Endoscopic DCR

Tear duct obstruction& Dacryocystorhinostomy(DCR)

Sometimes, tears cannot drain from the eyes and this can lead to a blockage of the duct that transports tears from the surface of the eye to the nose.

What is a Dacryocystorhinostomy (DCR)?

This is a surgical procedure to improve tear drainage by forming a new tear duct into the nose bypassing any existing blockage. It is usually performed under a general anaesthetic as a day

Causes

Tears are constantly being produced by the eye; these usually drain out through the normal tear drainage system arising from the inner corner of the eyelid, down the tear duct into the nose.

The tear duct narrows with age, resulting in the system overflowing and tears rolling down the cheeks. This is particularly bad in situations when more tears are produced, for example when outdoors in windy weather.

Other causes of tear duct blockage include facial injuries or certain nose or sinus diseases.

Some patients have a blocked tear duct from birth. The entrance to the tear duct can be blocked by other causes which are not discussed here and not suitable for DCR treatment.

What does the surgery involve?

DCR involves opening up your existing tear sac and connecting it directly into the nose to forma new tear drainage pathway. This requires removal of the small amount of bone that liesbetween your tear sac and your nose. The tear sac can be reached from inside the nose(Endonasal DCR) or from the skin between your eye and nose. There are two types of DCRsurgery: external and endoscopic.

External DCR

The surgery takes place througha 10-15mm cut (incision) in the side of your nose. This heals up very quickly and is rarely visible when healing is complete.You will have stitches, which are usually removed 7-14 days later. As part of the surgery, a small polythene tube (they do not assist with drainage) is positioned internallyto ensure that the newly made passage remains open during the healingstage. This tube is removed after 6-12weeks.

Endoscopic DCR

Endoscopic DCR is a minimally invasive procedure to unblock tear ducts. The operation is very similar to external DCR, except there is no cut through the skin and no scar afterwards. Access is through your nose, using a small thin camera (endoscope). As with all DCR surgery, a small tube will be placed internally, positionedin the newly created passage and this will be removed

after four to six weeks.

Removal of tube

The tube might be visible just inside your nose, but do not worry if it is not visible after surgery; itwill be removed during your next outpatient appointment. It is tied inside your nose and a loopcan occasionally stick out from the inner corner of your eyelids. If this happens, the softpolythene tube can gently be pushed back into place.

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