ENDSCOPIC DACRYOCYSTORINOSTOMY

What is DCR (Dacryocystorhinostomy ) 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.

Who needs DCR surgery?

DCR surgery is worthwhile if the watering is bad enough to really interfere with activities of daily living. It is also recommended if you frequently develop a collection in your tear sac or have had an infection in the tear sac (acute dacryocystitis) as a result of the blocked tear duct.

There are two ways of doing the surgery:

• Externally - through the skin

• Endoscopically - from within the nostril.

Endoscopic DCR is performed more routinely.

What is an endoscopic DCR?

In this operation the tear sac is reached from the inside of the nose, using a small telescopic instrument called an endoscope. The endoscope allows the surgeon to see inside the nose and make an opening between the tear sac and the lining of the nose but without using stitches. There is no cut in the skin for this operation. Silicone tubing is always placed at the time of surgery to keep the new tear passage open.

What type of anaesthetic is used?

The operation may be done under general anaesthetic (you are completely asleep) or under local anaesthetic (you remain awake but have injections to numb the operated area and an injection in a vein to make you feel calm and relaxed). Your eye specialist will discuss with you the type of anaesthetic you will require.

Can I have both tear ducts operated on?

Normally we operate on one side at a time otherwise the operation might take too long or require too much anaesthetic. Once you have recovered from one operation, you can go on the list to have the other side done. Endoscopic DCR can sometimes be done on both sides during the same session.

What happens after the operation?

After a general anaesthetic you may need some time that day to sleep off the anaesthetic before you are ready to resume normal activities. After a local anaesthetic you will be ready to have a drink and a snack fairly soon after the operation.

Often there is some bleeding from the nose. Usually there is only a little trickle from the nostril or down the back of the throat. If there is bleeding at the end of the operation the surgeon may put special packing material through your nostrils. The pack is removed the next day. If you have heavy bleeding after you have left hospital, please contact the Day surgery or our eye clinic for advice.  If afterhours or during public holidays then please call Royal Victorian Eye and Ear Hospital at (03) 9929 8666 for advice.  Do not blow your nose hard for at least 6 weeks after the operation as this may cause bleeding to occur.

You will also be given eye drops to use four times a day. You may be given a nasal spray to loosen crusts inside your nose. You should take it easy for the first week after the operation, and stay off work until your first clinic visit. Please ask for a certificate for work if you need one.

If you have a glass “tube” put in at the time of the operation, you should be careful not to explore the inner corner of your eye or blow your nose until it has been removed, or it may dislodge. If you do dislodge it by accident, please phone our eye clinic to let us know what has happened. It should be possible to reposition the tube.

What are the risks of the operation?

• General anaesthetic can carry risks especially if you are unwell or overweight. Usually a local anaesthetic would be advised in this case.

• Local anaesthetic injections can very rarely damage the tissues of the eye, but usually prompt treatment would help to resolve any problem.

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