Summary
When the nasolacrimal duct (the tube connecting the corner of the eye to the nose) becomes blocked, tears overflow on to the cheek and the tear sac may become infected. A dacryocystorhinostomy (DCR) creates a new drainage channel from the tear sac directly into the nose. The endoscopic approach achieves this entirely through the nostril, leaving no facial scar.
Who is this for?
Patients I commonly see for endoscopic DCR:
- chronic watering due to nasolacrimal duct obstruction,
- previous episodes of dacryocystitis (infection of the tear sac),
- a fluid- or mucus-filled tear sac on syringing,
- patients keen to avoid a facial scar.
The endoscopic approach is particularly suited to younger patients, those who have had previous surgery, and those with concurrent nasal pathology.
What the procedure involves
The operation is performed under general anaesthetic and takes around 60 minutes. Through the nostril, an endoscope is used to identify the lacrimal sac through the bone, remove a small disc of bone with a fine drill, and open the sac directly into the nose. A fine silicone stent is left in place for 6–12 weeks to keep the new drainage pathway open while it heals.
Recovery and what to expect
- A nasal pack may be left in place overnight, usually removed before discharge.
- Mild nasal congestion and a small amount of bleeding for a few days.
- Avoid nose-blowing and heavy exercise for 2 weeks.
- Sniffing salt-water spray several times a day for 6 weeks.
- The silicone stent is removed in clinic at 6–12 weeks, a quick, painless procedure.
Risks and alternatives
Risks include bleeding, scar tissue narrowing the new drainage channel (the most common reason for failure), and very rarely injury to nearby structures. Failure rates are 5–10%; a redo procedure is straightforward where required.
Alternatives include:
- external DCR, an open approach via a small skin incision, useful for some specific anatomical situations,
- Lester Jones tube, when the blockage is higher in the system.