Dacryocystorhinostomy (DCR) is a surgical procedure for watery eyes / tearing (epiphora) due to blockage of the tear duct.
Indications for surgery
There are a variety of causes of watery eyes or tearing including blocked tear duct, overproduction of tears (often due to irritation of the eye) or problems with the eyelid position or function. DCR is a procedure used to open the tear duct (lacrimal sac) into the nose with the aim of bypassing the blockage and improving drainage.
DCR can be performed via an external or an endoscopic approach. Dr Timperley uses an endoscopic approach which avoids any external incisions and is performed in similar manner to endoscopic sinus surgery under general anaesthetic. In some patients, septoplasty (straightening the nasal septum) is needed to access the required area in the nose.
In most cases the surgery can be performed as day surgery and pain is usually minimal. Eye drops are used for the first 2 weeks. There will be some bleeding from the nose which is usually minimal but there is a risk of heavier bleeding. If septoplasty is performed there may be splints in the nose which are removed after 5-6 days in the clinic and there may or may not be a small silicone tube in the corner of the eye – if so, this is removed in the clinic.
You may be aware of air blowing through the tear duct with nose blowing or sneezing after surgery.
Complications of surgery
As with any anaesthetic or surgical procedure there are always risks of complications. Whilst the incidence of serious complications is very rare, it is important you are aware of them so you can discuss them with your surgery before your operation.
Some bleeding is normal postoperatively, but occasionally heavy bleeding may require treatment with packing in the nose or returning to the operating theatre.
Avoid aspirin, vitamin E, fish oil or herbal supplements for at least a week before and one week after surgery. Using an anti-inflammatory such as nurofen / ibuprofen for post op pain relief is fine.
Failure / recurrence of symptoms
The success rate of endoscopic DCR is high, similar to that of external DCR but there is a risk of ongoing symptoms, possibly requiring further surgery.
Infection / granuloma formation
This is usually easily managed but can be a cause of persistent symptoms.
The following risks only apply if septoplasty is performed
Septal infection or haematoma
If there is increasing pain and/or nasal blockage you must contact your surgeon immediately. Infection can occur in the tissues, or rarely a collection of blood can accumulate in the septum requiring drainage.
Rarely (around 1:100) a hole may develop through the septum. This often doesn't cause any symptoms, but if it does, surgical repair may be necessary.
Sense of smell
The sense of smell is often poor while the nose is blocked during the first weeks after surgery but then recovers. However, on very rare occasions the sense of smell can become permanently distorted or lost.
Numbness or altered sensation
Numbness behind the front teeth is fairly common, but usually resolves over several months. Occasionally this can be permanent however.