Lacrimal Drainage Surgery

DCR or dachryocystorhinostomy is a procedure that is performed to create a new tear drain when your current tear drain between the eye and the nose becomes blocked.

The tear drain start at two tiny openings called punctum that are located in inner aspect of both the upper and lower lids. Each of these is connected to the tear sac by very fine tubes called canaliculus. The tear sac is located in the inner corner of the eye next to the nose. A bony canal called the nasolacrimal duct drains the tears from this sac in to the nasal cavity.


Tear drainage
With every blink, the eyelids spread tears evenly across the eye to keep it moist and the remaining tears are then pumped in to the puncta and lacrimal sac. From the lacrimal sac the tears are drained in to the tear duct and the nose. If the tear duct is blocked , the tears spill over your eyelids on to you cheeks. Stagnant tears can result in an infection in the tear sac. External or endoscopic DCR can be performed to correct this problem.

Features of blocked tear duct
Excessive watering is the most common symptom but recurrent conjunctivitis or a painful swelling in the inner aspect of the eyelid can also occur. A careful history and examination help exclude other causes of a watery eye (such as hay fever, allergy, blepharitis, etc)

Treatment options
When other causes of a water eye have been ruled out and the surgeon has confirmed a blocked tear duct, the most successful solution is dachryocystorhinostomy or DCR surgery. Depending on the precise area of obstruction and nasal anatomy the surgery can either be carried out inside the nose using an endoscope so there is no skin incision (Endonasal DCR) or a small skin incision may have to be made on the skin to carry out the surgery (External DCR). A new tear drain is created to by-pass the obstruction and open directly in to the nose. A fine silicone stent is temporarily inserted in to the new tear drain (for 8 to 12 weeks) to keep it open during the healing process.

DCR surgery can be performed under general anaesthesia but can also be performed under local anaesthesia with sedation. Most patients go home the same day after the surgery and are advised to use antibiotic drops and ointment for a week after surgery.

Postoperative care
A small pad is placed in front of the nostril overnight as most patients experience minor bleeding from the nose after surgery. If you’ve had an external DCR, there may also be a small dressing on the skin near the bridge of the nose. The dressing and the pad can be removed the next day and the drops and ointment are used as advised for one week. There may also be nasal drops to instil for a few days. Patients are advised to sleep with their head elevated for 2 nights (use several pillows) to reduce the risk of bleeding.

Skin sutures if any are removed one week after surgery. The DCR tubes are removed 8 – 12 weeks after surgery. This is done in clinic and after spraying some local anaesthetic in the nose.

You should expect to be off work for about one week after surgery. Patients are advised not to blow their nose for one week and avoid swimming for two weeks

How will I know if the surgery has worked?
Most patients will experience in resolution of the discharge and watering after surgery but watering can sometimes persist till the tubes are removed.

Risks and complications
Some patients experience minor bleeding from the nose for the first day or 2 after surgery. Minor bruising and swelling can be expected on the side of the nose (external DCR) that settles within a week or two. The small skin scar for patients undergoing external DCR usually fades within six months. Scar tissue may occasionally block the drain, which may require additional surgery to clear.

Significant bleeding and infection are potential risks but are uncommon. Mr Durrani usually discusses all the relevant risks & benefits in detail prior to surgery.