Obstructions within the lacrimal drainage channels will often require an operation called a dacryocystorhinostomy or DCR for short. This operation has been performed for over 100 years and tends be very successful when performed correctly. However, the chance of success varies from patient to patient and is dependent on various factors including type and site of obstruction, patient symptoms and any previous surgery.
The vast majority of patients who suffer from a blocked tear duct systems usually have a blockage located near the end of the system within the nasolacrimal duct.
The aim of DCR surgery is to create a new bypass channel so that the tears can pass from the lacrimal sac into the nose again through the new bypass channel; therefore bypassing the blockage within the nasolacrimal duct. Thus the patient no longer has a watery eye since stagnation of tears no longer occurs.
A new bypass channel is created by removing the intervening bone between the lacrimal sac and nasal cavity and then connecting the lacrimal sac to the lining of the inside of the nose.
A small length of soft plastic tubing is threaded through the bypass channel, to help maintain patency of the new drainage system whilst the new bypass channel heals. This is easily removed in the outpatient clinic shortly after the operation (usually within 3 months)
DCRs are usually performed as a daycase procedure. Although, DCRs can be done under local anaesthesia, many patients prefer general anaesthesia.
External DCR & Endoscopic DCR
• In the UK, the vast majority of DCR surgery is by external DCR. This is performed through a small cut of the skin on the side of the nose (External DCR). On the whole, the scar becomes so inconspicuous that patients do not report it to be a cosmetic issue.
• Increasingly, DCR surgery is performed with the aid of a special telescope to look up the nose (Endoscopic DCR). This allows for faster surgery, quicker patient recovery after surgery and no visible scars.
Currently, success rates for external DCR surgery are greater than endoscopic DCR surgery for all types of blockage. Whether or not surgery can be performed endoscopically is dependent on numerous factors including nasal access and the location of the obstruction.
Mr Cheung performs both types of operation
After DCR surgery: This lady has undergone conventional external DCR surgery on the right side of her nose (right picture). Notice that when performed well, the scar blends in very well to become invisible.