Dacryocystorhinostomy (DCR) Surgery
What is Dacryocystorhinostomy (DCR) Surgery?
DCR surgery is the procedure used to treat watery eyes due to nasolacrimal duct stenosis or obstruction. Nasolacrimal duct obstruction is a plumbing problem and therefore requires surgery to fix the plumbing. The narrowed nasolacrimal duct is too tight to open and surgery creates a new passage inside the nose for the tears to flow and bypass the obstruction. Once the tears can flow properly into the nose, the watering improves.
How is DCR surgery performed?
Anaesthetic
DCR is usually done under general anaesthetic with injection of local anaesthetic around the inner corner of your eye and the side of the nose as well. It can be done under intravenous sedation if the anaesthetist thinks that it is safer this way due to other medical problems.
Techniques
- Endonasal/Endoscopic DCR
This is the modern technique where the surgery is performed inside the nose so there is no external scar. The new tear passage is created inside the nose and checked to make sure it is working well. Swelling and bruising will still be present on the eyelids. We prefer this technique as it provides a faster recovery, less pain and no scarring.
- External DCR
This is the traditional technique. A small (about 1cm) vertical incision is placed on the side of the bridge of the nose (close to where the nose pad of glasses would sit). The surgery proceeds into the nose from the outside and create the new tear drainage passage.
- Silicone stent
One problem with creating a new passage in the human body is that the body tends to heal and try to close the hole created. In order to increase the chance of keeping the DCR patent, a silicone stent is inserted at the end of the surgery so the body can heal around the stent, leaving a patent hole. This is similar to ear piercings – an earring needs to be inserted after the piercing or else the wound would close. The stent is left in place for about 1 month and then removed in the clinic. There is no pain with the removal.
How effective is DCR surgery?
DCR surgery is general very safe and effective. The vast majority of patients experience an improvement in their symptoms. As discussed above, the body tries to heal and occasionally scar tissue can obstruct the newly created DCR, causing the eye to water again. If this is mild then it can be left alone. If this is significant then sometimes revision surgery is performed to identify the scar tissue and remove it, in order to establish tear drainage again.
Eye conditions we treat
Explore the range of eye conditions we can help manage and treat for better vision and eye health.