Tear Duct Surgery or Dacryocystorhinostomy (DCR)

Tear Duct Surgery

If the symptoms indicate a blocked tear duct, the eye care expert will first determine a confirmed diagnosis. Depending on the patient’s condition, they may sometimes recommend tear duct surgery or dacrycystorhinostomy (DCR).

Diagnosing a Blocked Tear Duct

Identifying a blocked tear duct involves detecting the location of the blockage within the lacrimal system. If the eye surgeon suspects tear duct blockage, they will perform a tear drainage test to assess whether the tears are draining correctly.

The surgeon will place a single drop of a benign dye on the surface of the eye and observe. The duct blockage is determined by the amount of dye that will drain off the eye’s surface. In addition, the following tests may be used to identify tear duct blockage:

Probing and irrigation: A probe (narrow tube) is inserted into the lacrimal system to establish whether the duct is open. Then the doctor will flush a saline solution through the nasolacrimal duct to evaluate if the tear drainage system is working adequately.

Imaging tests: Technologies such as CT scan, X-ray, or MRI may be employed to track a particular dye which is placed in the tear drainage system to identify any blockage.

Surgery for a Blocked Tear Duct

Patients with blockages in the tear drainage system often need tear duct surgery. This is a surgical procedure which can unblock the tear duct and is known as a dacryocystorhinostomy (DCR).

In case the tear duct is blocked partially, the surgeon may try to open it via flushing water through it. If this is ineffective or the duct is blocked entirely, then tear drainage surgery often is the most efficient solution.

The various types of tear duct surgery are as follows:

• External DCR: The surgeon places a tiny incision on the top side of the nose near the nasal bridge. They will then remove a small bone fragment to enable drainage between the lacrimal sac and the nose. In some patients, a temporary tube is placed into the opening to allow the duct to remain open and prevent scarring. This opening is sealed using sutures while the tube is taken out in nearly eight weeks.
• Endoscopic or endonasal DCR: The doctor can use an endoscope to perform tear drainage surgery through the nose. An endoscope is a slender tube with a small camera and light attached to it. This procedure is akin to external DCR but without the placement of any incisions.
• Artificial tear duct implantation: In this surgical procedure, a glass-like tube, known as Jones tube, is implanted behind the lid to create better tear drainage. This procedure involving permanent artificial tear ducts is commonly used when the nasolacrimal duct cannot be repaired or opened.
• Dacryocystorhinostomy: This procedure is usually carried out as outpatient surgery under general anesthesia.

Post-Operative Care

Post-op care for tear duct drainage surgery (Dacryocystorhinostomy) is vital. The patient may experience some bloody discharge from the nose for a few days following a tear drainage surgery. They should avoid blowing their nose for at least five days after the surgical procedure.

The surgeon may prescribe a nasal decongestant spray and antibiotic ointment for the incision area as well as eye drops to prevent swelling and infection.