Dacryocystorhinostomy Surgery (DCR)

Dacryocystorhinostomy (DCR) surgery is a procedure used to treat blockages or abnormalities in the tear drainage system, which can cause watery eyes, infections, and other symptoms. The tear drainage system includes the tear sac (lacrimal sac), the tear ducts (nasolacrimal ducts), and the tear drain (punctum). DCR surgery involves creating a new channel between the tear sac and the nose to allow tears to drain properly.

There are two main types of dacryocystorhinostomy (DCR) surgery are: .

• External DCR surgery: This procedure involves making a small incision in the skin near the tear sac (lacrimal sac) to access the tear drainage system. The surgeon will then create a new channel between the tear sac and the nose to allow tears to drain properly. This procedure may be recommended for people with a blockage or abnormality in the tear drainage system that is causing symptoms such as watery eyes, infections, or discomfort.
• Endoscopic DCR surgery: This procedure involves using a thin, flexible endoscope (a camera and light attached to a tube) inserted through the nostril to access the tear drainage system. The surgeon will then create a new channel between the tear sac and the nose to allow tears to drain properly. Endoscopic DCR surgery may be recommended for people who have had previous unsuccessful attempts at treating their symptoms with medications or other methods, or for those who are not suitable candidates for external DCR surgery.

PROCEDURE

The specific steps of Dacryocystorhinostomy (DCR) surgery will depend on the type of procedure being performed and the individual patient’s needs. Here is a general overview of the procedure for both external DCR and endoscopic DCR surgery:

• Pre-surgery preparation: Before the surgery, the patient will have a consultation with an eye doctor to discuss the procedure and any potential risks or complications. The patient may also need to undergo certain tests, such as a scan of the eye, to help the surgeon plan the surgery.
• Anaesthesia: Before the surgery begins, the area will be numbed with anesthetic to minimize discomfort during the procedure. The anesthetic may be administered as an injection or as eye drops.
• Making an incision: In external DCR surgery, a small incision will be made in the skin near the tear sac (lacrimal sac). In endoscopic DCR surgery, a thin, flexible endoscope (a camera and light attached to a tube) will be inserted through the nostril to access the tear drainage system.
• Performing the surgery: The surgeon will then create a new channel between the tear sac and the nose to allow tears to drain properly. In external DCR surgery, this may involve making an incision in the bone near the tear sac and then connecting the tear sac to the nose using a small tube or implant. In endoscopic DCR surgery, the surgeon will use the endoscope to guide the creation of the new channel.
• Closing the incision: Once the surgery is complete, the incision will be closed with sutures or other methods. In endoscopic DCR surgery, no incision is made, and no sutures are needed.
• Recovery: Most DCR surgeries are performed on an outpatient basis, meaning the patient can go home the same day as the surgery. The patient will need to follow the post-surgery instructions provided by the eye doctor, which may include using eye drops or taking medications to help with recovery. It is important to follow these instructions carefully to ensure a successful recovery.
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It is important to note that DCR surgery is a major procedure and carries certain risks and complications. The decision to undergo surgery should be made in consultation with an eye doctor, taking into account the individual patient’s needs and the potential benefits and risks of the procedure.

CONDITIONS in which DCR is Required

Dacryocystorhinostomy (DCR) surgery is typically recommended for people who have a blockage or abnormality in the tear drainage system that is causing symptoms such as watery eyes, infections, or discomfort. Some common conditions that may require DCR surgery include:

• Nasolacrimal duct obstruction (NLDO): This condition occurs when the tear ducts (nasolacrimal ducts) become blocked, causing tears to build up and overflow. NLDO can be congenital (present at birth) or acquired later in life.
• Dacryocystitis: This is an infection of the tear sac (lacrimal sac) that can cause swelling, pain, and discharge. It can be caused by a blockage in the tear drainage system or other factors such as allergies or a foreign object in the eye.
• Chronic Dacryocystitis: This is a recurrent or long-lasting form of Dacryocystitis that may require surgery to clear the blockage and prevent further infections.
• Failed probing: Probing is a procedure used to clear a blockage in the tear drainage system in children with NLDO. If probing is not successful in relieving the blockage, DCR surgery may be necessary.