What is Dacryocystorhinostomy (DCR)
Dacryocystorhinostomy is a procedure to help tears drain from the eye. You may have this surgery if one of your tear ducts (nasolacrimal ducts) is blocked and you have excessive tearing (epiphora).
Normally, tears drain from the eye into a sac on the side of the nose (lacrimal sac). Then, the tears go through the nasolacrimal duct and into the space between the nostrils (nasal cavity). During DCR, an opening is made in the lacrimal sacso that tears can reach the nasal cavity without having to pass through the blocked nasolacrimal duct. The surgery can be done in two ways:
- Through an incision made between your eye and nose (external DCR).
- Through a nostril (endonasal DCR).
Tell a health care provider about:
- Any allergies you have.
- All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
- Any problems you or family members have had with anesthetic medicines.
- Any blood disorders you have.
- Any surgeries you have had.
- Any medical conditions you have.
- Whether you are pregnant or may be pregnant.
What are the risks?
Generally, this is a safe procedure. However, problems may occur, including:
- Bleeding.
- Infection.
- Allergic reactions to medicines or dyes.
- Damage to other structures or organs, such as the tissue around the eye or the muscles that control the eye.
- Scarring.
- Failure to relieve epiphora after surgery.
What happens before the procedure?
Hydration
Follow instructions from your health care provider about hydration, which may include:
- Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.
Eating and drinking restrictions
Follow instructions from your health care provider about eating and drinking, which may include:
- 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
- 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
- 6 hours before the procedure – stop drinking milk or drinks that contain milk.
- 2 hours before the procedure – stop drinking clear liquids.
Medicine
Ask your health care provider about:
- Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
- Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
- Taking over-the-counter medicines, vitamins, herbs, and supplements.
General instructions
- Ask your health care provider how your surgical site will be marked or identified.
- Plan to have someone take you home from the hospital or clinic.
- Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.
What happens during the procedure?
- To
lower your risk of infection:
- Your health care team will wash or sanitize their hands.
- Your skin will be washed with soap.
- You
will be given one or more of the following:
- A medicine to help you relax (sedative).
- A medicine to numb the area (local anesthetic).
- A medicine to make you fall asleep (general anesthetic).
- A solution may be placed in your nose to reduce swelling inside the nose (decongestion).
- If
you are having an external DCR:
- A small incision will be made on the side of your nose, below your eye.
- Tissue will be moved out of the way to allow access to the lacrimal sac.
- If
you are having an endonasal DCR:
- A tube with a small camera (endoscope) will be placed into your nose through your nostril.
- Instruments needed for the procedure will also be placed into your nose.
- A small amount of bone may be removed to allow access to the lacrimal sac.
- An opening will be made in the lacrimal sac.
- The
opening in the lacrimal sac will be kept open using stitches (sutures)
or a thin, plastic tube (stent). If a stent is used:
- It will be kept in place with small sutures.
- It will be removed 1–2 months after the procedure.
- If
you are having an external DCR:
- Your incision will be closed with sutures.
- A bandage (dressing) may be placed over your incision.
- If
you are having an endonasal DCR:
- The endoscope and instruments will be removed from your nose.
- Cotton gauze may be placed inside your nose (nasal packing).
The procedure may vary among health care providers and hospitals.
What happens after the procedure?
- Your blood pressure, heart rate, breathing rate, and blood oxygen level may be monitored until the medicines you were given have worn off.
- You will be given pain medicine as needed.
- Do notdrive for 24 hours if you were given a sedative during your procedure.
Summary
- Dacryocystorhinostomy (DCR) is a surgery that is done to help tears drain from the eye.
- During this procedure, an opening is made in the lacrimal sac.The opening allows tears to drain directly from the sac into the nasal cavity.
- This procedure may be done through an incision between the eye and the nose (external DCR) or through the nostril (endoscopic DCR).
- The opening in the lacrimal sac will be kept open using stitches or a thin, plastic tube (stent).
