The Oculoplastics Centre | Adult and Paediatric Lid, Lacrimal and Orbit Surgery Sydney

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External DCR (dacryocystorhinostomy) Surgery

A common cause of tearing is from scarring or narrowing in the tear drainage system. This may be due to injury, infection or a stone (calculus) within the drainage system, but often we cannot be certain of the cause of the obstruction. As the tears are being constantly produced by the tear glands, if the tear drainage system is not working well then tears will build up and cause a watery eye or they can overflow over the eyelids onto the cheeks resulting in “epiphora”.

If there is a narrowing or blockage of the tear outflow tract then surgery can be performed to create a functioning tear drainage system. This surgery is called a Dacryocystorhinostomy or DCR.

Dacryocystorhinostomy (DCR) was initially described in 1829 as an external or skin based approach. An incision is made in the skin on the side wall of the nose to gain access to the tear sac and the nasal cavity. This procedure is commonly performed as a day surgical procedure under local anaesthesia with sedation.

What are the symptoms of a blocked tear duct?

Poor tear drainage can lead to recurrent infections, either in the form of conjunctivitis, or even severe infection and abscess formation within the tear duct and sac.

More common symptoms include, blurring of vision, inability to keep glasses from fogging up and mucus discharge.

When should tear duct obstruction be treated?

If your tearing is severe enough to cause significant symptoms and interfere with quality of life it is reasonable to have surgery. Recurring conjunctivitis is a relatively strong indicator to proceed to surgery however once a patient has suffered an episode of dacryocystitis (severe infection or abscess within the tear duct) DCR surgery must be performed to avoid recurrent severe infections.

What does the treatment involve?

Surgery is under a local anaesthetic with sedation to make it a comfortable experience. The procedure takes about 45 minutes. A fine silicon stent is placed in the tear duct and is removed in the rooms 2-4 weeks postoperatively. Very fine dissolving stitches are placed in the skin incision and will be removed if they are still present at the postoperative visit.

How will I look immediately after surgery?

Mild to moderate bruising associated with the skin incision on the side of the nose is not uncommon, however will settle within 1-2 weeks.

What is the recovery time?

Cold packs for 2 days to improve postoperative swelling is advised as well as taking it easy for the first week (no bending, straining or lifting more than 5kg), over the next week activity is increased to a normal level at week three.

What are the risks?

Any operation carries risk and this will be discussed fully at your consultation with Dr Wilcsek

How long do the results of the surgery last?

The success rate for endoscopic and external DCR is approximately 95%, however tear drainage is a very complex physiological process and tearing may be the result of a number of separate issues. Therefore careful patient selection is essential.

Patients have follow-up for three months to ensure that the new tear pathway matures well. After this period it is very unlikely for the tearing to recur.

Is there anyone who shouldn't have this surgery?

Many patients are on blood thinners such as aspirin. As the nose has a very rich blood supply, blood thinners are best stopped 7-10 days preoperatively. Depending on your general health this is sometimes not possible and Dr Wilcsek would then seek advice from your family physician or cardiologist.