Dacrocystorhinostomy (DCR) Surgery

The tear duct (or ‘nasolacrimal duct’) helps to form the natural pathway of tears to drain from the eye into the nose. A blockage of the tear duct can cause continuous watery eyes, mucous reflux and in some cases, acute bacterial infection.

The normal nasolacrimal system does not have much spare capacity (this is why we cry) and the narrow drainage duct that runs through the nose becomes narrower with age. In some cases eye or sinus infections can worsen this narrowing.

DCR is an operation to form a new tear drain between the eye and nose. It allows tears to drain by bypassing the blocked nasolacrimal duct. A DCR will be offered after other causes of watery eye (such as reflex watering due to dry eye) have been excluded and treated. Syringing with salty water through your tear duct system in the clinic and examining the nose with a telescope will help to confirm the presence of a blocked tear duct as the cause for your watering eye.

DCR surgery involves opening the tear drainage passage so that the tears drain into the nose. A small amount of bone is removed between the tear sac and nose in order to bypass the blocked nasolacrimal duct. Temporary silicone tubes are often inserted internally to ensure the new passage remains open in the healing phase. The tubes are removed from the nose in the clinic between 4-6 weeks after surgery.

DCR surgery is usually performed as a day only procedure under general anaesthesia where you are asleep and typically takes 60-90 minutes. Occasionally patients will stay in hospital overnight. If a patient is not medically well enough for a full general anaesthetic, they may be suitable for an external DCR under local anaesthetic with sedation. Local anaesthetic will prevent any discomfort but you may hear a crunching sound which is quite normal and not much different to a visit to the dentist.

When there is a complete blockage of the tear duct system, DCR surgery has a 90-95% success rate of improving a watery eye or mucous reflux. In partial obstruction, success rates range between 50-70%. Rarely, if the blockage is in the tiny tear canals on the eyelid (canaliculi), the success rate is less, varying between 50-90%. Dr Kaushik will discuss if you have a complete or partial blockage and the likely outcome of the surgery. Minimally invasive endonasal DCR and external DCR have the same rates of success.

Alternatives to DCR have been trialed in various parts of the world with limited success. These include balloon stenting, tube insertion without creation of a new tract and small osteum laser DCR. None of these treatments approach the success rates of DCR.

DCR surgery aims to improve your quality of life through an improvement of tearing or recurrent eye infections. Your symptoms are unlikely to improve without the surgery, however in the vast majority of cases no harm comes from opting to delay or not proceed with DCR surgery. Rarely, in the case of major infection, a DCR may be urgent or highly recommended.

Blood thinning medications such as aspirin, clopidogrel (Plavix, Iscover), Pradaxa, Apixaban and warfarin need to be stopped prior to DCR surgery. Please let your surgeon know if you are taking any blood thinning medications, so that we can discuss this with your GP.

Anti-inflammatory drugs and supplements including: ibuprofen (Nurofen), fish oil, ginger, ginseng and garlic should be ceased 2 weeks prior to surgery.

Most people require a week off work as some nose bleeding is normal after the operation, particularly in the first 24-72 hours. There is usually no significant pain after the surgery however you may experience some grittiness of the eye, discomfort, swelling and bruising. Your nose will feel blocked for 1-2 weeks due to nasal packing used in the operation.

Persistent tearing in the postoperative period is normal until the tubes are removed and postoperative swelling has settled. Specific postoperative care instructions will be provided on the day of surgery.