DACRYOCYSTORHINOSTOMY (DCR)

Indications for Dacryocystorhinostomy (DCR)

DCR is typically recommended when:

1. Chronic Nasolacrimal Duct Obstruction: When the tear duct is blocked and conservative treatments, like massage, antibiotics, or tear duct dilation, do not alleviate the symptoms.
2. Recurrent Infections: Patients who experience repeated infections (dacryocystitis) in the tear sac due to the blockage.
3. Excessive Tearing: When the patient experiences chronic excessive tearing, which may be caused by the inability of the tear duct to properly drain tears.
4. Tear Duct Trauma or Injury: In cases where trauma or injury to the tear duct causes permanent damage, DCR can help restore the drainage pathway.
5. Congenital Tear Duct Blockage: In infants and children with congenital tear duct obstructions that do not resolve on their own.

Procedure

DCR can be performed in two ways: external DCR and endoscopic (or internal) DCR. Both procedures have the same goal, which is to create a new drainage pathway for tears to bypass the blocked duct.

1. External DCR:

This is the more traditional approach, typically used for more complicated or recurrent cases. It involves the following steps:

1. Incision: A small incision is made on the side of the nose, near the corner of the eye, to access the blocked tear sac.
2. Creating an Opening: The surgeon then creates a hole in the tear sac and the nasal cavity to allow the tears to drain directly into the nose.
3. Placement of a Stent: Sometimes, a stent (a small tube) is placed to keep the new opening open as it heals.
4. Closure: The incision is closed, and the patient is monitored for any signs of infection or complications.

2. Endoscopic (Internal) DCR:

Endoscopic DCR is a minimally invasive technique that uses a small camera (endoscope) to perform the procedure through the nose. The steps include:

1. Nasal Access: The surgeon inserts an endoscope into the nasal cavity to locate the blocked tear duct.
2. Creating a Hole: A hole is made in the bone near the nasal cavity and the tear sac, allowing tears to drain into the nose.
3. No External Incision: Since this method is performed entirely through the nose, no external incision is required, leading to less visible scarring.
4. Stent Placement: Similar to external DCR, a stent may be placed temporarily to maintain the opening.

Recovery

• Post-Surgery Care: After the procedure, patients may be prescribed antibiotics to prevent infection and pain relief medication to manage any discomfort. Eye drops and nasal sprays may be recommended to help with healing.
• Swelling and Bruising: Some swelling and bruising around the eyes and nose are common after surgery, particularly with external DCR. This typically resolves within a few days to weeks.
• Stent Removal: If a stent is used, it is usually removed after a few weeks to months, depending on the surgeon’s recommendations.
• Follow-Up: Regular follow-up appointments are necessary to monitor the healing process and ensure the tear duct is functioning correctly. A follow-up appointment typically occurs within a week after surgery, and then at regular intervals as needed.

Benefits of Dacryocystorhinostomy (DCR)

1. Restores Normal Tear Drainage: The primary benefit of DCR is the restoration of normal tear drainage, which alleviates excessive tearing and the discomfort that comes with it.
2. Prevents Recurrent Infections: By creating a new drainage pathway, DCR can prevent repeated eye infections (dacryocystitis) that result from the blocked tear duct.
3. Improved Quality of Life: DCR often leads to a significant improvement in the quality of life by eliminating the symptoms of epiphora (excessive tearing), which can be socially and emotionally distressing.
4. Minimally Invasive Option (Endoscopic DCR): The endoscopic method involves no external incisions and typically results in quicker recovery and less scarring compared to traditional external DCR.

Risks and Complications

Like any surgery, DCR carries potential risks, including:

1. Infection: Although rare, there is a risk of infection, especially if proper post-surgical care is not followed.
2. Scarring: In the case of external DCR, scarring may occur at the incision site.
3. Stenosis or Recurrent Blockage: The new drainage pathway may narrow or become blocked again in some cases.
4. Tear Duct Failure: Occasionally, the tear duct may fail to function as intended, and additional treatments may be required.
5. Nasal Complications: For endoscopic DCR, there is a small risk of nasal bleeding or damage to the nasal structures.
6. Epiphora Recurrence: Although the success rate is generally high, there is a chance that excessive tearing may return, especially if the duct becomes obstructed again.

Success Rate

DCR has a high success rate, especially with modern techniques like endoscopic surgery. The success rate for relieving symptoms of excessive tearing and preventing infections is typically over 90%. However, success can vary depending on the complexity of the blockage and the patient’s overall health.

Conclusion

Dacryocystorhinostomy is a well-established and effective surgical solution for chronic tear duct obstructions. By creating a new drainage pathway, DCR relieves symptoms of excessive tearing and reduces the risk of infections, significantly improving patients’ quality of life. With advancements in minimally invasive techniques like endoscopic DCR, patients can benefit from quicker recovery times, less visible scarring, and effective outcomes. However, as with any surgery, there are risks, and a thorough consultation with an ophthalmologist or oculoplastic surgeon is necessary to determine the best treatment approach for each individual.