Dacryocystorhinostomy
What is dacryocystorhinostomy (DCR)?
Dacryocystorhinostomy is performed to cure a watery sticky eye caused by the narrowing or blockage of the nasolacrimal duct. A new pathway is created between the lacrimal sac and the nose, bypassing any obstruction below the lacrimal sac and allowing the tears to be drained normally again. A similar operation can also be performed to alleviate blockages occurring higher in the lacrimal drainage system.
Who requires dacryocystorhinostomy (DCR)?
Dacryocystorhinostomy is useful if epiphora is affecting everyday life activities. It is also recommended if you suffered an infection in the lacrimal sac area (acute dacryocystitis) because of the blocked nasolacrimal duct; this can cause recurrent redness and painful edema.
There are two ways to perform the surgery:
- Externally – through the skin
- Endoscopically: through the nostril
What is external DCR?
A small incision is made at the side of the nose to access the lacrimal sac. A piece of bone between the lacrimal sac and the nose is removed to reach the inside of the nose. The lacrimal sac is open and connected to the inside of the nose, so that a direct path is created between the sac and the nose. A soft silicon tube (a stent) or a spiral is inserted in the lacrimal passage to keep it open during the healing process. This stent is not visible and is removed at the clinic 10 to 12 weeks after the surgery.
The surgery lasts approximately 30-45 minutes.
The success rate for this procedure is 85-90%. Success means that lacrimation stops completely. For the treatment of the inflammation (acute dacryocystitis) the success rate is over 99%.
What is endoscopic DCR?
In this procedure, the lacrimal sac is accessed 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 create an opening between the lacrimal sac and the inside surface of the nose, but without the use of sutures. No incision is made on the skin. The opening is smaller than it would be in an external DCR. A silicon tube is again placed during the surgery to keep the new lacrimal passage open.
What type of anesthesia is used?
The procedure is usually performed using local anesthesia and sedation.
What are the risks of the surgery?
- Bleeding from the nose or in the tissues around the eye is common, especially the first hours after surgery. It is usually rather mild and stops quickly.
- Shifting of the tube. This is rather uncommon, unless you blow your nose abruptly.
- Infection. This is unusual as intravenous antibiotics are administered during the surgery and oral antibiotics are administered postoperatively.
- Scars at the side of the nose after the external DCR. Usually the surgical incision heals well and the scar is almost invisible after 2-3 months.