Dacryocystorhinostomy: Treatment for a Blocked Tear Duct
What is a dacryocystorhinostomy?
A dacryocystorhinostomy (DCR) is a surgery that creates a new path for tears to drain between your eyes and your nose. You may need this surgery if your tear duct has become blocked. The procedure can be performed externally through an incision in the skin, or endoscopically through the nose without leaving a skin incision. Both methods are equally successful.
Blocked Tear Duct
Your eyelids each have a small opening that drains away tears produced normally by your eyes. Blinking pushes tears into these openings. From there, the tears empty into a small tube and then into a larger area: the lacrimal sac. This sac leads to the tear duct, which goes around bony structures surrounding your nose and drains into your nasal cavity.
Symptoms of a Blocked Tear Duct
- Discharge from the eye
- Pain at the tear duct or surrounding area
Causes of a Blocked Tear Duct
In most cases, the cause of a blocked tear duct is not known. Other times, the blockage can be caused by health problems such as:
- Anatomical problems you were born with
- Chronic nasal and sinus inflammation
- Obstruction from a tumor
- Trauma to the nose
An ophthalmologist will perform testing of the tear duct to determine if there is obstruction and what the cause may be.
DCR Through the Skin (External Procedure)
During an external DCR, your oculoplastic surgeon creates an 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. The surgeon leaves a small tube there to help keep the new tear duct open.
Endoscopic DCR (Minimally Invasive)
During an endoscopic DCR, the sinus surgeon works together with the eye surgeon to bypass the tear duct by creating a new opening directly from the lacrimal sac to your nasal cavity. Going through the nasal passage under endoscopic vision, the sinus surgeon creates an opening in the bone that overlies the lacrimal sac. A connection is then created between the lacrimal sac and your nasal cavity. The ophthalmic plastic surgeon usually places a small tube there to help keep the new tear duct open.
Why might I need a dacryocystorhinostomy (DCR)?
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. This is a much more common treatment for adults than for children. Your health care provider might first recommend less invasive treatments. These may include warm compresses, massage, and antibiotics for an infection. Or the provider might advise having 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. For example, you might need a different kind of surgery if a tumor blocks your duct.
You and your health care provider may need to discuss what type of DCR will be best for you. Sometimes, 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 might be able to avoid an external scar. Ask your eye doctor about the benefits and risks of all your treatment options.
What are the risks of a dacryocystorhinostomy (DCR)?
All procedures have risks. Risks of this procedure include:
- Abnormally fused tissue in the nose
- Displacement of the stent placed in the duct
- Excess bleeding
- Prominent facial scar (external DCR only)
It’s also possible that the DCR will not be effective.
Your risks may differ according to your age, your health conditions, and the type of DCR performed and the reasons for it. Talk with your doctor about all your concerns and about the risks that apply the most to you.
How do I prepare for a dacryocystorhinostomy (DCR)?
Talk with your doctor about how to prepare for the procedure. Ask if you need to stop taking any medicines. You can’t eat anything after midnight before the day of the surgery.
Your doctor may want 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 (DCR)?
Talk with your doctor about what will happen during the procedure. The details of your surgery will differ if it is an external or an endoscopic approach. Usually, a doctor trained in ophthalmic plastic surgery performs the external surgery or partners with a sinus surgeon to perform an endoscopic DCR — in either case, with the help of a team of specialized nurses. In general, you can expect the following during your surgery:
- You may be awake during an external DCR 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.
- For other external DCRs, and during all endoscopic DCRs, you will receive anesthesia to make you sleep. You will sleep deeply through the surgery and won’t remember it afterward.
- Your ophthalmic plastic surgeon may make a small incision below or near your eyelid, in the space below your eye and beside your nose.
- The ophthalmic plastic surgery doctor may expose the tissue beneath the incision. He or she will make a small hole in the bone beneath to open a new passageway between the lacrimal sac and your nose.
- Your sinus surgeon may use an endoscope to work through the nose to make an opening in the bone that overlies the lacrimal sac, to make a new passageway between the lacrimal sac and your nose.
- In most DCR cases, a small tube called a stent will be placed in the opening to help keep the passage open.
- For an external DCR, your incision will be closed with stitches.
- For an endoscopic DCR, no sutures or nasal packing will be placed.
Blocked Tear Duct Surgery Recovery
Ask your doctor about what you should expect after your external DCR surgery. Your nose may need to be refilled with packing material to reduce the chance of bleeding. In most external and endoscopic DCR 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 or antibiotic eyedrops to help prevent infection. Your doctor might also give you instructions about rinsing the nasal cavity. You may need other medicines too, such as steroids and nasal decongestants.
There may be a little soreness after the procedure, but over-the-counter pain medicines should relieve the discomfort. It is normal to have some bruising after an external DCR. There is typically no bruising after an endoscopic DCR. Ask your doctor if there are activities you should avoid while you recover.
You will need close follow-up care with your doctor to find out if the surgery was effective. You may have a scheduled appointment soon after the procedure. You will need continued follow-up care to monitor how you are doing after your surgery. If a stent was placed, it might need to be removed a few weeks after the procedure. Tell your doctor right away if you have excessive bleeding, a fever, or increasing pain or swelling.
Before you agree to the test or the procedure, be 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
- The possible side effects or complications
- When and where the test or procedure will be performed
- Who will do the test or procedure and that person’s qualifications
- What would happen if you do not have the test or procedure
- Any alternative tests or procedures to consider
- When and how will you 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
The Johns Hopkins Sinus Center provides state-of-the-art evaluation and treatment for a variety of nose and sinus conditions, including environmental allergies, nasal obstruction, nasal tumor and related disorders.