Tear Duct Surgery - Dacryocystorhinostomy

Dacryocystorhinostomy (DCR) is the standard method of treating nasolacrimal duct obstruction (blocked tear ducts). This procedure has origins as far back as 25 BC but the modern procedure was described in 1904. Although there had been substantial refinements in technique the principles of the operation have not changed. Essentially an anastomosis ( new connection ) is created between the lacrimal sac and the nose to bypass the obstruction in the nasolacrimal duct. Tears still flow into the nose as always but into a different part of the nose.

Refinements in anaesthetic technique have meant that most patients can have a DCR performed under monitored local anaesthetic in a Day surgery setting. Patients who are not suitable for local anaesthesia or have special Medical considerations may require general anaesthesia and/or an overnight stay in hospital.

A specialist anaesthetist examines the patient and using a number of medications induces neurolept anaesthesia or twilight sleep. Local anaesthetic is then injected in the area of the operation and a local anaesthetic pack is placed in the nose. The patient usually has no recollection of this stage of the procedure. While the local anaesthetic eliminates pain during the procedure, enough sedation is given to keep the patient relaxed . Most patients have only fleeting memories of the procedure, but this technique allows most to be awake enough to leave hospital in a couple of hours.

The surgeon and then makes a small incision near the in the corner of the eye and through this the lacrimal sac is reflected away from the bone. A hole in the bone is then created with instruments to expose the lining of the nose. The tear sac and then nasal lining are then that both opened and joined together with sutures. The tear sac then becomes an out-pocket in the outer wall of the nose. Silicon tubes may be inserted through the canaliculi ( Upper Tear Ducts ) and into the new opening. The skin incision is then closed with a few fine sutures.The length of time to perform the procedure varies considerably depending on individual patient anatomy but on average the actual operating time is in the order of 30-35minutes.

Postoperatively patients are asked to take things quietly and to sleep with their head elevated until the swelling has resolved. Ice packs to the wound are used for the first 48 hours. It is important to avoid blowing the nose for 2 weeks after surgery as this can cause bleeding. Most patients are fit to return to work within a week.

This standard technique of dacryocystorhinostomy enjoys a success rate of 90-95% . Failure is usually due to formation of scar tissue in the new opening and can mostly be overcome with a second procedure.

For most patients the facial scar after a DCR fades to almost imperceptability. However there are some patients for whom any scar is highly undesirable ( e.g. People in the public eye , models, those prone to keloid scars etc ). For these patients there is the option to perform the procedure entirely through the nose avoiding the external scar altogether. This has obvious attractions but in the past has been tempered by a lower success rate ( 60-70 %) compared to the external procedure. Recent reports are suggesting higher success rates however, and it may be that this will become a more common approach in the future.