Dacryocystorhinostomy, or DCR, is a surgical procedure designed to correct a blockage in the tear drainage system of the eye. This blockage occurs in the nasolacrimal duct, which is the final passage tears take before draining into the nose. Normally, the lacrimal system collects tears through small openings in the eyelids, channeling them through tiny canals and a tear sac before they enter the duct. When the duct is obstructed, tears cannot drain properly, resulting in epiphora, or excessive tearing. DCR surgery creates a new, direct pathway for tears to bypass the non-functional duct and flow freely into the nasal cavity.
Understanding Tear Duct Blockage and When DCR is Necessary
The obstruction of the nasolacrimal duct, often referred to as NLDO, prevents the normal flow of tears. This blockage causes tears to pool on the eye’s surface and spill over onto the cheek, which is the most common symptom. Beyond simple tearing, the stagnant fluid in the lacrimal sac can become a breeding ground for bacteria, leading to recurring infections and inflammation, known as dacryocystitis.
Patients frequently experience chronic tearing, a sticky mucus discharge from the inner corner of the eye, and sometimes painful swelling near the side of the nose. These symptoms often worsen in cold or windy environments, which naturally stimulate tear production. When symptoms become bothersome, or when acute infections occur repeatedly, a DCR procedure is typically recommended.
Before surgery is considered, NLDO is confirmed through diagnostic tests, such as a dye disappearance test, which times tear drainage. DCR is usually the preferred treatment for acquired blockages in adults, which happen later in life due to inflammation, trauma, or age-related narrowing. This differs from the treatment for infants with congenital NLDO, where initial management often involves lacrimal massage or a less invasive probing procedure.
The Dacryocystorhinostomy Procedure
The DCR procedure works by creating a connection between the tear sac and the nasal cavity, bypassing the blocked portion of the nasolacrimal duct. Surgeons utilize two main approaches: the External DCR and the Endoscopic/Endonasal DCR. Both techniques share the goal of creating a new drainage route, but they differ significantly in how the surgeon gains access to the tear sac.
The External DCR is the traditional method, requiring a small incision of about 10 to 20 millimeters on the side of the nose, near the inner corner of the eye. Through this incision, the surgeon exposes the lacrimal sac and removes a small portion of the bone to access the nasal cavity, creating an opening (osteotomy). This direct visualization allows for a precise connection (anastomosis) between the lining of the tear sac and the nasal lining.
Alternatively, the Endoscopic DCR is a minimally invasive approach performed entirely through the nostril, using a thin camera and specialized instruments. This technique avoids an external skin incision, resulting in no visible scar and less disruption to the muscles around the eye.
In both methods, a temporary, thin silicone tube or stent is often placed through the new pathway to hold the opening patent while the tissues heal. The tube runs from the eye, through the new connection, and into the nose. It remains in place for several weeks to months before being removed in a follow-up visit.
Post-Operative Care and Expected Recovery
Following a DCR procedure, patients typically experience some bruising and swelling around the eye and nose, which is a normal part of the healing process. Discomfort is usually mild and can be managed with over-the-counter pain medication. The surgeon will provide specific instructions, often including using antibiotic eye drops and nasal sprays to prevent infection and keep the surgical site clean.
Patients are usually advised to limit strenuous activity, such as heavy lifting or vigorous exercise, for about one to two weeks, as this can increase swelling or bleeding. Patients must avoid blowing the nose forcefully for several weeks to prevent dislodging the silicone stent or causing a nosebleed. When sneezing, patients should try to do so with their mouth open to reduce pressure in the nasal cavity.
The temporary stent is typically removed in the clinic after about six to twelve weeks, once the new tear drain is fully healed. Follow-up appointments allow the surgeon to monitor the new pathway and ensure it remains open. The procedure has a high success rate, generally ranging from 85% to over 90%. Potential complications can include bleeding, infection, or the new drainage hole scarring closed.