Dacryocystorhinostomy Surgery

What is DCR surgery?

This is performed for blockage of the nasolacrimal duct. It is a “bypass” operation which aims to create a new channel to allow tears to drain directly from the eye into the nose, bypassing your own blocked tear duct. This involves the removal of some bone from the side of the nose (which is not visible from the outside), and the temporary insertion of silicone tubes into the new bypass channel.

How is DCR surgery performed?

DCR surgery can be performed in 2 ways. The most common way is via a small incision through the skin in the side of the nose (EXTERNAL DCR). It can also be performed from within the nose, using a nasal telescope and other special equipment (ENDONASAL DCR). Your ophthalmologist will discuss with you which is the best approach for you.

DCR surgery usually requires a general anaesthetic and an overnight stay in hospital.
It is very successful surgery in standard cases of nasolacrimal duct obstruction, with 90% success rates achieved. In more complex types of nasolacrimal duct obstruction, success rates are slightly lower, and the DCR may be combined with other surgical techniques to achieve a new drainage channel.

What are the risks of DCR surgery?

The risks of general anaesthetic will be discussed with you by your anaesthetist.

The risks of DCR surgery include (but are not limited to):

• Infection
• Bleeding from the nose
• Scar on side of nose (in external DCR)
• Complications of the silicone tube moving or being lost
• Accidental entry into the orbit of the eye or anterior space of the skull leading to leakage of cerebrospinal fluid (this is very rare)

What to expect after DCR surgery?

You may have some bruising and swelling of the skin around the nose and eye, which subsides within one week.

You may have some blood spotting from the nose in the first 24-48 hours after surgery. This can usually be easily controlled with simple pressure and head posturing. Some patients develop a larger nose-bleed that requires packing of the nose, but this is uncommon.

Pain after surgery is usually mild and easily controlled with simple pain-killers like Panadol.

Care after surgery:

In the first 24 hours, you are encouraged to rest in bed, and remain slightly upright. You will avoid hot drinks (to reduce the risk of nose-bleeding). You will be started on oral antibiotics for 1 week, to reduce the risk of infection. You will also be given an antibiotic ointment to place on any skin incisions on the side of the nose.

Any skin sutures in the side of the nose are removed 1 week after surgery, in the office.

Any silicone tubes placed during surgery are removed 6 weeks after surgery, in the office. Often, the watering does not completely improve until these tubes are removed.

You should avoid any heavy exertion or physical exercise in the first 2 weeks after surgery. You must avoid blowing the nose until the silicone tubes are removed at 6 weeks after surgery.

Your vision is not affected and most patients will be back to work and normal activities from 3 days after surgery.