Dacryocystorhinostomy (DCR) surgery resolves blocked tear ducts, a common cause of watery eyes and recurrent infections. The surgery creates a new pathway for tears to drain from the tear sac into the nasal cavity, bypassing obstruction. Understanding the recovery process and potential post-surgical issues helps patients differentiate between expected symptoms and signs of complications.
Expected Post-Operative Experience
Following DCR surgery, patients experience temporary symptoms. Mild swelling and bruising around the eye and nasal bridge are common and resolve within two to four weeks. Nasal congestion or stuffiness persists for two to three weeks as internal tissues heal and any temporary packing or stents are in place.
Patients might also notice minor bloody or watery discharge from the nose, which subsides within three to five days. Mild discomfort or a dull ache around the surgical site is expected and managed with over-the-counter pain medication. If a silicone stent was inserted, a slight overflow of tears may occur until its removal, which happens after several weeks or months.
Recognizing Potential Complications
Some patients may encounter complications that warrant prompt medical evaluation. Persistent tearing or re-obstruction of the tear duct, surgical failure or recurrence, can occur if scar tissue forms within the new drainage pathway. This can lead to a return of watering eye symptoms.
Signs of infection include increasing pain, redness, swelling, warmth around the surgical area, pus discharge, or a fever. Excessive bleeding manifests as significant or prolonged nosebleeds that do not subside with gentle pressure. Stent-related issues involve the silicone tube becoming displaced, causing irritation or discomfort, or being prematurely removed. If the tube “loops out” towards the eye, it should be taped to the side of the nose and reported to the surgeon.
Excessive tissue growth, such as scarring or granuloma formation at the surgical site, can block the newly created passage. Rarely, serious complications such as changes in vision or double vision can occur. Temporary numbness or altered sensation around the surgical area may also be experienced due to nerve irritation.
Addressing and Managing Complications
Upon recognizing any signs suggestive of a complication, immediate consultation with the surgeon is important, as early intervention can prevent more serious issues and improve the overall outcome. Diagnostic approaches include a clinical examination to assess the surgical site, and imaging studies like dacryocystography or CT scans to visualize the drainage pathway and identify blockages.
If surgical failure or recurrence occurs due to scar tissue, revision DCR surgery is performed to reopen the blocked passage. Balloon dacryoplasty, where a small balloon is inflated within the duct to widen it, or other interventional procedures may be considered. For infections, treatment involves oral or intravenous antibiotics, and in instances of abscess formation, drainage is necessary.
Managing excessive bleeding involves nasal packing to apply pressure, or cauterization to seal bleeding vessels. In rare, severe cases, surgical intervention is required to control the hemorrhage. Stent-related problems, such as displacement, require repositioning of the tube, or its early removal or replacement. When scarring or granuloma formation is identified, treatment options include steroid injections to reduce inflammation and tissue growth, or surgical removal of the excess tissue to restore patency.
Long-Term Outlook and Follow-Up Care
The long-term outlook following DCR surgery is favorable, with high success rates in restoring normal tear drainage. External DCR, for instance, has reported success rates ranging from 85% to 99%. Endonasal DCR also shows high success rates (91-96%). Most surgical failures are identified within the first two years after the procedure.
Adhering to post-operative follow-up appointments is important for monitoring healing and detecting late-onset issues. These appointments allow the surgeon to assess the drainage pathway’s patency and address concerns. While successful outcomes are common, very late recurrence of tear duct obstruction rarely occurs. Consistent follow-up care helps maintain surgical results and ensures ongoing tear duct health.