Dacryocystorhinostomy: Treatment for a Blocked Tear Duct

What is a dacryocystorhinostomy?

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

Blocked Tear Duct

Your eyelids have two small openings that drain some of the tears covering your eye. Blinking pushes tears into these openings. From there, the old tears empty into a small tube and then 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 and drains into your nasal cavity.

Sometimes, this drainage system gets blocked. This can cause a lot of tearing or discharge from the eye. The blocked duct often becomes 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 you were born with
  • Chronic nasal infections
  • Obstruction from a tumor
  • Trauma to the nose
  • Conjunctivitis
  • Nose polyps

During a DCR, your surgeon creates a new opening from the lacrimal sac to your nasal cavity. The surgeon makes a small 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 beneath. This opening then connects your lacrimal sac and your nasal cavity. Sometimes, the surgeon leaves a small tube there to help keep the new tear duct open.

Why might I need a dacryocystorhinostomy?

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

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

Not everyone who has a blocked tear duct needs a DCR. A DCR is a much more common treatment for adults than for children. Your healthcare provider might first recommend less invasive treatments. These may include warm compresses, massage, and antibiotics for an infection. Or a healthcare provider might advise a procedure to try to dilate the nasolacrimal duct. If your symptoms are severe, however, you may need a DCR.

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

You and your healthcare provider may also need to discuss what type of DCR will be best for you. Sometimes, healthcare providers perform the procedure externally. Other times, they use a rigid tube inserted into the nasal cavity to perform the surgery. With this approach, you may be able to avoid having an external scar. Ask your eye doctor about the benefits and risks of all your treatment options.

What are the risks of a dacryocystorhinostomy?

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 will not be effective.

Your risks may differ according to your age, your other health conditions, the type of DCR performed, and the reasons for it. Talk with your doctor about all your concerns and about the risks that are most applicable to you.

How do I prepare for a dacryocystorhinostomy?

Talk with your doctor about how to prepare for your dacryocystorhinostomy. Ask whether you need to stop taking any medicines before the procedure. You will need to avoid eating anything after midnight before the day of the surgery.

Your doctor may want 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 a dacryocystorhinostomy?

Talk with your doctor about what will happen during your dacryocystorhinostomy. The following describes an external approach to DCR. But the details of your surgery may differ somewhat. Usually, a doctor trained in ophthalmic plastic surgery performs 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 receive a medicine to help you relax. The doctor uses packing materials soaked with anesthetics inside your nose 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 an injection to numb the area.
  • In other cases, you may receive anesthesia to put you to sleep. If this is the case, you will sleep deeply through the surgery and won’t remember it afterwards.
  • Your doctor may make a small incision below or near your eyelid in the space below your eye and beside your nose.
  • Your doctor may expose the tissue beneath this incision. He or she will make a small hole in the bone beneath. This opens a new passageway between the lacrimal sac and your nose.
  • In some cases, your doctor may place a small tube here, called a stent, to help keep the passage open.
  • Someone will surgically close your incision with stitches.

What happens after a dacryocystorhinostomy?

Ask your doctor about what you should expect after your surgery. You may need to have your nose refilled with packing material 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.

Be sure to follow your doctor’s instructions about caring for your eye, nose, and wound. You may need to take antibiotics to help prevent infection. Your doctor may also give you instructions about rinsing your nasal cavity. You may also need other medicines, like 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. It is normal to have some bruising around the area. Ask your doctor whether you should avoid any specific activities while you recover.

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

Next steps

Before you agree to the test or the 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 will you get the results
  • Who to call after the test or procedure if you have questions or problems
  • How much will you have to pay for the test or procedure

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