Bleeding:
A nose-bleed can occur up to 10 days after surgery. This happens to about one in 50 patients. In most cases, the bleeding will stop by itself, but if it continues or is very heavy you should attend the accident and emergency department at your nearest ospital.
Infection:
This is rare, but a possible complication. When you leave the hospital, you will be given drops to use during the days to prevent infection.
Scar formation:
In case of external DCR, the incision on the side of the nose is usually small but might occasionally need to be massaged.
Blockage:
Rarely, a scar can form inside leading to blockage of the drain again and requiring another operation. Sometimes, it might require surgical insertion of a small pyrex tube known as a Jones tube, which stays permanently in the tear duct.