What is Dacryocystorhinostomy?

Dacryocystorhinostomy (DCR) is surgery that diverts tear system drainage. It establishes a new tear fluid opening, which permits tear fluid to pass from the tear sac directly into the patient's nasal cavity (the open space within your nose). Dacryocystorhinostomy (say "DAK-re-oh-sis-to-RY-NOST-oh-me") is also known as "tear duct surgery."

Tear liquid is supposed to drain through a unique drainage channel that empty the the nose, so why does overproduction of tears (due to irritation, allergies or crying) clog up the the nose and make it stuffy? If tear fluid can't drain, it can lead to many issues. Some are just a nuisance, but some can be severe, like infections.

DCR surgery can treat conditions that are very common, especially among children. But there are many reasons why adults (especially those over the age of 65) might need such a surgery too.

Preparation for DCR

Before any child or patient undergoes tear duct surgery, they see a surgeon, either an ophthalmologist or an otolaryngologist (ENT), who can do this surgery. Typically, a surgeon from one field will collaborate with a surgeon from the other field. Some surgeons can do the entire surgery solo, but not typically.

The surgeon(s) speak about DCR surgery and will recommend some tests to make sure that patient is healthy enough for this surgery. They'll also check for any conditions affecting surgery or recovery.

Patients will also sit down with an anesthesiologist before their (or your child's) surgery. Tear duct surgery always involves anaesthesia of some type.

After the surgeon clears any patient for this surgery, they will give more explicit instructions on the following:-

• Drugs: The surgeon informs whether the patient should stop taking any drugs before surgery and how and when to do so safely.
• Pre-surgery skin preparation: He may ask you to wash your face with special soap. You'll put it on before your surgery (typically the night before) to minimize the risk of infection.
• Fasting: The doctors fix the diet for the patient to prevent chances of some effects like vomiting or pneumonia that may occur due to an empty stomach.

What happens during Dacryocystorhinostomy?

At the beginning of DCR surgery, a nurse or other healthcare provider inserts an intravenous (IV) line into a vein. The line enables the anesthesiologist to give medications and fluids during the operation.

Once an IV is in place, a surgeon or anaesthesia provider will provide medications that make you fall asleep. The physician can perform the surgery either from the outside (external) or inside (Endonasal) of your nose.

External Dacryocystorhinostomy

• The physician makes a small incision in the skin between the eye and the nose.
• They open the bone fragment that divides the tear sac from the nasal tissue below.
• They can put a tube in through this hole into the tear sac, threading the bottom end of the tube so that it drains into nasal cavity. The tube acts as a stent, or support frame, keeping the channel from the tear sac to the nasal cavity open.
• Once surgeons have secured the tissue and tube in place, they may close the incision in the skin by suturing.

Endonasal Dacryocystorhinostomy

• The doctor conducts a nasal endoscopy to form an incision inside the nose to penetrate the bone, separating the nasal pit cavity from the rip sac.
• Once inside the bone, they will create a void through it.
• They will create an opening in the tear sac outside the nose.
• Most surgeons will then pass tubing through the puncta in your eyelids and into the tear sac, tugging until it passes through the opening in the bone. They will keep the tubing ends in place.
• A surgeon may use a foam packing to keep the tubing in place and reduce postoperative bleeding.

How long is Dacryocystorhinostomy?

Surgeon times for tear duct surgery are slightly longer, depending on the methods they apply. If this is the first surgery, the external approach is a little longer, 45 minutes to 50 minutes. First-time Endonasal procedures are closer to 30 minutes. However, if this is a second surgery, those times are less.

What are the benefits of Dacryocystorhinostomy?

DCR surgery unclogs the tear fluid drainage so patient doesn't have excess tear fluid in and around eyes. Both external and Endonasal DCR surgeries are practical and successful enough with a significant percentage.

Risks/Complications

Pain, bleeding, and infection are a few problems the patient may experience. Regarding side effects, they may be Scar appearance or changes in tissues, stenting or displaced tubing.

• Wound reopening or skin scarring (external method only)
• Bone-related healing and closure complications (Endonasal method only)

A rare — but serious — complication of DCR is a condition called cerebrospinal fluid (CSF) leak. This may feel like fluid running down the back of the throat or a constant runny nose. If this happens, the patient will need to have another surgery to patch the leak with fat taken from your abdomen.

Other factors may determine which complications or side effects the patient will likely experience. The surgeon(s) are the best source of information about what you can and should expect.

Effects after Dacryocystorhinostomy

Surgery on tear ducts is usually an outpatient procedure, so it's not unusual for people to go home on the day of their surgery. If you received general anaesthesia for your surgery, your surgeon(s) and other caregivers will want to keep you under observation for a little while after you wake up. That observation time is to watch for any sign of complications from the anaesthesia or surgery.

It's also standard practice for your surgeon(s) to prescribe pain medication, antibiotics, anti-inflammatory medication, decongestants or other drugs. You must take your medications exactly as directed. Your surgical team will have to see you a week post-op. This is to check your incisions and have them remove any gauze or packing they left behind to avoid bleeding.

External DCR surgery

One week later, you will see your surgeon for the removal of stitches. In this period, your surgeon may adjust the doses of some medications or let you finish them. Nevertheless, you may be asked to take some medications for another week or two. Your surgeon will determine how and when the stenting tubes should be removed (if used).

Endonasal DCR surgery

About a week after your surgery, you'll have your first follow-up visit. During that visit, your surgeon(s) will prescribe a saline wash for your nose. It's essential to use this exactly as prescribed (don't substitute other products for the prescribed wash).

You will then have further follow-up reviews with your surgeon(s) to ensure everything in your nose usually heals. They may also remove the stenting tubes at one of these reviews.

How Much Time Is Needed for Recovery?

The recovery time for tear duct surgery is the same for both the external and Endonasal procedures. Both take several weeks at least to recover fully. That's because both are cutting into your bone, and the edges of those cuts will need to heal. In some cases, it will take several months. As the patient recovers, there are certain things they don't want to do. One of the most important things not to do is blow their nose. Blowing the nose will reopen wounds and knock out tissue or stenting tubes. You'll need to refrain from blowing your nose for at least a week after surgery. Your surgeon will tell you about other things you shouldn't do and how long you'll need to avoid them.

When do I call the healthcare provider?

Contact an eye care specialist in case you detect any alteration or feel any of the following symptoms:-

• Fever
• Swelling or redness near the site of surgery
• Bleeding or oozing from the wound (after external DCR surgery) or nosebleeds (after Endonasal DCR surgery) not stopping

Other Common Questions

What are DCR alternatives?

There are several other ways a healthcare provider might recommend other than DCR, which include:-

• Observation: Since symptoms are merely bothersome, individuals may not wish to treat nasolacrimal duct obstruction.
• Medical treatment: A doctor can give nonsurgical therapy for nasolacrimal duct blockage in some cases, such as antibiotic-steroid eye drops.
• Tubes: Another operation the doctor may suggest is placing tubes in regular tear drainage system. They will stay there for three to six months to see if that relieves your symptoms.
• Conjunctivodacryocystorhinostomy (CDCR): That is typically the last option in nasolacrimal duct obstruction when DCR fails.

Why Choose Tender Palm Super-Speciality Hospital for Dacryocystorhinostomy in Lucknow, India?

Tender Palm is the Best ENT Hospital for Dacryocystorhinostomy (DCR) in Lucknow, India. We have a skilled team of ENT surgeons experienced in advanced tear duct surgeries. We offer both external and endonasal DCR procedures using high-precision endoscopic techniques for accurate tear drainage restoration. Our hospital provides personalised care, post-operative follow-up, and minimally invasive options to ensure faster healing, improved comfort, and long-lasting relief from chronic tearing and tear duct blockages.

To Seek an Expert Consultation for Dacryocystorhinostomy Procedure in Lucknow, India

Call us at +91-9076972161
Email at care@tenderpalm.com

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