Tear duct surgery (DCR)

The tear drainage system consists of tiny openings in the eyelids, tear ducts, the tear sac, and a canal leading into the nasal cavity. Its function is to drain tears produced by the eye. When this pathway is blocked, tears do not drain properly, accumulating on the eye surface and overflowing, a condition known as epiphora or watery eyes. This blockage can also lead to the accumulation of mucous or purulent discharge, swelling and pain in the inner corner of the eye, and recurrent infections.

Dacryocystorhinostomy (DCR) surgery is considered when there is a significant blockage in the tear sac or the canal leading to the nose, causing persistent watering, discharge, or recurrent infections. Before surgery, other causes of watery eyes, such as dry eye or eyelid problems, are investigated to ensure that the blockage is indeed the primary cause of symptoms. The surgery aims to create a new drainage pathway, allowing tears to flow normally.

Before surgery, you will be asked to provide information about all medications, supplements, or vitamins you take regularly. The team will decide whether any medicines, including blood thinners, need adjustment; do not stop them on your own. Preparation includes an eye examination and any further tests needed for your health and planned anesthesia, which may include blood tests. Follow the clinic's precise eating and drinking instructions because fasting requirements depend on the anesthesia and procedure plan. It is advisable to avoid smoking for several weeks before surgery to improve the healing process.

The goal of DCR surgery is to create a new connection between the tear sac and the nasal cavity, bypassing the blockage. There are two main approaches: the external approach and the endoscopic (internal) approach. In the external approach, a small incision is made in the skin next to the nose, through which the tear sac is exposed, and an opening is created in the nasal bone. The tear sac is then sutured to the nasal lining through this opening. In the endoscopic approach, the surgery is performed through the nostril using endoscopic instruments, without an external skin incision. In this approach, a small piece of bone is removed from the nose to create the bypass. Sometimes, a thin silicone tube is threaded through the new opening to keep it patent during healing, and it is removed after several weeks or months.

The surgery can be performed under general or local anesthesia, depending on the surgical approach and the patient's overall medical condition. The endoscopic approach is usually performed under general anesthesia, while the external approach can also be done under local anesthesia. The surgery typically lasts about an hour. Most patients are discharged home on the same day or the morning after.

After surgery, mild swelling, subcutaneous bruising around the eyelids (especially with the external approach), slight nasal bleeding, and a feeling of nasal congestion may occur. Pain can be managed with analgesics. Rare but possible complications include increased bleeding, infection, wound dehiscence, and scarring in the operated area that could lead to re blockage of the tear ducts. In some cases, difficulty wearing glasses for one to two weeks may occur due to sensitivity in the nasal area.

You will receive detailed instructions for post operative care, including the use of antibiotic eye drops and saline nasal spray (for the endoscopic approach). You should avoid strenuous activity, lifting heavy objects, rubbing your eyes, and blowing your nose for about two weeks. If a silicone tube was inserted, follow the instructions regarding its care. In case of fever above 38 degrees Celsius, spreading redness, severe pain not relieved by analgesics, significant bleeding from the nose or eye, or wound dehiscence, seek medical evaluation.