Dacryocystorhinostomy (DCR)

Dacryocystorhinostomy (DCR) surgery is a procedure performed to treat chronic tearing or watery eyes (epiphora) caused by a blockage or obstruction in the tear drainage system. The surgery involves creating a new drainage pathway between the tear sac (located in the inner corner of the eye) and the nose, bypassing the blocked or narrowed nasolacrimal duct.

Methods of Dacryocystorhinostomy (DCR) Surgery

DCR surgery can be performed using two main approaches:

  1. External DCR: In the traditional external approach, a small skin incision (approximately 1-1.5 cm) is made on the side of the nose, where the edge of a pair of glasses would rest. Through this incision, the surgeon removes a small piece of bone to create the new drainage pathway between the tear sac and the nose. Skin stitches are used to close the incision and are typically removed about a week after surgery.

  2. Endoscopic DCR: The endoscopic approach is a less invasive method where the surgery is performed from inside the nose, avoiding any external skin incisions and potential scarring. An endoscope (a thin, flexible tube with a camera) is used to access and visualize the surgical area, and the new drainage pathway is created through the nasal cavity.

Procedure and Recovery

DCR surgery typically takes about an hour and is usually performed under general anaesthesia.

After surgery, some patients may have small silicone tubes (stents) placed to keep the newly created passages open during the healing process. These tubes are usually removed 4-6 weeks after surgery.

DCR surgery is often performed as a day case, meaning the patient is discharged on the same day of the surgery. However, in some cases, an overnight hospital stay may be necessary.

DCR surgery is highly successful in improving watery or sticky eyes when there is a clear blockage or obstruction in the tear drainage system. The success rate is typically around 90-95% in cases with a demonstrable blockage.

However, in cases where there is no clear blockage demonstrated on tests like syringing or imaging scans (such as CT scans or dacryocystography), the success rate may be lower. This suggests that other factors may be contributing to the symptoms, and the surgery may not be as effective in those situations.