Dacryocystorhinostomy

What is DCR?

Dacryocystorhinostomy (DCR) is a type of surgery to create a new tear drain between your eyes and nose. You may need this surgery if your own tear duct has become blocked.

Your eyelids have two small openings that drain some of the tears covering your eye. Blinking pushes tears into these openings. From there, the tears empty into a small tube. Then they go into a larger area called the lacrimal sac. This sac leads to the tear duct. This duct passes around some bony structures surrounding your nose. Then it drains into your nose.

When this drainage system gets blocked, it may cause a lot of tearing or eye discharge. The blocked duct sometimes gets infected as well.

In most cases, the cause of a blocked tear duct is not known. Other times, the blocked tear duct can be caused by health problems, such as:

• Anatomical problems that were present at birth
• Long-term (chronic) nasal infections
• Blockage from a tumor
• Injury to the nose
• Conjunctivitis
• Nose polyps

During DCR, your surgeon creates a new opening from the lacrimal sac to your nose. The surgeon makes a small cut (incision) in the skin, in the area under your eye and next to your nose. Through this incision, your surgeon creates a small opening in the bone below. This opening then connects your lacrimal sac and your nose. Sometimes the surgeon leaves a small tube there to help keep the new tear duct open.

How to say it

DAK-cree-oh-SIHS-toh-ri-NOS-tuh-mee

Why might I need DCR?

The procedure is done to ease the symptoms of a blocked tear duct. These include excessive eye watering or crusting around your eye. If the duct is infected, you may have these symptoms:

• Swelling and soreness around your eye
• Eye irritation
• Mucous discharge

Not everyone who has a blocked tear duct needs DCR. DCR is a much more common treatment for adults than for children. Your eye care provider might first advise less invasive treatments. These may include warm compresses, massage, and antibiotics for an infection. Your provider might advise a procedure to try to widen (dilate) the nasolacrimal duct. But if your symptoms are severe, you may need a DCR procedure.

Depending on the cause of your blocked tear duct, you may need another type of treatment. You may need a different type of surgery if a tumor blocks your duct.

You and your eye care provider will discuss what type of DCR will be best for you. There are two types:

• External DCR. The surgeon makes a small cut (incision) on your nose to get to the tear ducts.
• Endoscopic DCR. A tube is inserted into your nose to do the surgery. With this method, you may not have a scar.

Ask your eye care provider about the benefits and risks of all your treatment options.

What are the risks of DCR?

All procedures have risks. Some possible risks of this procedure include:

• Abnormally fused tissue in the nose
• Displacement of the stent placed in the duct
• Excess bleeding
• Infection
• Prominent facial scar

There is also a risk that the DCR won't be effective.

Your risks may differ according to your age, your other health conditions, the type of DCR done, and the reasons for it. Talk with your eye care provider about all your concerns. Ask about the risks that apply to you.

How do I get ready for DCR?

Talk with your eye care provider about how to get ready for your DCR. Ask if you need to stop taking any medicines before the procedure. Follow any directions you are given for not eating or drinking before the surgery.

You may need to have certain tests before the procedure to get a better idea of your anatomy. These might include:

• CT scan of your nasal passages
• MRI scan of your nasal passages

What happens during DCR?

Talk with your eye care provider about what will happen during your DCR. The following describes an external approach to DCR; however, the details of your surgery may be different. Often a healthcare provider trained in oculoplastic surgery does the surgery with the help of a team of specialized nurses. In general, during your surgery you can expect the following:

• You may be awake during the surgery. You may be given a medicine to help you relax. The eye care provider uses packing materials soaked with anesthetics inside your nose. This is to make sure you don’t feel anything. This packing material may also have medicine to help you bleed less during the procedure. You may also need a shot (injection) to numb the area.
• In other cases, you may be given anesthesia to put you to sleep. If this is the case, you will sleep deeply during the surgery. You won’t remember it afterward.
• Your provider may make a small incision under or near your eyelid in the space below your eye and next to your nose.
• Your provider may expose the tissue under this incision. They will make a small hole in the bone below. This opens a new passageway between the lacrimal sac and your nose.
• In some cases, your provider may place a small tube (stent) here. This is to help keep the passage open.
• Your provider will surgically close your incision with stitches.

What happens after DCR?

Ask your eye care provider what to expect after your surgery. You may need to have your nose refilled with packing material. This is to reduce your chance of bleeding. In most cases, you will be able to go home the same day. Plan to have someone go home with you after the procedure.

Follow your provider’s instructions about caring for your eye, nose, and wound. You may need to take antibiotics to help prevent infection. Your provider may also give you instructions about rinsing your nose. You may also need other medicines, such as steroids and nasal decongestants.

The area may be a little sore after the procedure. But you should be able to take over-the-counter pain medicines as prescribed. It is normal to have some bruising around the area. Ask your eye care provider if there are any activities you should not do while you recover and for how long.

You will need close follow-up care with your provider to see if the surgery was effective. You may have a scheduled appointment the day after the procedure. You will need continued follow-up care to watch how you are doing after your surgery. If you had a stent placed, you may need to have it removed a few months later. Get medical attention right away if you have a lot of bleeding, a fever, or increasing pain or swelling.

Next steps

Before you agree to the test or procedure make sure you know:

• The name of the test or procedure
• The reason you are having the test or procedure
• What results to expect and what they mean
• The risks and benefits of the test or procedure
• What the possible side effects or complications are
• When and where you are to have the test or procedure
• Who will do the test or procedure and what that person’s qualifications are
• What would happen if you did not have the test or procedure
• Any alternative tests or procedures to think about
• When and how you will get the results
• Who to call after the test or procedure if you have questions or problems
• How much you will have to pay for the test or procedure