Dacryocystorhinostomy (DCR)
Treatment for a Blocked Tear Duct

What is Dacryocystorhinostomy (DCR)?

Dacryocystorhinostomy (DCR) is a surgical procedure designed to treat a blocked tear duct, which prevents tears from draining properly from the eyes into the nasal cavity. This procedure creates an alternative drainage pathway between the eye and the nose, alleviating the symptoms of tear duct blockage. The DCR surgery can be performed either externally through a small skin incision or endoscopically through the nose—both methods are highly effective.

Blocked Tear Duct Symptoms?

A blocked tear duct often results in excessive tearing, eye discharge, and pain around the tear duct area. It occurs when the normal drainage system is obstructed, causing tears to accumulate instead of flowing through the tear duct to the nasal cavity.

How Does a Blocked Tear Duct Work?

Each eyelid contains a small opening to drain tears, which are produced by the eyes. The tears move from the eye into small tubes and then into the lacrimal sac, which leads to the tear duct. The tear duct runs around the bony structures of the nose and drains tears into the nasal cavity.

Symptoms of a Blocked Tear Duct?

The common symptoms of a blocked tear duct include:

  • Excessive tearing (epiphora)
  • Mucus or pus discharge from the eye
  • Pain and tenderness around the tear duct or eye
Causes of a Blocked Tear Duct?

In many cases, the cause of a blocked tear duct remains unknown. However, other factors that may contribute to a blockage include:

  • Congenital (born with) anatomical problems
  • Chronic sinus and nasal inflammation
  • Tumor obstruction
  • Nasal trauma or injury
  • Conjunctivitis (eye infection)

An ophthalmologist can perform various tests to identify if there is a tear duct obstruction and determine the underlying cause.

Types of Dacryocystorhinostomy (DCR) Procedures?
  1. External DCR (Traditional)
    During an external DCR, a small incision is made beneath the eye, next to the nose. This incision allows the surgeon to access and create an opening in the bone to connect the lacrimal sac to the nasal cavity. A stent may be placed to keep the new drainage pathway open.
  2. Endoscopic DCR (Minimally Invasive)
    The endoscopic DCR involves a minimally invasive technique where a sinus surgeon, with the assistance of an ophthalmic plastic surgeon, creates a new tear drainage pathway through the nasal passage. This approach does not leave visible scarring as it avoids any incisions on the skin.
Why Would You Need Dacryocystorhinostomy (DCR)?

DCR surgery is typically recommended for individuals with a blocked tear duct that causes persistent symptoms like excessive watering of the eyes, crusting around the eyes, or recurrent eye infections. If the tear duct is infected, additional symptoms may include:

  • Swelling and tenderness around the eyes
  • Irritation or pain in the eye area
  • Mucous discharge from the eye

Not all blocked tear ducts require surgery. In some cases, less invasive treatments such as warm compresses, antibiotics, or tear duct dilation may be sufficient. However, DCR surgery becomes necessary when other treatments fail to resolve the symptoms or if the blockage is severe.

What Are the Risks of Dacryocystorhinostomy (DCR)?

As with any surgery, there are risks associated with DCR, including:

  • Infection
  • Bleeding
  • Displacement of the stent
  • Abnormal tissue fusion in the nose
  • Prominent scarring (in external DCR)
  • Surgery failure, where the procedure does not relieve symptoms

Discuss with your doctor the risks specific to your health, age, and the type of DCR procedure you undergo.

How to Prepare for Dacryocystorhinostomy (DCR)?

Before undergoing DCR surgery, you will need to consult with your doctor about necessary preparations. Typically, you will be advised to avoid eating or drinking after midnight the night before the surgery. Your doctor may also recommend pre-operative imaging, such as a CT scan or MRI of the nasal passages, to gain a better understanding of your anatomical structure.

What Happens During Dacryocystorhinostomy (DCR)?

The surgical procedure will differ depending on whether an external or endoscopic DCR is performed. In general:

  • You may be awake during an external DCR, with anesthesia used to numb the area.
  • For endoscopic DCR, general anesthesia is administered, and you will remain unconscious during the procedure.
  • The surgeon will create a new passageway between the lacrimal sac and the nasal cavity. In some cases, a stent will be placed to ensure the tear duct remains open after surgery.
Recovery After Dacryocystorhinostomy (DCR)?

Recovery time after blocked tear duct surgery varies depending on the type of DCR procedure. Most patients can return home the same day. You may experience some mild discomfort or bruising (more common with external DCR). Over-the-counter pain relievers can help manage any pain.

Post-operative care typically includes the use of antibiotic drops to prevent infection, and you may be advised to rinse your nasal cavity to keep it clean. Follow-up appointments are necessary to ensure that the new tear duct is functioning properly and that no complications arise. If a stent was placed, it may need to be removed after a few weeks.

Conclusion

Dacryocystorhinostomy (DCR) is an effective treatment for a blocked tear duct, helping restore normal tear drainage and alleviate symptoms like excessive tearing and eye irritation. Whether you choose the external or endoscopic DCR procedure, it is important to consult with a specialized ophthalmic plastic surgeon or sinus surgeon to determine the best treatment plan for your condition.

For more information on tear duct surgery, dacryocystorhinostomy, or blocked tear duct treatment. For more information or to book an appointment, please connect with us at +91 93223 64002. Meet our Senior Eye Surgeon & Retina Specialist, Dr. Shahnawaz Kazi, for expert advice and personalized care at Ashu Laser Vision & Ashu Eye Hospital. We look forward to assisting you with your eye care needs!

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