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What is Endoscopic Dacryocystorhinostomy (DCR) Surgery?

DCR surgery is done to treat a watery, sticky eye caused by narrowing or blockage of the tear drainage tubes, which run from the inner corner of the eye into the tear sac and then down into the nose.

A new passage is made between the tear sac and the nose and this bypasses any blockage below the tear sac and allows tears to drain normally again.

The operation is also performed in a modified way to relieve blockages higher in the tear drainage system.

Why do I need a DCR operation?

You will undoubtedly have been suffering from a watery eye, possibly repeated eye infections or continually sticky eye discharge and sometimes a painful infection of the tear sac that forms a lump between your eye and your nose (dacryocystitis). 

Your doctor will have referred you because you have a blocked tear drain.

What happens during the surgery?

Your Ophthalmic (Eye) Surgeon has referred you to have an Endoscopic DCR. This is an operation done jointly by the Ear, Nose and Throat (ENT) surgeon and the Ophthalmic Surgeon. 

The operation is carried out using a fine telescope through the nose. A new connection is made between the tear sac and the inside of the nose. A very fine clear rubber tube may be placed in the tear ducts, from the inner corner of the eye (where it is just visible) with the ends emerging inside the nose.

This tube is left in place for a variable period (usually 6 - 12 weeks) while healing takes place and is then removed. The ENT surgeon may occasionally use a dressing inside the nose (nasal pack) at the end of the operation to avoid a nosebleed.  The operation can take approximately 45 to 60 minutes and is performed under a general anaesthetic.

What happens after my operation?

You will need to stay overnight on the ward. You will be seen by your consultant’s team the next morning and if you had a nasal pack this will be removed by one of the nurses.

You may have slight bleeding from your nose after removal of the nasal packs. You will be advised to stay in bed for one hour after removal of the packs. You will usually be able to go home on the day following your surgery. You may be given medication to take home.

Your surgeon will arrange to see you at The London Clinic in about 6 - 12 weeks following your operation.

POTENTIAL ISSUES WITH THIS SURGERY

  • General anaesthetic can carry risks especially if you are unwell or overweight. Usually a local anaesthetic would be advised in these cases. 
  • Local anaesthetic injections can very rarely damage the tissues of the eye, but usually prompt treatment would help to resolve any problem.
  • Bleeding from the nose or into the tissues around the eye. Bleeding is quite common in the first few hours after the operation. Usually it is only slight and settles quickly. Heavy bleeding would need to be stopped by packing the nose or rarely by another operation.
  • Displacement of the tube. Usually this does not happen, unless you blow your nose hard or fiddle with the tube at the corner of your eye. It is usually possible to replace it.
  • Infection. This is unusual as antibiotics are given into a vein during the operation and drops are prescribed for you to use after the operation. If the cut on the side of your nose becomes red, swollen and very sore, please see your GP or Eye Casualty to see whether antibiotic tablets are necessary.

What care is needed after my operation?

  • Do not blow your nose for the first two weeks after the operation. The operation has connected your tear sac to the lining of your nose. If you blow your nose you will blow air and germs into the operation wound and this can cause an infection.
  • Do not rub your eye. A fine silicone rubber tube is sometimes left in your tear ducts to splint them. This joins the inner part of the upper lid to the lower lid. If rubbed, the tube may accidentally come out.
  • Take your medication. You will be given antibiotic drops and possibly capsules/tablets to keep germs away during healing. Please use them as instructed.
  • Wash any stickiness from your eye gently with cotton wool and cooled boiled water.
  • Your doctor may give you a spray for the nose to help with your breathing. Please use this as instructed.

Do I need to take time off work?

We usually advise patients to take two weeks of rest following this operation.

How long will I stay in hospital?

You will usually be discharged from The London Clinic the day following the surgery.

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