A procedure that relieves the obstruction in the duct that drains tears into the nose, using probing, silicone tube placement, or creation of a new drainage pathway (DCR), depending on the level of blockage.
Indication
- Persistent and unilateral tearing (epiphora)
- Fullness in the lacrimal sac with infected discharge upon pressure (chronic dacryocystitis)
- Recurrent eyelid and lacrimal sac infections
- Persistent lacrimal duct obstruction beyond 12 months of age in infants
- Acquired duct obstruction due to trauma or prior surgery
- Pre-operative repair requirement in patients planned for facial surgery
Preparation
- Detailed ophthalmologic and lacrimal pathway examination
- Irrigation, probe testing, and imaging (CT-dacryocystography) when indicated
- Active conjunctivitis or skin infection should be treated first
- Adjustment of blood-thinner medications under physician guidance
- Fasting for 6-8 hours before surgery in cases planned under general anesthesia
How it's performed
- The level of obstruction (upper, middle, lower) is determined by clinical and imaging assessment
- In infants and selected adults, probing is performed and a silicone tube placed if needed
- In adults with complete obstruction, dacryocystorhinostomy (DCR) creates a new pathway between the lacrimal sac and the nose
- DCR may be performed endoscopically through the nose or via a small skin incision (external)
- A silicone tube is placed in the new opening to keep it patent for 2-6 months
- Intranasal packing and antibiotic therapy are initiated
Post-procedure
- Discharge usually on the same day or the next day after endoscopic DCR
- Nasal irrigation and nasal spray care, especially important in the first 2-4 weeks
- Use of antibiotic and anti-inflammatory drops/sprays
- The silicone tube is removed in an outpatient setting after 2-6 months
- Reduction in tearing becomes evident over weeks; follow-up at 1, 3, and 6 months
Risks
- Nosebleed (usually mild and self-limiting)
- Narrowing or closure of the new opening over time
- Irritation or displacement related to the silicone tube
- A fine scar on the skin with the external approach
- Rare infection in surrounding tissues
FAQ
Is surgery always required for my baby's persistently watering eye?
In most infants, lacrimal duct obstruction resolves on its own within the first year with massage and hygiene. For obstructions persisting beyond 12 months, a pediatric ophthalmologist may consider options such as probing.
Does DCR surgery leave a scar on the face?
In endoscopic DCR, the procedure is performed through the nose, leaving no skin scar. In external DCR, a small incision is made on the lateral nasal wall; once healed, it usually becomes a fine, hard-to-notice scar.
Does the tearing improve immediately after surgery?
Tearing may continue for the first 1-2 weeks due to swelling and the intranasal healing process. Most patients notice significant improvement within a few weeks; the final outcome stabilizes within 2-3 months.
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